AAPS News 1973

1973 INDEX
AAPS NEWS LETTERS and BULLETINS

JANUARY THROUGH
Index No.
Name or Item
Type
Date
A10
April
June
August
AAPS Cotostrophe Major Medical Insurance

Plan
4
NL
March
5
8
AAPS Chapter Organization Manual Order

Blank
5
AAPS Filmstrip Project
10
11
14
AAPS Florida Chapter
10
10
13
AAPS Medical Economics Committee
Report
18 LB -
Information Bulletin
Legislative Bulletin
Index No.
NL
NL
NL
NL
AAPS Private Doctors Institute

2
NL
Date
June
AMA Bylaws
NL
June
AMA Code of Ethics
6
9
NL
NL
May
July
NL
January
11
NL
NL
NL
NL
February
May
July
September
2
9
April
August
September
December
American Medical Political Action

Committee (AMPAC)
NL
May
August
Amer.icon Physicians Guild
NL
July
2.19.73
American Physicians Union
NL
July
July
August
November
American Urological Association South

Central Section
12
NL
October
Association of American Medical Colleges
NL
May
December
Association of American Medical Society

Executives
NL
2-19-73
Anthony, E. E., M.D.
NL
April
Anthony, Mrs. E. E.
NL
January
NL
NL
NL
NL
NL
Type
AAPS Opens Washingtan Office

AAPS Pamphlet Rack
News Letter
Emergency Bulletin
American Medical News
AAPS Index
AAPS Lawsuit
Name or Item
NL EB -
AMA Board of Trustees

NL
NL
NL
AAPS Annual Meeting
DECEMBER
NL
April
3-6-73
13
NL
November
Bauer, Alfred W., M.D.
13
NL
November
Bauer, William I., M.D.
8
11
NL
NL
June
September
NL
February
NL
NL
NL
NL
April
June
September
December
NL
January
-8-
February
3-6-73
4
6
10
6
AAPS Resolutions
10
13
NL
NL
NL
March
May
August
NL
NL
NL
May
August
November
Bennett, Wallace, Senator
8
11
3-6-73
AAPS Statement
14
AAPS Washington Bulletin
2-15-73
AAPS Woman's Auxiliary
3-6-73
Bierce, Ambrose
"Big Brothe-r Medicine" Annual Meeting
Brochure
Ainsworth, Thomas, M.D.
13
NL
November
NL
May
NL
July
NL
NL
NL
NL
NL
January
February
May
July
November
NL
NL
NL
NL
NL
NL
NL
NL
January
February
April
May
June
July
September
OctDber
Blasingame, F.J.L., M.D.
American Academy of Family Physicians,
The
American
Hospital
Association
2
6
9
13
American Medical Association
2
5
6
8
9
11
12
8-16-73
10
NL
August
January
May
Blue Cross Blue Shield
NL
NL
Breslow, Lester, M.D.
NL
March
Buerger, Walter, M.D.
NL
February
Caine, Curtis W., M.D.
NL
April
-cCalifornia Chapter of AAPS
NL
February
California Council for Health Plan

Alternatives
NL
March
California Medical Association
NL
June
Date
Index No.
Type
NL
March
13
NL
November
NL
May
12
NL
October
NL
May
12
NL
October
Cohen, Harold M., M.D.
NL
March
Cohen, Wilbur J.
1
12
NL
NL
NL
January
February
October
14
NL
December
Name ar Item
California Medical Group
Campbell, Mrs. R. L.
Name or Item
Index No.
Type
2-15-73
Federal Register Reprint FDA

Catholic Hospital Association
CHAMPUS
Chenault, John M., M.D.
Chrysler
Columbus (Ohio) Dispatch

Commission on Quality Health Care
Assurance
NL
May
Congressional Record
EB
5-23-73
11
NL
September
Cooper, John A. D., M.D.
NL
May
Council of Medical Staffs
NL
July
Coy, Francis, M.D.
11
NL
September
Crane, Phil, Repr.
NL
February
13
NL
November
Cullum, Mrs. Albert G. J.
Florida Medical Association

Food and Drug Administration (FDA)
11
NL
September
6
8
NL
NL
May
NL
February
13
NL
November
Gitlitz, Benjamin 0., M.D.

Gral, Thomas, M.D.
Grinker, Roy R., Sr., M.D.
NL
July
NL
January
14
NL
NL
October
December
NL
April
Group Health Association of America
12
Hampton, H. Phillip, M.D.

Harris Poll
14
NL
December
HASP (Ill. State Med. Soc.)
11
NL
September
Hassard, Howard
12
NL
October
NL
January
January
March
Health Insurance Plan of Greater

New York
Health Maintenance Organization (HMO)
14
NL
NL
NL
NL
Nl
NL
NL
NL
Helms, Jesse, Senator
13
NL
November
Holy Family Hospital
13
NL
November
House Commerce Committee
10
11
NL
NL
August
September
EB
5-23-73
5
8
12
NL
NL
NL
April
June
October
NL
May
Darling Case
NL
May
Debauching The Currency
NL
February
Deitrick, John E., M.D.
NL
May
NL
NL
NL
NL
April
May
June
September
Devils' Dictionary
NL
January
Dingell, John, Jr., Repr.
NL
January
Dingell, John, Sr., Repr.
NL
January
6
10
11
Dept. of Health, Education, and Welfare
8
11
12
13
Doenges, James L., M.D.
11
NL
September
House Subcommittee on Public Health

and Environment
Dole, Robert, Repr.
12
NL
October
Hunter, Robert B., M.D.
NL
May
Dominick, Pete
H.. Senator
Dorrity, Thomas G., M.D.
May
August
September
October
November
December
3-6-73
4
6
DuVal, Merlin K., M.D.
NL
NL
March
May
NL
January
-I
Indiana State Medical Association
E-
Edgecombe-Nash Medical Society (N.C.)

Edwards, Charles C., M.D.
June
Group Health and Welfare News
Constantine, Jay
Date
13
5
10
11
12
NL
NL
NL
NL
NL
November
April
August
September
October
England, Mrs. Robert G.
13
NL
November
Ervin, Sam J., Senator
14
NL
December
"Eulogy of the Doctor"
11
NL
September
Jackson, Carmault B., M.D.

Jaggard, Robert
s.,
12
NL
October
January
NL
EB
M.D.
2-21-73
3-6-73
Javits, Jacob, Senator

Joint Commission on Accreditation of
Hospitals (JCAH)
13
NL
November
NL
May
NL
NL
February
November
13
Name or Item
Index No.
Type
Index No.
6
8
Medicare
K -
NL
NL
January
March
NL
May
Kennedy, Edward M., Senator
11
NL
September
Kennedy-Griffiths Bill
12
NL
October
12
NL
Kaiser-Permanente
Kennedy Bill (HMO)
Kentucky Medical Association
Name or Item
Date
King, Mrs. Merrill
October
Medicine and the State
11
"Medicine Without an Ethic"
Type
NL
NL
Date
May
June
NL
September
NL
January
3-6-73
Melvin, Art
12
NL
October
NL
March
10
NL
August
National Association of Physicians and

Surgeons Trust
12
NL
October
National Professional Standards Review

Council
NL
June
Nebraska House of Delegates
Mills, Wilbur, Repr.

Moore, Thomas G., Jr.
Murray-Wagner-Dingell Bill
3-6-73
Knapp, Robert D., Jr., M.D.

Komanetsky, William M., M.D.
NL
April
10
NL
NL
August
December
NL
January
14
Kramer, Maurice A.
-N-
3-6-73
13
NL
November
l -
NL
May
NL
January
6
8
11
NL
NL
NL
May
June
September
Northam.Harry E., Memorial Free Enterprise

Essay Contest
1
NL
January
NL
May
New York Times, The

Lafourche Parish Medical Society (La.)
Laird, Melvin
NL
January
10
NL
August
La Motte, William 0., Jr., M.D.
Nixon, Richard M., President
NL
February
Lombardo, Virginia E.
13
NL
November
Long, Russell B., Senator
12
NL
NL
October
December
13
NL
NL
July
November
NL
May
Oklahoma State Medical Association Reprint

"PSRO Is a Four Letter Word"
2
NL
February
Louis, John, M.D.
11
NL
September
Orange Co. Medical Society (Fla.)
NL
September
Lutheran General Hospital
11
NL
September
Lynch and Raphael
11
NL
September
Lynch, Judge William
13
NL
November
14
Lord, Bissell & Brook
-0-
4-6-73
Louisiana State Medical Society
-- Mc Mccampbell, S. R., M.D.
11
-PPacoima Memorial Lutheran Hospital

(Calif.)
NL
March
Peer Review Organization
NL
February
November
February
Peterson, Maurice W., M.D.
NL
May
Peterson, Mrs. Maurice W.
13
NL
NL
July
Porterfield, John D., M.D.
12
NL
October
13
NL
November
PSRO Pledge Card
NL
NL
April
July
NL
NL
EB
NL
January
February
Mcintyre, Thomas J., Senator
McKenzie, Walten H., M.D.

McMahan, R. R.
Oklahoma Stale Medical Association
NL
-M-
3-6-73
4-6-73
PSRO
MacNeal, Perry S., M.D.
13
November
NL
January
NL
July
6
12
NL
NL
NL
May
June
October
NL
March
8
10
NL
NL
June
August
11
January
May
August
13
10
NL
NL
NL
NL
July
Marihuana Brochure
Massachusetts Physician
Medicaid
Medi-Cal
Medical Economics
Medical News Report
Medical Staff Bulletin
NL
3
4
2-21-73
March
4-6-73
5
6
8
9
10
12
NL
NL
NL
NL
NL
NL
April
May
June
July
August
September
NL
NL
October
November
14
NL
December
Public Law 89-749
EB
5-23-73
Public Law 91-515
EB
5-23-73
Name or Item
Index No.
Public Law 92-603

2
3
4
.5
0
10
13
14
Type
NL
NL
EB
NL
NL
NL
NL
NL
NL
Date
January
February
2-21-73
March
April
May
August
November
December
Name or Item
Index No.
Type
Sherrill, William M., M.D.
14
NL
December
Siemers, William F., Rev.
11
NL
September
Social Security
12
NL
October
NL
March
13
NL
November
St. Joseph Hospital (Chicago, Ill.)

Steunebrink, Sjoerd, M.D.
Subcommittee on Retirement, Insurance
Health Benefits
Supreme Court
-QQuality Assurance Program (QAP)
Symms, Steven 0., Repr.

2
0
13
Quinlan, Donald, M.D.
4
0
13
14
NL
NL
NL
NL
February
May
July
November
NL
NL
NL
NL
March
May
November
December
Date
NL
January
NL
June
11
NL
September
NL
May
6
12
NL
NL
May
Octobe
NL
April
12
NL
October
-TTennessee State Legislature

Texas Medical Association House of
Delegates
Thomassen, E. H., M.D.
-RRarick Bill (HR-9375)
13
14
NL
NL
November
December
Rarick, John R., Repr.
12
NL
October
Ramsey, Hugh S., M.D.
NL
January
NL
3-6-73
May
NL
April
Ribicoff, Abraham, Senator
12
NL
October
Roche, George C. Ill, Ph.D.
NL
NL
February
3-6-73
March
Rogers, Frank A., M.D.
13
14
NL
NL
November
December
Rogers, Paul G., Repr.
EB
5-23-73
12
NL
October
NL
January
Raymond, James J., J.D.

Reaves, Robert G., M.D.
Roth, Russell, M.D.

Roy, William R., M.D., Repr.
-5Satterfield, David, Repr.
Saxon, Mrs. Michael_ R.
10
12
13
14
NL
NL
NL
NL
August
October
November
December
13
NL
November
3-6-73
Schreiber, Jack, M.D.
3-673
Schwartz, Harry
Sellman, Richard L., M.D.
NL
January
12
NL
October
NL
April
NL
NL
January
February
NL
July
Seminar '76
Shambaugh, George E., Jr., M.D.
UAW
-V2-15-73
Volunteer Legislative Key-Man
-W.5
NL
NL
January
April
NL
February
10
11
NL
NL
August
September
12
NL
October
Waldie, Jerome R., Repr.

Wall Street Journal, The
Weinberger, Caspar, Secy., HEW
Welch, Claude E., M.D.
Williams, Kenneth J., M.D.
NL
May
14
NL
December
Wohlers, Albert H., & Co.
NL
March
Wolpert, Edward A., M.D.
NL
July
8
12
NL
NL
June
October
NL
April
NL
Winter, F. 0., M.D.
Schenken, John R., M.D.
Scott, Hugh, Senator
-u-
Woodcock, Leonard
Woodhull, F. Earl, M.D.
Woolley, Frank
7
10
12
13
NL
EB
NL
NL
NL
January
3-6-73
March
5-23-73
August
October
November
NL
March
-YYoung, Thomas L.
THE VOICE FOR PRIVATE DOCTORS
Index No.
January, 1973, Volume 27, No. 1
Private Doctors Institute

Not Every Society is Blind
Cohen, Wilbur J., loves It
Reprints Available
Stop Wasteful Government Spending
PSRO
Marihuana Brochure Available
HMO Bill Again Introduced
AAPS Does Have Help
Aid from New York Times???
Essay Contest
Bound AAPS News letters Available
Food for Thought
PRIVATE DOCTORS INSTITUTE

INDEPENDENCE!
RIGHTS!
FREEDOM!
Are we losing them?

What are we going to do about it?
at home with your neighbors. It will vastly increase understanding of the truths underlying
man's basic nature.
WHAT IS IT?
SEMINAR '76 is a unique self-discovery experience. It is a concentrated citizenship

workshop.
A new program, SEMINAR 76 provides an

opportunity to rediscover and bring into
sharp perspective America's beliefs concerning basic human rights and freedoms what freedom means and what rights are
and what they are not.
The focus of SEMINAR '76 is on the personal rediscovery of the basic principles on
Can we win? Can we win without understanding?

To get some answers, attend the PRIVATE DOCTORS INSTITUTE, April 12-15 at the Drake Oakbrook Hotel on the outskirts of Chicago. To supply
these answers, AAPS has arranged sessions of
SEMINAR '76 for the last two days of the Institute
to help us identify our fundamental beliefs so we
can better understand why we are losing and
what can be done to reverse the course of battle.
SEMINAR 76 is a tool you can begin using now
which this nation was founded, providing an

opportunity to examine in depth the true
meaning of "life, liberty and the pursuit of
happiness."
zation. Listed below, in language taken out of

propaganda pamphlets of this socialist outfit, a~e
objectives clearly demonstrating the way it would
unAmericanize America, the kind of alien America it would create:
WHAT'S IN IT FOR AAPS MEMBERS?
A new awareness by members of the meaning and value of good citizenship.
Human values are placed above property

values.
Economic cooperation is substituted for competition and corporate profit.
A new respect for logical reflection; a deeper appreciation of the need to fulfill responsibilities in order to enjoy rights and
freedoms; a better understanding of "the
rule of law."
Personal interests can be identified with the

collective interest.
Advanced self-confidence, consciousness of

leadership opportunity and ability to articulate one's life philosophy.
Health care for all people is defined as a

human right rather than a market-place
commodity going to the highest bidder.
Control of the economy is taken away from

the "very rich" and "very few" and returned
to the hands of the worker and consumer.
Enhanced understanding and appreciation

of the American heritage, way of life and
democratic government.
Establishment of dependable "accountability" tools to discover, measure and compare
proposed changes relative to basic ideas.
Over the years, the true meaning of rights and

freedom - the true meaning of the American
dream, the American SYSTEM - has become
blurred. It will be even more smudged in the next
two years by Communists and their fellow travelers whose ambition is to trample our rights and
destroy freedom. If we don't want the American
dream to become a Communist nightmare, we
must act now!
Already, the Communists and their cohorts are
mounting a nationwide propaganda campaign to
transform celebration of the 200th Birthday of our
Republic into a vehicle to debase the American
ideal, to destroy our freedoms and our rights, and
to soften us for eventual totalitarianism. A leftwing organization calling itself "the People's Bicentennial Commission" is busily trying to use the
Birthday observance to foment a "new revolution"
intended to "bring about fundamental changes in
America." To give you an idea how urgent it is
for action to be taken to reinforce and firm up the
foundations of the real America, let me present a
few of the socialistic goals of this radical organi-
SEMINAR '76 has the potential of becoming an

effective counter-action to the propaganda of
hate of our fundamental beliefs spewing out of
such sources as this so-called "people's" commission. It will aid in the understanding so vital to
solving current attacks on our system.
So, plan now to attend the PRIVATE DOCTORS
INSTITUTE in April and participate in a unique
and rewarding experience - SEMINAR '76. If you
make reservations on or before March 16, the
Seminar fee will be $42.50 per person. Thereafter,
it will be $76.00 per person. So don't delay; mail
the enclosed reservation form today.
NOT EVERY SOCIETY IS BLIND

Not every medical society is blind to the grave
danger to medical freedom embodied in the new
PSRO Law nor hungry to hear the rustle and clink
of federal dollars that will flow to PSROs organized by medical societies but controlled by HEW.
A special Projects Committee of the Lafourche
Parish Medical Society, Thibodaux, Louisiana, has
thoroughly analyzed this iniquitous law and has
concluded that American physidans should undertake "all possible legal means to repudiate and
repeal" the PSRO law - "a concept of rationed,
poor quality, second-class government medicine

by edict of the Secretary of HEW." Committee
members agreed "there should be no cooperation" by the medical profession with government
to implement this law (the course of action being
pursued by the American Medical Association and
many other medical societies).
Noting that the effect of the PSRO law will
be to ration and standardize medical care
for the elderly and indigent, the Committee
declared: "This law . . . will change the
physician from a professional to a technician. Government medicine is to become
'cook book' medicine. It is shocking to the
physicians of this nation to learn that the
AMA has now expressed a desire to help
write the 'cook book.' "
The quality of medicine will deteriorate, said
the Committee. "The obvious reason being that
the nature of health care is such that it can never
be standardized or provided in rationed quantums
in accordance with various illnesses or health
conditions as this law seeks to do. Such massive
waste of physician manpower hours, diverted from
patient care, to be expended in paperwork, committee hearings, review proceedings, justification
for provision of services not allowed in the
norms, and police inspection duties will also contribute to inferior medical care and to costs."
And finally, the committee concluded, physician collaboration in the implementation of this
law (which I find to be an astonishing act of professional masochism) will inevitably lead to expansion of the PSRO Law, with its debasing controls
and stultifying standards, to the entire population.
COHEN, WILBUR J., LOVES IT
Whenever Wilbur J. Cohen is pleased with a
newly enacted law affecting health care, you can
be absolutely certain medical freedom has suffered
another staggering blow. No man has worked
more assiduously, nor with greater dedication, to
destroy the free institutions of medicine in America
by the substitution of government controls. Wilbur
J. Cohen has been and still is a tireless worker in
the vineyard of socialism. And Cohen is delighted
with the new Social Security Law (P.L. 92-603) and
its PSRO provisions.

He should be. This law fits so neatly into the
socializers' concept of gradualism. They are
convinced - and nothing so far has proved
them wrong - that the sure, certain way to
achieve the goals of socialism, particularly
socialized medicine, is to do it gradually, a
bit at a time.
In a recent speech to the Group Health Association of America (and no one can accuse that organization of devotion to the cause of medical
freedom), Cohen praised the new law, particularly
those provisions empowering the government to
establish uniform standards for medical procedure
and qualification. Cohen's observations were publish in the November, 1972, GHAA publication,
Group Health and Welfare News. Said the News:
"Cohen, who is now Professor of Education and
Dean of Education at the University of Michigan,
praised the cumulative effect of HR-1 (P.L. 92-603)
and said it provided an important interim step
toward the development of a national health security program" (which is another way of saying
socialized medicine).
Those who think that a federal program for
insurance against catastrophic expenses isn't
a bad idea - had better beware! Wilbur J.
Cohen views it as another step along the path
of gradualism toward the goal of socialized
medicine and Wilbur J. Cohen knows whereof he speaks!
REPRINTS AVAILABLE
Reprints of "Medicine Without an Ethic," an
article against abortion which appeared in the
journal of the Louisiana State Medical Society, are
available from the Society, 1700 Josephine Street,
New Orleans, Louisiana 70113.
STOP WASTEFUL GOVERNMENT SPENDING
Stop wasteful government spending! Restore
some semblance of fiscal sanity to government!
Stop political interference in medical practice! This
was the substance of AAPS, advice to a congressional subcommittee. Frank Woolley, AAPS Executive Director, and your President testified this
month in Washington before the Subcommittee on

Retirement, Insurance and Health Benefits of the
Committee on Post Office and Civil Service. Liberal Democrat Rep. Jerome R. Waldie of California, is Chairman of the Subcommittee.
Santa Claus in the field of health), the power of Britain has gradually collapsed.
AAPS was asked to testify on why medical care

costs have risen so fast, whether government
should control costs, whether the American people get the best possible quality of medical care
for their money.
Basically, we testified that:
Congress and the Executive Department,

more than anyone else, are responsible for
accelerating health care costs. By profligate
spending, the legislative a n d executive
branches have fanned inflation, driving up
all costs. Then, these two branches of government have used inflationary cost increases they created as an excuse for further government intervention in medicine. The
Judicial Branch, up to now, has acquiesed
in this "unsound moneyu attack upon our
system.
Medicare and Medicaid waste massive sums

of tax money and create a huge artificial
demand from the subsidized "worried-well"
which helps drive costs up.
Not only should government not try to institute dictation and control under the pretense of controlling costs - which is the very
antithesis of Americanism - bu.t Congress
should act immediately to eliminate programs, such as Medicare and Medicaid,
which contribute to inflation and create
artificial demand.
Congress and the Executive Department of

the federal government should recognize
the fact that in this area they have acted
without constitutional authority and have
adopted the position that it is legitimate
public policy to use force against individuals.
Congress should be forewarned by Britain's

experience. In pursuit the Utopian dream of
spending itself rich (and playing universal
The quality of medical care in the United

States and its availability is unsurpassed by
any other nation. Political intervention in
medical practice will surely blight prospects
for improvement. (See this News Letter, The
Case For American Medicine, by Harry
Schwartz.)
PSRO
We have prepared an exhaustive analysis in
question and answer form of the important provisions of P.L. 92-603 (HR-1), including Professional
Standards Review Organizations. This document
examines the law section by section and demonstrates, by its own language, how it will destroy
medical freedom by forcing doctors to become
paid agents of government, exercising police
powers over their colleagues, and how it will
erode medical quality by forcing physicians to
practice medicine by government-dictated norms
of diagnosis and treatment. This Question and
Answer pamphlet has been mailed to you. It is
vital that you study it carefully and take action
to implement suggestions of what to do. Most importantly, sign the Declaration of Loyalty to Medical Ethics and Professional Independence which
makes it clear that ethical physicians will not collaborate with Professional Standards Review Organizations. Urge your colleagues to declare their
loyalty and independence. Additional copies of
the Declaration are available on request. Also,
take other action to repeal this Law which has no
basis in the Constitution. And if you think government can be reasoned with (as the AMA apparently does), ponder this frank threat by the highest
ranking physician in government, Merlin K. DuVal, M.D., Assistant HEW Secretary for Health, in
an interview with AMA's American Medical News
for December 25:
"In effect, Congress is saying to the medical
profession, 'we will give you the authority
and resources you need to assure the public
that the medical care you provide Medicare
and Medicaid patients is appropriate and of
good quality.' If doctors fail to take this
challenge seriously, if they fail to make

PSRO work, then I shudder to think what
could come next."
willing to sacrifice even a fraction of the freedom

of physicians, particularly the American Medical
Association, we have been pushed a long way
down the road to tyranny.
MARIHUANA BROCHURE AVAILABLE

AAPS DOES HAVE HELP
An informative brochure on marihuana is
available from the Scientifif Information and Education Council of Physicians, Inc., (SIECOP) Lock
Drawer # 249, Melbourne, Florida 32901.
HMO BILL AGAIN INTRODUCED

Rep. William R. Roy, M.D., liberal Democrat
from Topeka, Kansas, has once again introduced
his bill to make discrimination against private
medicine public policy of the federal government.
Roy's bill would authorize appropriation of a
third of a billion dollars ($333.4 million) of the
taxpayer's money for planning, developing and
operating 150 new prepaid group practices flying
under the false colors of Health Maintenance Organizations. Dr. Roy's bill (HR-51, referred to Interstate and Foreign Commerce Committee) would
also subsidize expansion of existing HMO's like
Kaiser-Permanente and Health Insurance Plan of
Greater New York. Is this a device to help bail
HIP out of its recent financial troubles? Community rating would be mandatory for all HMOs receiving federal funds.
Rep. John Dingell, Jr., borrowing liberally (excuse the pun) from that monumental failure known
as the British National Health Service, has drafted
and introduced a bill to socialize medicine in this
country (HR-33). The Michigan Democrat is a son
of the late and notorious John Dingell, Sr., coauthor of the Murray-Wagner-Dingell Bill in the
l 940's, one of the earlier proposals for socialized
medicine.
Look for numerous bills to nationalize medicine
in this 93rd Congress, including measures sponsored by labor unions, the health insurance industry, Blue Cross-Blue Shield, American Hospital
Association and the American Medical Association. Does that give you an idea how many true
friends the principle of freedom in this country
really has? When organizations like these are
In Medical News Report (MNR), Blasingame

Associates, 535 North Michigan Avenue, Chicago,
Illinois 60611, it is pointed out that:
"In what has to be history's classic example of
legislative insult to a profession of the stature
of medicine, the PSRO law endows the Secretary of HEW with the wisdom to judge the
competence of physicians to evaluate the performance of their peers." The Secretary will
put physidan-organized PSROs on probation,
decide how much they are capable of doing
and keep them on probation until he decides
they are capable of performing peer review.
And all the while, added MNR, physicians
will be forced to conform to norms of diagnosis and treatment dictated by HEW.
AID FROM NEW YORK TIMES???

One of the last places the medical profession
would look for help in its struggle for freedom
would be The New York Times, whose support of
political interference in private affairs has become legendary. Nevertheless, a member of the
paper's editorial board, Harry Schwartz, has
written a book in defense of American medicine The Case For American Medicine - a book which
attempts, in his words, "to tell the other side of
the story, to help turn the national discussion of
medical-care delivery into more of a debate and
less of a dreary repetition of inaccurate cliches."
The book is published by David McKay Co., Inc.,
New York.
The introduction flavors the whole book. Here's
an excerpt:
"In his Devil's Dictionary, Ambrose Bierce defined a physician as 'one upon whom we set our
hopes when ill and our dogs when well.' The definition is still apt today, especially if we apply it
to the total American medical system and not

merely to physicians. American medicine is now
at the height of its capability, providing more and more effective - help to a larger number of
our people than ever before. At almost every point
along the frontiers of the fight against death and
disability, American physicians and medical researchers are the world leaders. They are setting
new standards of excellence in such diverse fields
as heart and kidney transplants, knee and hip replacements, treatment of leukemia and hypertension, the prevention of RH incompatibility and the
application of new weapons against hyaline membrane disease in newborn babies. Yet never before has so ferocious an attack upon American
medicine been mounted as in recent years, an
attack that too often leaves the highroad of
reasoned criticism and descends to emotionalism
and misrepresentation."
This book, despite some obvious errors such as
". . . that nobody involved had anticipated a
sharp rate of medical care cost increases, [due to
Medicare and Medicaid]" and other unwise recommendations for a national health insurance
plan, contains fine ammunition to answer the attack on our "system." I urge you to get a copy
quickly and put the well substantiated parts to
good use, i.e., publicity, local college debates,
answering attacks in local press, radio and TV.
The Essay Contest was relatively successful in

educating the young of the nation in the value of
the American free enterprise system, including the
practice of private medicine. We urge that you
contact Dr. Ramsey, Indiana Headquarters, 420
East First Street, Bloomington, Indiana 47401, to
receive information about the "Indiana Plan" and
enlist the aid of your colleagues to sponsor the
AAPS Essay Contest in your area.
BOUND AAPS NEWS LETTERS AVAILABLE

Bound copies of the 1972 AAPS News letters
and Bulletins are available for $1.50 a set from
the AAPS office. This, too, is excellent ammunition.
Please order and use.
FOOD FOR THOUGHT
I hope our TV never gets like Russia's. Over
there it watches you.
For Freedom,
ESSAY CONTEST
Doctor Hugh S. Ramsey (Bloomington, Indiana),
Chairman of the AAPS Freedom Education Committee, is once again conducting the AAPS Harry
E. Northam Memorial Free Enterprise Essay Contest in the State of Indiana. He asks that members
in other states use the "Indiana Plan" to conduct
local and state contests until ten srote contests are
activated to enable the Association to sponsor it
as a National Event and offer cash prizes.
Robert S. Jaggard, M.D.

President
Enclosure: PRIVATE DOCTORS INSTITUTE

brochure
PRIVATE DOCTORS INSTITUTE, APRIL 12-15, 1973, DRAKE OAKBROOK HOTEL

ANNUAL MEETING, OCTOBER 11-13, 1973, SAN FRANCISCO, CALIFORNIA
ASSOCIATION OF AMERICAN PHYSICIANS AND SURGEONS

2111 Enco Drive. Suite N-515. Oak Brook . Illinois 60521
Frank K. Woolley. Executive Director
312/325-7911
Index No. 2
February, 1973, Volume 27, No. 2
The Real Crisis - Debauching the Currency - Not Medical Care
IS AHA Girding for AMA Showdown on PSRO?
AMA Tries to Plead Not Guilty
PSRO Is a Four-Letter Word
Dr. Roche Speaks at April Meeting
Resolutions Must Be in Before March 23
A Champion of Freedom Dies
JCAH Invites Recommendations
Cohen Wants AMA to Sell Doctors on National Health Plan
California Chapter Gets Moving
Not a Bad Idea
THE REAL CRISIS - DEBAUCHING THE

CURRENCY - NOT MEDICAL CARE
IS AHA GIRDING FOR AMA SHOWDOWN

ON PSRO?
Government plunderers have forced another

devaluation of the dollar; the second in 1.4
months. Political double-talk is polluting the airways to hide the fact that government is robbing
Peter to pay Paul. Now the politicians are blaming speculators when wild, irresponsible government plunder is the cause. The howls and snarls
of rage which we have heard and seen over television by the political plunderers, at even the
suggestion they stop the rate of increasing government waste and spending, should awaken
every honest producer of goods and services to
the truth. Unless we stop the political plunderers,
they will completely destroy freedom here as their
ilk have done elsewhere. The place for us to start
fighting the plunderers with all our strength, moraHy and legally, is to defeat the fradulent efforts
to force the nationalization of medicine upon us.
Let's expose PSRO and HMO for what they are frauds. Let's strengthen AAPS to increase resistance to more government - come to Oak Brook
April 12-15 and help strengthen our cause. Much
more than medical freedom is at stake. Going
along with government plunder to get along can
only result in disaster. Now is the time to act.
The American Hospital Association is moving

quietly and unobstrusively in a direction which
strongly suggests that it may be swiftly girding for
a show-down contest with the American Medical
Association for dominance over the legally decreed nationwide network of Professional Standards Review Organizations. The AHA is pushing
hard for rapid development of a new program of
hospitol-based peer review - entitled Quality Assurance Program. There is documentary evidence
available that AHA is carefuly structuring this
program so that QAP committees can possibly
qualify as PSROs. The American Medical Association, on the other hand, tried gnd failed to get
Congress to provide in the law (92-603) that medical societies or organizations set up by medical
societies would serve as PSROs. Since that failed,
AMA has publicly announced that it intends to
seek a dominant role over establishment of PSROs
and the drafting of PSRO regulations.
A lengthy, 11-section QAP manual put
out by AHA makes it clear that QAP
program goals are identical with those
of the PSRO law - to assure third-party
payors (government, labor unions or in-
surance carriers) that services they pay

for are (1) "medically necessary," (2)
"delivered in the most economical way
by using the least expensive facilities
and services available that will assure
the same or better quality of care," and
(3) are "in conformity to criteria of optimal use as determined by the physician's peers."
The AHA has advanced, as a justification for developing QAP programs in hospitals, a provision
of the law (92-603) which requires a PSRO to use
the services and accept findings of utilization review committees of hospitals as long as HEW approves of the arrangement. That, of course, is a
reasonably persuasive argument to the credulous
for developing working review programs in hospitals.
But the AHA manual on QAP indicates with
equal persuasiveness that AHA has something
else in mind. That something else is creation of
PSROs rooted in hospitals. The manual says that
a PSRO area would encompass approximately
300 physicians. It then suggests that smaller hos.pitals might wish to establish QAP programs as
shared services. The manual adds this significant
sentence: "It is also possible that if this shared
service utilization review program between hospitals involved 300 or more physicians, the program itself could qualify as a PSRO ..." And if
300 or more physicians are involved at a single
hospital, wouldn't that one hospital also have an
equal chance to qualify as a PSRO?
AHA has reported that the QAP program has already been implemented in
hospitals in several states and is rapidly
gaining acceptance in others. Physicians
should be aware that AHA proposes to
push forward throughout the nation a
program in hospitals that encompasses
the principle of PSRO and applies it to
the entire hospital patient population not just Medicare and Medicaid patients.
The QAP program, says AHA's manual,
"is designed to cover QII hospitalized
patients."
If it comes to pass that QAP committees do indeed become PSROs, will the same "norms" of
diagnosis and treatment forced on physicians for
the care of Medicare and Medicaid patients become standard for 5!!! patients?
The PSRO Law (92-603) stipulates that PSRO's
must be organizations of physicians. The QAP
committees, therefore, will be composed of members of the medical staff of each hospital. However, with many hospitals' By-Laws subordinating
medical staffs to hospital administrators, such
PSROs could turn out to be sorry "peer" review

mechanisms.
The Louisiana State Medical Association resolved, through its Executive Committee, to reject
totally the concept of QAP and to so inform all
members of the association.
AMA TRIES TO PLEAD NOT GUILTY
While officials of AHA are regularly conferring
with officials of HEW and pushing onward with
their QAP progrom, whot is the AMA doing?
AMA has called for a moratorium on establishment of PSROs "until more information, including rules and regulations regarding implementation of PSROs, is known." The AMA is also
feverishly trying to disavow any responsibility for
PSRO. An editorial in American Medical News,
Jon. 29, 1973, described it os "a mossive, complex, difficult - and unwanted - piece of legislation." Said the editoriol: ''When this legislation
was under consideraton by the 92nd Congress,
the American Medical Association questioned
whether o government operated program of
mandatory peer review geored in large part to
cost control could be effective without reducing
the quality of patient care."
In order that the record may be kept
stroight, it should be recalled th<:Jt the
AMA demonstrated no such concern
about preservation of medical quality
when it sponsored legislation for a compulsory, government-controlled program
of peer review in 1969 and 1970. A
mandatory Peer Review Organization
provision designated Title XXI was part
of AMA's first Medicredit bills drafted
by it and introduced at its request in
1969 and again in 1970. Primarily because of strong opposition by medical
societies around the nation, as well as
individual physicians, the AMA was
forced to abandon its PRO proposal.
This glaring inconsistency is important, particularly in the light of these recent disclaimers of the
AMA headquarters staff. Physicians must understand that the seed, which grew into the PSRO
weed, was planted by officials of the AMA. The
purposes of the AMA's proposed Peer Review
Organization were substantially the same as
those of the PSRO law (92-603). The AMA's PRO
was to be established to provide a "system of review of medical and other health services0 to be
rendered to Social Security Act recipients. It
would have empowered the Secretary of HEW
to establish and control, in every state, PROs
"which shall review the need for and quality of
such medical and other health services qnd the
appropriateness of charges for such services."
If it were appropriate for the AMA to sponsor

"mandatory review geared in large part to cost
control" in 1969 and 1970, why was it anathema
as the Bennett Amendment (which became the
PSRO law - 92-603) when it was under consideration in 1970, 1971 and 1972? Another important
question is: "If the AMA had not sponsored a bill
to establish compulsory government-controlled
peer review in 1969, would the subsequent Bennett Amendment have been drafted?" In other
words: "If the AMA had not planted that seed,
would the medical profession now be confronted
with the evil demands of PSRO?"
The AMA did not oppose the objectives of
PSRO, as made clear by William 0. LaMotte, Jr.,
M.O., Chairman of the AMA Council on Legislation, in testimony before the Senate Finance Committee in September, 1970. Praising the AMA's
PRO, Dr. laMottee added that PSRO "has a similar objective and such is indeed !auditory." He
said AMA opposed only certain provisions of
PSRO.
His testimony brought this comment from Sen.
Wallace Bennett, the Utah Republican: "Since i
am the author of 1he PSRO amendment and, of
course, since the AMA should know that the basic
concept behind the amendment is theirs, it seems
to me we are talking about details of operation
and not principles."
Neither Dr. laMotte nor members of the AMA
staff with him disputed Senator Bennett. In fact,
Dr. LaMotte added: 'We certainly commend you
(Senator Bennett) for your interest and your understanding of this problem and your willingness
to support an amendment for a structured peer
review mechanism."
Even though AMA officials planted
the seed, we can hope their pub Ii c
prayers for a crop failure are sincere.
On the record, we will have to wait and
see if it is just another case of one step
back in preparation for two steps forward into the public trough and for
more nationalization of medicine.
AAPS PAMPHLET ON PSRO
Order copies now for members of your Society
so physicians can learn the truth without doubletalk. Reprints available now: One copy - free;
2 to 10 - 75 cents; 11 to 50 - 50 cents each;
51 and over - 40 cents each. Plus postage for all
quantities.
PSRO IS A FOUR-LETTER WORD
Enclosed with this News Letter is a reproduction
of an editorial which indicates that there are still
influential physicians who thoroughly understand

the odious provision of the PSRO law and who are
not taken in by the blandishments of the collaborationists. This editorial from the January issue of
the Journal of the Oklahoma State Medical Association by the OSMA President, 5. R. Mccampbell, M.D., is a clear and thought-provoking recitation of the evils of this treacherous law.
DR. ROCHE SPEAKS AT APRIL MEETING
George C. Roche, Ill, Ph.D., one of the nation's
youngest college presidents, will be the banquet
speaker for the AAPS Private Doctors Institute in
April. At 37, Dr. Roche has won a nationwide
reputation as a leading exponent of the conservative cause. Not only is he a college president, a
position he assumed at Hillsdale College, Hillsdale, Mich., two years ago, he is an historian,
economist, author and lecturer. Dr. Roche, who
will discuss "The Moral lmperotive of Freedom"
at the AAPS meeting, was Director of Seminars
for the Foundation for Economic Education for
five years before becoming President of Hillsdale
College May 8, 1971. His contribution to the literature of conservatism includes "Legacy of Freedom," a study of the philosophic and moral underpinnings of Western civilization, and "Frederic Bastiat: A Man Alone," a biography of the
famous conservative French economic journalist.
Bring a student:
It is highly recommended that all of
you who will attend the sessions of
SEMINAR '76 on April 14-15 bring an
outstanding student to participate in this
unique experience. As explained in the
January News Letter, SEMINAR '76 provides an imcomparable opportunity for
deeper understanding of your fundamental beliefs. If each member brings a
student, some twigs may be bent in the
direction of liberty.
RESOLUTIONS MUST BE IN BEFORE MARCH 23
It must be strongly emphasized that regular resolution for the April Institute must be submitted to
AAPS Headquarters in Oak Brook on or before
March 23, or 20 days before the frist day of the
Meeting, as provided in the By-Laws. According
to the By-Laws, only resolutions of an emergency
nature can be accepted after March 23. Pertinent
resolutions are solicited.
A CHAMPION OF FREEDOM DIES
A strong and tifeless worker for medical freedom, Benjamin 0. Gitlitz, M.D., an AAPS delegate and a former president of the Wyoming
State Medical Society, was killed recently in a
plane crash near the Cheyenne Municipal Airport.

At the time of the crash, Dr. Gitlitz was flying a
patient to a Cheyenne hospital from Thermopolis
where he had practiced medicine for 30 years.
Dr. Gitlitz was 62 years of age. Just the night before his death, he was awarded the annual
Thermopolis Chamber of Commerce "Man of the
Year Award" in tribute to his stature as a physician and his myriad contributions to civic affairs.
He will be missed as a friend and as a warrior in
the endless battle ogainst those who would destroy our profession.
JCAH INVITES RECOMMENDATIONS
The Joint Commission on Accreditation of Hospitals has invited AAPS to offer suggestions, criticisms and recommendations on the Commission's
surveys, standards, etc. This represents an unusal
opportunity for AAPS to mt1ke constructive suggestions and recommendations to JCAH for improvement of patient care. If you have any suggestions or if you would like to serve on an AAPS
committee to develop proposals for the Commission, please notify AAPS headquarters.
COHEN WANTS AMA TO SELL DOCTORS ON
NATIONAL HEALTH PLAN
Regularly in the past, AAPS has warned physicians that part of the grand design of the socializers is to seduce medical societies into becoming
willing collaborators with those whose ultimate
goal is destruction of medicine's freedom. Now,
confirmation of the warning comes from none
other than Wilbur J. Cohen, one of this century's
most dedicated devotees of socialized medicine.
In an interview in the Washington Post published
February 4, 1973, Cohen observed that in his
opinion the power of the AMA reached its peak
in 1950 and has been declining since. In a moment
of frankness, Cohen added: "I would not like to
see the AMA completely eliminated from some
position of power and influence, because the
essence of making a new national health plan
work is to gain the acceptance of the individual
practitioner."
blind eagerness of the AMA to become

a collaborator in implementing that iniquitous honor known as PSRO. (Hasty
action by AMA at Cincinnati by voice
vote adopting the Board of Trustees report Z).
CALIFORNIA CHAPTER GETS MOVING
The California Chapter of AAPS is having Congressman Phil Crane - who last addressed the
National Meeting of the AAPS in Richmond, Virginia, in September, 1970 - address its Annual
Meeting the night of March 10th at Disneyland in
Anaheim. This is something that every California
member will want to attend and, it also suggests
what other State Chapters might do in up-grading their annual program.
Contact Walter Buerger, M.D., Secretary-Treasurer of the AAPS California Chapter, at 252 West
Badillo St., Covina, California 91722, for further
information.
NOT A BAD IDEA
The Wall Street Journal recently commented:
"In Locri, in ancient Greece, legislators who proposed new laws were required to appear with a
noose around the neck. If the proposal were rejected, then penalty was death by strangulation.
Small wonder no laws were introduced for 200
years."

President
Enclosures:
The success of that long-time strategy

is nowhere more evident than in the
Reprint from Oklahoma State Medical Association

Reservation Card
PRIVATE DOCTORS INSTITUTE, APRIL 12-15, 1973, DRAKE OAKBROOK HOTEL, OAK BROOK, ILLINOIS

2111 Enco Drive. Suite N-515. Oak Brook. Illinois 60521
312/325-7911
EMERGENCY BULLETIN
ASSOCIATION OF AMERICAN PHYSICIANS AND SURGEONS. INC.
312/325-7911
Robert S. Joggard, M.D., President

Frank K. Wooll~y. Executive Director
BULLETIN NO. 1-73
Index No. 3
February 21, 1973
AAPS proposes to sue the federal government to stop interference in the

practice of medicine. The following Press Release was released today for publication.
PRESS RELEASE
Legal counsel has been retained by the Association of American Physicians and
Surgeons to explore the possibility of suing the federal government to prevent i t
from interfering in the practice of medicine. This need for litigation by the
doctors against government was occasioned by a new law authorizing so-called
Professional Standards Review Organizations.
Under this law (P. L. 92-603) signed October 30, 1972, government employees
and not the patient's doctor would finally control medical decisions on a case-bycase basis. As might be expected, elaborate, expensive and top-heavy organizational
machinery is established by the law to hide the fact that iron-fisted control is
vested in the Secretary of HEW and his agents.
The Association of American Physicians and Surgeons (AAPS) is a nationwide
Association of independent doctors interested in retaining their freedom to use
their best ethical professional medical judgment solely for the benefit of their
patients. These doctors SEEK NO FEDERAL SUBSIDIES and are concerned with other
medical organizations which do. The reason for this concern is they realize
government subsidy means government control.
The President of AAPS, Dr. Robert S. Jaggard of Oelwein, Iowa, in announcing
the decision of the Board of Directors also said: "The new law would force physicians
to justify their medical decisions to federal employees and conform to governmentally
dictated standards of diagnosis and treatment for Medicare and Medicaid patients."
He added that "forcing physicians to conform to computerized norms of care on the
basis of averages, as decreed by government clerks without regard to the uniqueness
of each individual, would be a tragedy. This would mean that physicians would be
forced to provide Medicare and Medicaid patients with second-class medicine." He
went on to say "that this could lead to-such bureaucratically dictated medicine
being applied to everyone which is what 'National Health Insurance I would mean."
''The Board of Directors of AAPS, 11 Dr. Jaggard said, ''welcomes support from
any state or local medical society in resisting government interference in the
practice of medicine."
It is assumed by the Association, it will be necessary to take the case to
the Supreme Court and it is prepared to go that far in an effort to maintain the
freedom of physicians and their patients.
TO DO
See that your local medical society, newspaper, radio and TV station
have this information. Use pamphlet on PSRO and ii;tformation in November,
December and January News Letters to suppleme:p.t press release. Check
with Publicity Chairman of your State AAPS Chapter.
Index No. 4
March, 1973, Volume 27, No. 3
Attend Private Doctors Institute
March 23 is Resolution Deadline
AAPS-ISMA May Sue Government Over PSRO
~
Upholds Physician-Patient Privilege
Dr. Quinlan Denied Staff Privileges
i1
Rape of Taxpayers
Californians Dissatisfied
New Insurance Program Available
ATTEND PRIVATE DOCTORS INSTITUTE
without interference from government bureaucrats or anyone else.
There is a crisis in mf;ldicinel

~ut it's not what the planners and collaborators
say it is. It is not a crisis engendered by poor quality and excessive cost. Americans are the bene-
That's what it will mean to each of

us and to all of our patients if the government proceeds with enforcement of
the iniquitous Professional Standards
Review Organization law (P.L. 92-603).
ficiaries of the best medical care in the world, and

they get far more fo~ their health care dollars then
If you want to know what you as an individual
they did 20 or 30 years ago. No, that's not the
physician can do about this law and what mem-
crisis. The crisis is that all Americans -
patients
bers of AAPS can do together, I urge you to at-
and physicians alike - are about to lose the bene-
tend the Private Doctors Institute April 12-15 at
fits of the world's best medical system. The crisis is
the Drake Oakbrook Hotel at Oak Brook, a sub-
that the federal government, unless it can be
urb of Chicago. The PSRO law and what it will
stopped, will soon destroy the foundation upon
mean to you and your patients will be thoroughly
which our peerless system rests: Freedom - the
discussed at this most important meeting, and so
freedom of physicians to use their judgment and
will other schemes to destroy medical freedom.
knowledge and skill, and the tools of the profession, to serve the best interest of their patients
You can take part in discussions and decisions
that can profoundly affect your future. These discussions will cover such subjects as "Hospital Interfering with Medicine," "Law of Hospital vs.
Physician Liability," "Interference in Medicine by
Government," and "Compulsory National Health
Insurance."
Indiana State Medical Association is so disenchanted with PSRO that its Board of Trustees has
directed ISMA President fomes H. Gosman, M.D.,
to seek legal counsel to study the possibility of
filing a class action suit on behalf of member physicians to block enforcement of the PSRO law.
AAPS Executive Director Frank K. Woolley has
There will be bonuses for you for attending the

Meeting. First, George C. Roche Ill, Ph.D., gifted
young President of Hillsdale College
written Dr. Gosman offering to join forces in this

endeavor.
Hillsdale,
Michigan, and a true conservative, will discuss

"The Moral Imperative of Freedom" as the Ban-
UPHOLDS PHYSICIAN-PATIENT PRIVILEGE
quet speaker. Second bonus will be SEMINAR '76

during the last two days of the Institute. SEMINAR
Thomas G. Dorrity, M.D., Immediate Past-Presi-
'76 is a unique kind of concentrated citizenship
dent of AAPS, and Executive Director Frank K.
workshop guaranteed to be an exciting and un-
Woolley testified before a special subcommittee
usual self-discovery experience.
of the House Judiciary Committee in opposition to

a proposed new rule of evidence that would
With your medical freedom in jeopardy, this Institute is one you should
not miss. Several reservation forms
have been mailed to AAPS members.
You should have received another one
within the past few days. DON'T DELAY: MAIL A RESERVATION IN TODAY.
abolish the physician-patient privilege in all federal court proceedings. Only exception would be
communications between patient and psychiatrist.
DR. QUINLAN DENIED STAFF PRIVILEGES

Donald Quinlan, M.D., Northfield, Illinois, President-Elect of AAPS, has had his staff privileges
MARCH 23 IS RESOLUTION DEADLINE
at St. Joseph Hospital in Chicago terminated because he refused to sign, without qualification, a
Don't hold up resolutions for the Institute! Reg-
statement presented to him by the administrator
ular resolutions, according to AAPS By-Laws, must
which would have had the effect of authorizing
reach Association Headquarters in Oak Brook no
the Board of Directors to amend the by-Laws
later than 20 days before the first day of the
concerning the medical staff without approval of
Meeting. The deadline is March 23.
the staff. Dr. Quinlan, who has had staff privileges

at St. Joseph for l O years and has served on the
Executive Committee, has engaged legal counsel
AAPS-ISMA MAY SUE GOVERNMENT OVER PSRO
to obtain judicial review of the hospital's decision

if litigation becomes necessary to restrain the
AAPS announced it has retained legal counsel
hospital from arbitrarily changing the medical
to explore the possibility of suing the federal
staff by-laws without uncoerced approval of the
government to prevent the government's interfer-
staff. AAPS has encouraged Dr. Quinlan because
ing with the practice of medicine by implementing
the line must be drawn against the growing trend
PSRO. Subsequently, it was disclosed that the
among hospitals of arbitrarily insisting the phy-
sicians subordinate themselves to administrators
placing Medi-Cal, in order to "persuade" people
in matters involving medical judgment.
to sign-up. But worse Dr. Cohen also documents

cases in which North Valley subscribers were
forced to go to emergency departments of area
hospitals because North Valley wasn't open and
HMOs - GET-RICH-QUICK SCHEME
then North Valley tried to get the patient out of

the hospital or refused to pay the bill.
The advocates of tax subsidies for developing

and operating health maintenance organizations
For example, Dr. Cohen cites this case: "A child,
(HMOs) may be promoting a monstrous get-rich-
age l, very moribund child, was admitted to
quick s.cheme. Imagine the possibilities that will
Pacoima Memorial Lutheran Hospital with staph
unfold for fast-buck con artists, cleverly and
pneumonia and hemoglobin of 5 grams. The
shrewdly making promises they don't intend to
North Valley Medical Group was not available.
keep, if Congress enacts the Roy bill to pick tax-
if the staff doctor had not admitted this child, it
payers' pockets for a third of a billion dollars for
would have died. The attending physician . . .
developing HMOs. The Kennedy bill to blow up
was called daily by the North Valley Medical
to 3 billion of tax dollars on the same pretext is
Group to discharge the patient since hospitaliza-
fantastically more profligate. It boggles the mind.
tions were too expensive; in spite of the attending

physician's explanation that the prognosis was
Enormous opportunities will open up for the
grave." (Emphasis ours)
unscrupulous to set up HMOs with premediated

intent to harvest huge profits by giving the least
Another year-old child of a North Valley sub-
service possible at the highest capitation fees the
scriber was admitted to a hospital as an emer-
traffic will bear. The very nature of this scheme
gency case suffering bacterial pneumonitis with
makes this kind of taxpayer rape more than just
meningismus. Child might have died if refused admission. When North Valley was billed for medi-
a speculative possibility.
cal services, "they denied the claim since 'the

Anyone who is skeptical of these
statements should read a letter written
by Harold M. Cohen, M.D., Chief of
Staff of Pacoima Memorial Lutheran
Hospital, Lake View Terrace, California, to the California Department of
Health Care Services about misrepresentations and poor quality care given
to Medi-Cal patients by North Valley
Medical Group, an HMO which is a
division of Consolidated Medical Systems, Inc. Consolidated is a subsidiary
of HMO International.
child's application had not, been processed.'"

(Emphasis ours)
"The responsible medical community continually has to 'bail this group out' to prevent tragedy,"
said Dr. Cohen. "The responsible citizens and
responsible medical community feels this group is
dangerously misrepresenting its benefits and especially its capability; its care of the patients has
been negligent and dangerous, relying on emergency rooms and the community physicians to bail
it out. If this group is not censured immediately,
Dr. Cohen's letter documents cases in which

representatives of the North Valley Medical Group
countless people will be deprived of adequate

care and suffer morbidity and mortality."
engaged in various misrepresentations, including

the false statement that it was a new plan re-
You may be tempted to dismiss Dr. Cohen's
statements as exaggerations of a medical doctor
is significantly less than other well-estab-
who was disgruntled because his hospital was
lished pre-payment group practice plans.
losing a few bucks on some patients it didn't want
Futhermore, the physicians employed by
to take care of in the first place. If so, consider
CMG on the whole have substantially low-
the fact that Dr. Cohen's letter is part of a com-
er professional qualifications than Cali-
prehensive report on the deficiencies of the California Medical Group, another HMO that is also
fornia physicians generally, with 40%

having graduated from foreign medical
a subsidiary of HMO International. The report
schools or schools of osteopathy generally
was prepared by the California Council for Health
known as not meeting the standard of
Plan Alternatives. The California Council, signifi-
U. S. medical education. The ratio of
cantly, is an organzation of labor unions through-
qualified specialists is even worse. Report
out the state.
notes there are no obstetricians and the

equivalent of only two pediatricians for
110,000 subscribers, among whom a high
In a letter transmitting a copy of this report to

Thomas L. Young, Chairman of,, the Health and
proportion are children. (Emphasis ours)
Welfare Committee of Teamsters Joint Council

(Only the most naive would miss the
#42, the California Council's Executive Director,
point that the way to make money from an
Thomas G. Moore, Jr., had this to say:
HMO is to restrict services, cut down on

"Our experience in making this evaluation leads moe to one overriding concern: CMG represents a new and rapidly growing form of profiteering medical
care organization designoed to exploit
our members, the poor, and anybody
else who becomes a member." (Emphasis ours) "Roesponsible union leaders
should not only protect their membership from this kind of organization but
should actively oppose the growth of
these programs in the community at
large. I think the reasons for this concern are clear in the report."
staff and by any means at hand get as

many subscribers as possible to provide
the revenue. A government subsidy, direct or indirect, would serve to put a thick
layer of frosting on the financial cake.)
The decision to hospitalize at CMG is

done by committee, except in emergencies.
That decision is made by a general practitioner and two other physicians under
him. "One must question whether this is in
the best interest of the persons served,"
observed the report.
The report was signed by Moore and by Lester
CMG provides half or less hospital care
Breslow, M.D., who is Dean of the School of Pub-
than other well-recognized prepayment
lic Health at the University of California at Los
group practice plans and this "extremely
Angeles and Co-Chairman of an Advisory Com-
low use of' hospital care by CMG raises
mittee to the California Council for Health Plan
the question whether needed hospitaliza-
Alternatives. The report is lengthy. Here are its
tion is actually being provided by CMG to
highlights.
its prepaid enrollees."
Ratio of physicians to population to be

served by the California Medical Group
Subscribers are "assigned" to one of 21

clinics which would appear to offer the
convenience of accessibility. Fact is, however, that evening and weekend coverage
is available at only 7 of the 21.
even with appointments, and hurried,

impersonal physician contacts are common complaints. These may all be ascribed, to one d-egree or another, to less
than ideal physician/population ratios."
"There appears to be a high rate of

physician turnovE;lr and certain clinics have
only one or two physicians on the staff. In
addition, CMG is mixing some 30,000 feefor-service patients in with their commercial and Medi-Cal prepaid patients. It is
In spite of this highly critical report, California's

Health and Welfare Agency glossed over the
specifics of the criticism and renewed its approval
of CMG for Medi-Cal patients.
worth noting that where this situation has

existed, it tends to bring on conflicts, with
CALIFORNIANS DISSATISFIED
prepaid patients usually the one shortLabor union criticism of the California Medical
changed."
Group and Kaiser is not the only evidence to sup-
CMG told investigators it m a i n ta i n s
port the long-standing contention of AAPS that
quality through an automated "peer re-
prepaid group practice by whatever name is no
view" system. But when questioned about
health panacea but is, on the contrary, a device
"norms// used as quality criteria, CMG in-
to control the doctor and short-change the patient.
sisted outside standards community in general -
those in the
were not appli-
cable to its physicians. CMG physidans'

performance was measured only against
CMG
11
11
norms" of which, said the report,
we were unable to obtain more precise
delineation. 11
In a news story on the state's approval of CMG,

the Los Angeles Times noted that it is one of about
25 HMOs contracting with the state to furnish
health care to Medi-Cal
patients.
11
Many of
these state contract plans," said the Times, "have

recently been subject to heavy criticism by some
of their patients and by organized labor. 11
Various and sundry liberals in the hierarchy of

labor, in Congress, is the press and elsewhere
have been trying to make the world believe that
HMOs will prove to be the nirvana of health care.
And Kaiser-Permanente has often been held aloft
as the standard upon which to judge them all. A
couple of sentences buried in this report written
by an organization of labor unions may well
tarnish that shining halo accorded the Kaisertype operation.
"Over the years, Trust Funds (source

of labor's health and welfare money)
have become increasingly aware of subscriber dissatisfaction with Kaiser services. Difficulties in making appointm-ents, lengthy waits to see physicians
Another group reportedly lost its contract because of hank-panky with members of the Legislature in obtaining the contract and because officers insisted on using unaccredited hospitals
owned by the organizer of the group.
On top of all this, disenchanted

Medi-Cal patients, (formerly cared for
by physicians of th-eir own choice) now
have grown weary of poor service from
the HMOs and are dropping out in increasing numbers. Los Angeles County
Medical Association has sent out a call
to its members to volunteer for service
to these patients who now want to return to the superior care formerly provided by their own private physicians
through Medi-Cal.
Said LACMA in a letter to members: "The disenrollment procedure may take as long as 90
It was for that reason that the $300,000 AAPS

Catastrophe Major Medical Insurance Plan was
days. During this period the patients may not
developed. It is intended to compensate for costs
have a Medi-Cal card and may not have a phy-
beyond those covered by basic insurance. After
sician to go to for care. These patients need phy-
a $15,000 deductible, this new plan takes over
sicians who will volunteer to see them during the
and pays 100% of eligible expenses up to a max-
disenrollment period should they need care."
imum of $300,000 for up to 5 years.
If labor union leaders are becoming

disillusioned, liberal members of Congress who are blindly pushing this dubious scheme should take heed. Hopefully, common sense will prevail over
political expediency.
All the above information was submitted by
AAPS Executive Director, Frank K. Woolley, to the
Subcommittee on Health of the House Interstate
Premiums are extremely low. For example, a

member under age 40 will pay less than $25.00
annually for this important umbrella protection.
Complete details of this new plan will be sent
to members. Check your mail or write to our Insurance Administrator - Albert H. Wohlers & Co.,
AAPS Group Insurance Plans, 720 Garden Street,
Park Ridge, Illinois 60068.
and Foreign Commerce Committee during hearings on HMO legislation earlier this month.
A new organization is forming -
Doctors In
Medicine Who Imitate The Socialists. It will be

known by its initials: the DIMWITS.
NEW INSURANCE PROGRAM AVAILABLE
For Freedom,
AAPS will make available a $300,000 Catastrophe Major Medical Insurance Plan exclusively
to Association members. Catastrophe Major Medical Insurance Plan is the newest form of HospitalMedical-Surgical Insurance. It provides protection
against those truly serious accidents or sicknesses
that result in catastrophic expenses. Basic Hospi-
President
talization and/or Major Medical Insurance provides for the "normal" hospital-surgical-medical
protection, but not catastrophe protection.
Enclosure: State on AAPS
PRIVATE DOCTORS INSTITUTE, APRIL 12-15, 1973, DRAKE OAKBROOK HOTEL, OAK BROOK, ILLINOIS

312/325-7911
Index No. 5
April, 1973, Volume 27, No. 4
Keep Those Pledges Coming
AMA Spokesmen Favor Compulsion
It's Right out of Orwell
Suit Against Compulsion
First PSRO Regulation?
Will Distribute Hippocratic Oath
Annual Meeting Approaching
KEEP THOSE PLEDGES COMING
The response to our plea for pledges to help
AAPS pursue the suit against the federal government to nullify the PSRO law and to keep free
medicine free in America has been impressive.
The response demonstrates widespread devotion
to the AAPS goal of preventing the federal government through PSRO or any other law from
destroying the freedom of private physicians to
practice medicine as their judgment dictates.
But it is not enough!
"
We need the support of everyone we can get,

everyone who believes in safe-guording personal
liberty in our nation. If you haven't done so already - and hundreds have - please send in
the "Outlaw PSRO" pledge card; another copy is
enclosed.
In addition, and this is most important, inform all your colleagues who are
not AAPS members about the action
AAPS is taking to protect the interests
of ALL physicians and ALL patients by
filing this suit to block the PSRO law.
Ask them to join and pledge financial
support for this action which is vital to
the future of ALL physicians.
The firm of attorneys engaged by AAPS for
this action have reported that their investigation
of the legal problems of such a suit leads them
to conclude there is a good cause of action
against the government. The firm is now taking
the necessary steps to properly file suit in federal
court.
Your help and the help of your colleagues is

urgently needed, since it is probable that this
case will have to be taken all the way to the U.S.
Supreme Court.
Join the hundreds of other physicians who have
volunteered their support. This may be the last
opportunity free physicians will have in this
country to stand up and be counted on the issue
of retaining medical freedom.
Show us we can count on you.
AMA SPOKESMEN FAVOR COMPULSION
Recent statements by two high-ranking representatives of the American Medical Association
emphasize why thousands of physicians believe
with unshakeable conviction that the AMA is
undermining physicians in the practice of private medicine and turning its bock on the best
inerests of millions of patients.
First, H. Phillip Hampton, M.D., Chairman of
the AMA Council on legislation, recently told a
House Post Office and Civil Service Subcommittee
thot more controls are needed over the quality of
medical care and that the compulsory controls of
the PSRO law will be superior to peer review programs conducted voluntarily by physicians now.
Second, Robert B. Hunter, M.D., member of the
AMA Board of Trustees and Chairman of the AMA
PSRO Task Force, indicated at a PSRO meeting
that he can't distinguish the difference between
compulsion and voluntarism and sees nothing
alarming in the former.
Here are significant portions of Dr. Hampton's

testimony in response to questions from Rep.
Jerome Waldie (D-Calif .), chairman of the subcommittee.
Q. "In your statement concerning the
PSRO provisions that were enacted

last year, you mentioned that what
we did was formalize a practice that
had been in existence within the profession for decades. You conclude ...
'It is apparent that this program can
have a profound effect upon the provision of services.' Why would It have
any effect at all if it is simply formalization of a practice that has been
in existence for decades?"
A. "The formalization makes it possible
to improve the effectiveness of peer
review, providing a mechanism . . .
that is needed in making these evaluations and judgments."
In answer to another question, Dr. Hampton
said peer review now involves "many types of effort," and added that "PSRO does provide a
formal mechanism through which many of these
judgments can be made and, hopefully, it will
enable the development of a more effective
handling system ..."
Astonishingly, Dr. Hampton appeared undecided how desirable it is for government to impose
controls on physicians.
Q. "Does it (PSRO) provide more control
over the activities of the doctors than

the prior system did before its formalization?"
A. "I believe it will, in that controls will
not be as varied in different parts of
the community .. There will be more
standardization, I believe, of the control mechanism through PSRO. How
desirable that is and how much it
may interfere with evolutionary development of better controls will be
determined by what happens."
Then Mr. Waldie asked this question: "Do you
think, doctor, there are sufficient controls now over
the quality of medical care that is delivered to
the consumer ... ?"
Dr. Hampton: "I believe that the controls could
be improved. Therefore, I think that they are not
sufficient."
The remarks of Dr. Hunter indicating confusion
o v e r the difference between government-controlled and voluntary peer review were made at
a recent PSRO meeting in Washington, D.C., jointly sponsored by the AMA and the Association of
American Medical Society Executives. He used

the term "militant alarmsmen" to deride those who
are indeed alarmed at the prospect of bureaucrats
setting standards by which physicians will practice medicine.
"For all my professional life, which is now 27
years, I have been practicing with a physiciansponsored prepaid plan," he declared. ''This includes the peer review of every service I render,
every X-ray I take, every fracture I set and every
dollar I charge on this physician-sponsored plan.
I have not found it alarming."
There is a vast, unbridgeable gulf between voluntarism and compulsion. It is sad that the AMA's
chief spokesman on PSRO cannot discern the difference. It is also sad that he cannot see the trap
in the PSRO law, the device in the law by which
physicians are to be lured into willingly accepting
controls - the provision calling for rotation of
physicians to exercise these controls at government's bidding.
''The beauty of the thing is exactly what is expressed in this new law, that the work is done by
fellow practicing physicians, and there is a rotation of assignment so that everybody has to take
a whack at it," he said. ''That is clearly spelled
out. I tell you that this may very well be the salvation of this nation-wide program."
Dr. Hunter fails to recognize that the "salvation" of this vicious PSRO law giving government
control over the case-by-case practice of medicine
will be the destruction of medical freedom in
America.
Nor does he seem to understand that an M.D.
Degree doesn't confer benevolence on its possessor after he accepts a salaried function in the
federal Hierarchy. We have not seen freedom
protected or this diverted course of tyranny diverted by any of the M.D.'s in the federal hierarchy in the last 20 years. Wise medical leaders
fully understand that naive physicians should not
be encouraged to believe that they can improve
medical practice by gaining control of the levers
of government compulsion. it didn't happen in
Germany and it isn't going to happen in other
places - including here. Freedom - not coercion
- is the right answer.
IT'S RIGHT OUT OF ORWELL
Orwell's 1984 is coming sooner than you think.
Dr. Charles C. Edwards, the highest-ranking
physician in the federal government, made a statement at the recent Annual Meeting of the American Society of Internal Medicine that has an unreal kind of double-think/double-speak quality
about it. Twice in a speech at the meeting, Dr.
Edwards referred to the Professional Standards

Review Organization "concept of self-regulation."
The fundamental concept of the PSRO law is
government control of physicians engaged in the
practice of private medicine. The law cannot be
justified on any other basis. But Dr. Edwards, to
the astonishment of many delegates to the society
of internists' meeting, easily confused government
control of physicans with self-regulation by physicians, even though the two are mutually contradictory.
Dr. Edwards wasn't alone in engaging in Orwellian double-speak. Sen. Wallace R. Bennett,
the Utah Republican who was the author of PSRO,
described the PSRO law as "an exciting opportunity for medicine to decide its own destiny." Without batting an eye or hesitoting a second, Bennett declared that under PSRO, "physicians will
maintain firm control over the day-to-day practice
of medicine - that is the main purpose of the
Bennett amendment."
But if anyone were confused by this
"self-regulation" bit, Dr. Edwards soon
disclosed what the Nixon Administra.
tion really has in mind - and it isn't
self~regulation. "The federal government, he said, "has the responsibility to
see to it that standards of performance
in the field of health are as high as
scientific knowledge and human understanding will permit." He added that
"the business of government in developing and carrying out regulations that
have an impact on the practire of medicine is to make certain that the profession adheres to its own high standards. This we intend to do."
SUIT AGAINST COMPULSION
Isn't there something incomprehensibly anomalous about compulsory membership in organizations whose policies profess a dedication to freedom of the individual? Four California physicians
- three of them AAPS members - find it so. The
four have filed suit in a state court to outlaw compulsory membership in the American Medical
Association and the California Medical Association.
Plaintiffs in the suit are F. Earl Woodhull, M.D.,
Anaheim; Robert G. Reaves, M.D., Anaheim; E. H.
Thomassen, M.D., Newport Beach (all AAPS members), and Richard L. Sellman, M.D., Tustin. All are
members of the Orange County Medical Association.
The suit seeks an injunction to prohibit the
county medical association from requiring the
payment of dues to AMA and CMA as a condition of membership in the county association.
The four claim they "derive no benefit'' from

membership in the AMA, whose activities and objectivE:5 are "f~r removed" from their practices
and, m some instances, are detrimental to their
best interests in particular and the medical prof~~sion and the public in general. The physician
litigants also ask the court to enjoin the AMA from
"exercising any control or dominion" over CMA
?nd OCMA. They brand compulsory membership
m the AMA "an arbitrary and discriminatory
practice" that is "contrary to law and to public
policy."
They seek relief from the court on grounds they
are threatened with expulsion from the county
association and they need OCMA membership
"not only to earn a livelihood but to achieve maximum potential achievement and recognition" in
their profession. Their attorney, Mark A. Smith,
said that before the suit was filed, OCMA members were polled on voluntary against compulsory
membership in AMA and 82% voted in favor of
voluntary membership.
FIRST PSRO REGULATION?
In the AAPS pamphlet evaluating the iniquitous
PSRO law, it was pointed out that the law requires
- not permits, but requires - government to
harass, hound and embarrass physicians who do
not willingly submit to controls and to hold these
physicians up to public ridicule. Those of us who
have been pointing out how vicious this law will
be have been dismissed as "militant alarmsmen"
by AMA's chief apologist for its policy of collaboration, as noted elsewhere in this News Letter.
Apparently, the protagonists of collaboration
have failed to mark, or do not care, that embarrassing physicians whose medical decisions
do not conform to bureaucratic notions of what
constitutes adequate medical care has become
public "sport'' fostered by the U.S. Department of
Health, Education and Welfare.
As of March 19, it became HEW policy to make

public the names of physicans who, in the opinion
of Medicare carriers or intermediaries, "have engaged in a pattern of furnishing services or supplies in excess of the medical needs of patients."
This new regulation is now a fact and has the
force of law. Before final adoption, an amendment was approved as a carrot to those doctors
who had objected to the sk:lr-chamber nature of
the original draft, which gave accused physicians
no chance to defend themselves.
Unfortunately, however, the "amendment carrot" offers very little to guarantee justice to an accused physician. It simply says that his or her name
will not be disclosed until after consultation with
"a professional medical assoctation functioning ex-
ternal to the administration of the Medicare program, or if appropriate, the state medical authority." And it adds that the name will not be disclosed unless the accused "has had an opportunity
to submit a statment or evidence on his own behalf
and that such statement or evidence is taken into
account in determining whether his name should
be disclosed."
As in the case of PSRO, the physicians under
these new regulations will be heard by HEW,
whose agents already have judged him guilty.
Medicine is f.ar from an exact science. Opinions
on specific cases will differ legitimately and honestly among physicians. But this new regulation
confers upon employees or insurance companies
the authority to over-rule the judgment of physicians on what their patients need.
Is this due process? It is not! Even with the
amendments to the regulation, it still smacks of
star-chamber proceedings. It stands as an ugly
violation of America's traditional concept of justice. Public disclosure of physicians' names will
hold them up to public scorn and ridicule, not as
a consequence of proper legal procedure~
simply because laymen have been given authority
to make medical judgments in conflict with those
of physicians.
Is this what the American Medical Association
wants for its members? It's what it's going to get
and it's a foretaste of things to come when the
PSRO regulations are drafted and enforced.
In point of fact, there is evidence
that this regulation affecting Medicare
is indeed the first PSRO regulation to
be adopted by HEW.
A news release announcing that the new regulation has become effective stated HEW Secretary Caspar Weinberger " . . . observed that the
new rules are consistent with the provisions of the
newly enacted Social Security Amendments of
1972." These amendments are P.L. 92-603, which
contains the PSRO law.
That's what collaboration with your friendly
little federal bureaucrat gets you.
LOYAL AAPS MEMBER DIES
It has only recently come to the attention of
AAPS officers that the Association has lost another

active and loyal member, Robert D. Knapp, Jr.,
M.D., Shreveport, La. Dr. Knapp and his oldest
son, Paul, were killed earlier this year in a plane
crash.
WILL DISTRIBUTE HIPPOCRATIC OATH
At the recent AAPS Private Doctors Institute,
the House of Delegates approved a proposal by
Curtis W. Caine, M.D., Chairman of the Committee
on Ethical Conduct, for the Association to print
and distribute copies of the Hippocratic Oath. Dr.
Caine pointed out, however, that several versions
of the Oath have evolved over the centuries, and
a decision must be made on which version will be
distributed.
Dr. Caine has requested members of AAPS to
send to the home office the language of the Hippocratic Oath they have in their possession. It will
then be decided which one will be printed and
distributed.
ANNUAL MEETING APPROACHING
The way tempus fugits, it is not too early to set
aside the dates for the AAPS Annual Meeting for
1973. Mark your calendar and be sure to attend.
The dates are October 11-13 and the place is the
Mark Hopkins Hotel, San Francisco. An outstanding program is being planned, with top-level
speakers and panelists who will frankly, forthrightly and honestly discuss important issues, both
current and prospective, that affect the practice
of private medicine. Reserve the dates and plan
to attend.
Thought for all time: Morality is the judgment
to distinguish right from wrong, the vision to
see the truth, the courage to act upon it, the
dedication to that which is good, and the integrity to stand by the good at any price.
For Freedom,
President
Enclosures: OUTLAW PSRO Pledge Card
Order Blank for Organization
Manual
Order Blank for Pamphlet
Display Rack

PRIVATE DOCTORS INSTITUTE, APRIL 18-20, 1974, OAK BROOK, ILLINOIS

312/325- 7911
May, 1973,
e
e
e
Members Express Pride in AAPS
Senate Votes to Destroy U.S. Medical System
'4!P
Is AMA Misleading Members?
Why Is QAP So Important?
Index No. 6
Volume No. 27 N9. 5
Will AMA Move to Washington?

PSRO Oppostion Growing
MEMBERS EXPRESS PRIDE IN AAPS

It was heard often-the sound, and the echo, of
pride in the only remaining nationwide, medical
organization in America with the necessary courage and the required dedication to the ideal of
individual freedom to legally challenge an attempt by the federal govenment to smother the
freedom of the nation's physicians and patients.
That pride in the Association of American Phys.icans and Surgeons set the tone for the AAPS Private Doctors Institute at the Drake Oakbrook Hotel
in April.
Cent~r stage at the meeting was the decision
of the Board of Directors to file suit against the
Department of Health, Education and Welfare
to stop HEW from enforcing the freedom-destroying provisions of the Professional Stanards Review Organzation sections of P.l. 92-603.
That historic decision was ratified by
the House of Debegates unanimously
with the adoption of a resoultion endorsing the action of the Board, resoZ.Ving that this effort "to maintain
the freedom of physicians and their patients and the quality of medical care
in this country" should be carried to
the United States Supreme Court if
necessary, and authorizing a special
assessment of the membership if it becomes necessary to finance the litigation.

The resolution pointed out that PSRO would
force physicians to conform to "government-imposed 'norms' of diagnosis and treatment," that
"standardization of medical care would seriously
impair the quality of medical care to the detriment of patients," that "this unjust law would be
employed to subject physicians to public scorn
and ridicule and thereby undermine public confidence in the medical profession," that enfor,ement of PSRO would "violate the constitutional
rights of physicans and patients," and that the
law is based on the false assumption that government can improve quality and reduce cost and
the misrepresentation that "physicians are responsible for rising health care costs whereas the
blame actually lies with profligate government."
The House of Delegates also recommended the
Association work for repeal of the PSRC law.
In another action, the House adopted a strong
statement of opposition to legislation in Congress
proposing subsidization of per capita prepaid
group practice (newly labeled HMOs). Federal
subsidy of HMOs, said the resolution, would
"unfairly discriminate a g a i n st fee-for-service
medicine." Declaring that subsidization represents

"another wedge being driven in.to the free choice
private competitive market system," the resolution said the legislation "should be opposed by
whatever n:eans are available to the Association."
chall.enged, the quality of medical care

will deteriorate, and the patienfi, the
doctor and the hospital will all b.e the
poorer." They agreed that physicians
are still independent contractors and
that there is a mutual responsibility
for the care of hospitalized patients.
Assault on Freedom
The Institute also provided delegates a forum

.for an in-depth panel J:fiscussion of another insidious kind of assault on the freedom ~nd independence of physicians - the spreading belief among
hospital boards and administrators that medical
staff physicians are subservient to the hospital
administration and that they are agents of the
administrator and not independent contractors.
The lesson of the panel discussion is that physicians throughout the nation should be alerted to
this recently accelerated threat to their independ.ence and freedom. It was agreed that the problem has been intensified by misinterpretation of
the celebrated Darling case to mean that hospital
boards are responsible for the qual,ty of medical
care in the hospital. This misinterpretation has
been widely distributed through efforts of Kenneth J. Williams, M.D., Director of Medical Affairs
of the Catholic Hospital Association, and officials
of the American Hospital Association.
Members of the panel were Thomas G. Dorrity,
M.D., Immediate Past President of AAPS; James
J. Raymond, a St. Louis attorney who has helped
physicians successfully resist take-over by hospital
administrations, and Donald Quinlan, M.D., AAPS
President Elect, who has lost hospital privileges
for refusing to give up his independence to a
hospital administration.
Legal Counsel Advised
Panelists also stressed that physicians on medical staffs should engage legal counsel to protect
their rights. Raymond pointed out that physicians
can sign away their right to legal redress if they
agree to conform to medical staff by-laws which
are written by the hospital administration and
which can be amended at will by the hospital
administration.
The House of Delegates also adopted resolutions:
Authorizing the Board of Directors to take

necessary action "to more effectively restrain third parties from interfering in the
exercise of independent judgment by licensed members of the medical profession
provjding medical care in harmony with the
ethics of the profession."
Expressing belief labor unions have been

an important force for nationalizing medicine and that physicians should be informed
of "possible adverse effects of membership
"in labor unions and warned of possible
dangers of attempting to utilize union tactics in resisting interference by third parties."
Condemning any attempt by insurance carriers "to interfere with normal contractual
relations between doctors and patients regarding payment of fees and resolving that
the Association publicize any proved instances of such practices, with name of any
insurance company involved."
Recommending Blue Cross, Blue Shield and

other insurers "explore the possibility of
developing insurance plans to cover the
costs of certain diagnostic and therapeutic
procedures performed on an outpatient."
Dr. Dorrity, who is also a lawyer, pointed out

that the Darling case does not say that a hospital
is liable for the negligence of a physician as long
as the physician is an independent contractor and
is not an employee of the hospital.
The panelists, and Dr. Quinlan in
particular, emphasized that "if lay control of the case-by-case practice of
medicine is permitted to occur, in other
words, if the false interpretation of
the Darling case is permitted to go un-
-Rejecting price controls as a remedy fOt' inflation because the real cause of inflation
is government deficit spending and the real
remedy is restoration of government. fiscal
responsibility, and urging repeal of the laws
and regulations on price control.
Urging Congress to repeal PSRO and to

limit its activities to such matters as will
strengthen and defend this nation and restore its fiscal responsibility and prestige
among the other nations of the earth."
Calling on Congress to veto Rule 504 of

proposed rules of evidence for federal
courts because it would abolish privilege of
communication between physician and patient.
Noting FDA approves drug combinations

only when it is demonstrated the combination is more efficacious than its single components and that combinations "are often
desirable as more convenient and economical," and requesting FDA to reconsider its
stringent regulations on drug combinations.
Warning AAPS members and the public of

the adverse physical and psychological effects of marihuana
Urging widespread dissemination of a summary of research findings on marihuana

prepared by the Scientific Information and
Education Council of Physicians.
WILL AMA MOVE TO WASHINGTON?

Several years ago, the Association of American Medical Colleges moved its headquarters to
Washington, D. C. Purpose of the move was to
get AAMC closer to the spigot from which all
those federal dollars flow. The 1963 AAMC President, John E. Deitrick, M.D., recomended it. In a
speech to the association in October, 1963, he
noted that the federal government was "the
sourci' of almost half of all the funds expended
by members of this association." He added: 'We
are dependent upon Washington and all indications are that this dependence will increase." It
did. The move to Washington was, in fact, a confession that medical colleges. as represented by
AAMC, were willing to sacrifice whatever degree
of independence was necessary to obtain more
federal money. As a consequence, the decision of
Nixon Administration to cut back federal support
for medical research and training brought cries
of anguish from medical educators and from
AAMC President John A. D. Cooper, M:D., who
wrote, President Nixon that "academic health
centers" are "critically dependent upon a stable
level of federal support'' for their educational
research and service programs. (Emphasis supplied)
So it is that the decision of the AMA
Board of Trustees to explore the possibility of moving AMA to Washington
is vrewed with profound misgivings by
many AMA members. The very fact the
Board is serious enough about such a
move to appoint a committee to make
a recommendation is viewed as an
acknowledgement by the trustees and
influential members of the executive
staff that pursuit of political goals is
the primary mission of the AMA, not
the furtherance of the art and science
of medicine and the betterment of the
public health, as the AMA motto now
proclaims.
Disappointed AMA members have also expressed the opinion that a move to Washington
would amount to a public confession that the
AMA, too, is after federal dollars as its price for
collaborating with government on such programs
as PSRO.
Terse Announcement
Announcement of the committee appointment

was singularly terse, as if the Board were saying
the possibility of transferring headquarters to
Washington was not very important. John M.
Chenault, M.D., member of the Board and chairman of the study committee, was quoted as saying that "the Board continues to hear comment
about the merits of Chicago and Washington as
the site for AMA headquarters," and so a committee was named to study "the future housing
needs of the AMA and to consider the appropriate location of the association's facilities."
Reports from AMA indicate this proposal to

move has been instigated, as noted in Medical
News Report, by "influential members of the AMA
executive staff whose sole interest is in the association's political activities, who have little
knowledge and less interest in the organization's
scientific programs." If AMA does go to Washington, it will be a move linked directly to the fact
that the association's policies and adminitrative
decisions are now being made by members of the
board and the executive staff who have risen to
power in the AMA through American Medical
Political Action Committee (AMPAC).
If increasing dependence on government as a consequence of collaboration
and acceptanoo of federal money has
indeed become the primary mission of
the AMA, moving headquarters to
Washington would appear to be appropriate.
PSRO OPPOSITION GROWING

At least four state medical associations (Louisiana, Texas, Oklahoma and Nebraska) and the
Board of Trustees of a fifth, Indiana, have gone
on record in opposition to the Professional Standards Review Organization law. Most of these
actions will be transmitted to the AMA House of
Delegates for consideration at the Annual Meeting in June. Question is whether the strong fundamental opposition to PSRO which prompted
these resolutions (two of them call for repeal) will
have any effect on the AMA's dedication to the
theory that the way to medical freedom is collaboration with the federal government in forcing
the invidious PSRO law on physicians.
The AMA is pursuing collaboration wth zealous
determination. Whether the Boa.rd of Trustees and
the executive staff can be persuaded to work as
.hard for repeal of PSRO is questionable. It will
not be easy. If those who are opposed to PSRQ
are sincere enough and if they push hard enough
for adoption of a repeal resolution by the House
of Delegates, the Board could conceivably be
turned around at least far enough to organize a
repeal campaign.
Most forthright statement on the evils of PSRO

came from the House of Delegates of the Oklahoma State Medical Association. Its resolution had
this to say:
1. "It is agreed that PSRO . . . represents oppressive federal government at its worst."
2. "PSRO may save money but not lives."
3. "PSRO will create a new kind of charity
case-those on Medicare and Medicaid."
4. ''This law abrogates every political promise

made to Medicare and Medicaid recipients."
5. "PSRO further jeopardizes confidentiality
of patients' records."
6. "PSRO leaves too many options to the Secretary of HEW and his famous regulators that
could ultimately destroy the private practice of
medicine."
7. "PSRO is a lead-in prerequsite tosocialized

medicine."
8. "PSRO is punitive to physicians."
The OSMA House of Delegates declared further
that PSRO "is incompatible with the goals and
ideals of OSMA and the AMA Code of Ethics, as
well as the pledge to his patients of every practicing physician."
Resolution Noteworthy
Since the AMA is opting for political solutions

to PSRO (which means compromise with medical
freedom), the Nebraska resolution is noteworthy.
It declares that PSRO "purports to improve the
quality and reduce the cost of medical care
through political and bureaucratic intervention."
In view of AMA efforts to enlist all medical
societies in a massive program to help implement
PSRO, the Nebraska resolution significantly notes
that "the medical profession is already pre-judged
to have failed if PSRO does not work; this prejudgment being made by Senator Bennett: 'Failure should result only from a lack of will on the
part of physicians to ~o the job.'"
mediocrity" and to lower medical quality by "encouraging rulebook medical

care." Furthermore, PSRO would require violation of AMA's Code of Medical Ethics in order for physicians to
comply, the resolution added.
The Nebraska House of Delegates reaffirmed

support of the principle of voluntary peer review
and urged repeal of PSRO, declaring that it is
"contrary to existing principles of medical practice, as enunciated by the Nebraska Medical
Association and the AMA.
Texas Medical Association House of Delegates
also adopted a resolution which will be transmitted to the AMA House of Delegates calling for
"every effort'' to be made to repeal PSRO.
The Louisiana State Medical Society passed a
resolution in April, 1973 submitted by the Lafourche Parish Medical Society making it clear
that the House of Delegates "Forbid any contractural agreement, both directly or indirectly,
through commitments by a separately sponsored
Foundation or other organizations by whatever
nome ..."
The Indiana State Medical Association is on
record against PSRO by action of its Board of
Trustees. Also, many county medical societies such
as Harris County {Texas), Guilford County {North
Carolina), Washington County {Maryland), and
Charleston County {South Carolina) are expressing clear-cut opposition to the PSRO tyranny.
Each mail brings additional evidence that medical societies are waking-up to their peril.
Tennessee Legislature Opposed
While several state and county medical societies were taking official action to register their
opposition to PSRO, a resolution memorializing
Congress to repeal PSRO was adopted without a
dissenting vote by both houses of the Legislature
of the State of Tennessee. At the outset, the resolution condemned PSRO as "a new and foreign
philosophy of medical care in America," the philosophy that "henceforth, the 'care, diagnosis and
treatment' for private citizens by private doctors
shall comply with government concepts of medical care as approved by PSRO and the Secretary of Health, Education and Welfare for beneficiaries of Social Security programs."
PSRO is certain, said the resolution,
"to stifle innovation and encourage
The Tennessee scions resolved "that the United

States Congress should denounce the Professional
Standards Review Organization as ill-conceived
legislation and that such legislation should be
repealed at the earliest possible date as it is incompatible with good medico! care . . ."
Hopefully, this resolution could start a trend.
'
SENATE VOTES TO DESTROY

U.S. MEDICAL SYSTEM
Senate passage of the Kennedy Bill to subsidize
prepaid per capita group practice carried with it
a clear warning to the medical profession-it is the
vehicle expected to achieve back-door nationalization of medicine in the United States, since
frontal assault so far has failed.
This is a fact Sen. Edward M. Kennedy and
other sponsors of the bill did not deny during floor
discussion of the n e a r-billion-dollar measure.
One of the sponsors, New York's ultra-liberal Republicon Sen. Jacob Javits, even implied that the
HMO legislation was a lead-in to nationalized
medicine.
Two senators specifically labeled the
bill a backdoor approach to nationalization of medicine. They irere Sen.
Peter H. Dominick (R-Col.) and Sen.
Thomas]. Mcintyre <D-N.H.). No sponsor of the bill denied the accuracy of
th'e label.
Sen. Dominick, who opposed the bill, pointed
out that it "backs into a national health insurance
program without having gone through the Finance Committee in any way whatsoever." Sen.
Mcintyre supported the bill but observed, nevertheless, that funds authorized represented "a
downpayment on a back-door national health
insurance program keyed to closed panel health
maintenance organizations."
Both senators added the comment that the manner in which funds would be allocated to HMOs
would make them perpetually dependent on government subsidies to survive.
And that is the obvious intent.
On the Line
Sen. Javits put it on the line. After declaring

that reorganization of the "health care delivery
system" is a necessary prelude to a national
health plan, he said:
"Without it, we have.nothing, no
matter how elaborate the plan we may
erect or however we may choose to
back it up financially, because it is the
services and the facilities that count.
This is the way in which we inaugurate, really, what will ultimately become some form of national h e a l t h
scheme - which I think is the best
word considering the uncertainty as
to the exact form it will take.
"For all those reasons, I urge the
Senate to approve the substitute (new
version of Kennedy bill) as the best
way to prove the concept which we desire to get approved with respect to
HMOs, and to reconcile the differing
views as to the nature of the HMO
which we desire to develop under the
aegis of this law."
As passed by the Senate, the bill would authorize expenditure of $805 million not only to
develope and operate a nationwide network of
government-controlled HMOs unfairly competing
with private practice, but to subsidize for all
Americans the cost of joining these organizations.
Sen. Dominick explained how everyone would
be subsidized: "Since HMOs ... must charge one
uniform premium rate, all enrollees benefit from
federal subsidies. Those who cannot afford the
premium have the difference made up by the federal governmE":1t. Those who could afford higher
premiums benefit because the government subsidies allow them to pay a lower premium than
the HMO would otherwise have to charge . . . I
think we should pro,ide in this bill assistance for
development of HMOs and save national health
insurance for legislation which treats it in a comprehensive way."
Bill's Fate Uncertain
Scuttlebutt in Washington is that Kennedy and

Company strategy is to negotiate a subsidy figure
in a conference committee between the House
and Senate; to get a bill at all costs as a
foundation on which to build a propram of nationalized medicine in the guise of HMOs. Nevertheless, fate of the proposal is uncertain. There is
a $700 million gap between the Senate bill and
what the Administration and House members
want. A bill too fat with federal subsidies may
be vetoed by President Nixon, although he has
said in the pa!-t he favors a program of HMO subsidies.
Sen. Kennedy made it clear he is prepared to
settle for a nibble if he can't have the whole thing.
His original bill called for a massive $5 billion
HMO development program. He chopped that to
$1.5 billion to get the bill out of committee. Then,
to avoid defeat on the Senate floor, he agreed to
ax another $800 millon off the bill, dropping the
total subsidy to $700 million. The Senate restored
$100 million and the bill passed at $805 million.
Sen. Kennedy said in effect that he
wants a system of regimented HMOs
to replace the present nonsubsidized
free system. He said his bill "would
move us a tong ;;ay down the road
toward achieving the development of
HMOs in this country as an alternative
to the present system."And he acknowledged that he views his scaled-down
bill as the opening w~dge, "strictly a
temporary measure," leading to fullscale nationalized medicine.
Vicious Aspect
The most vicious aspect of the Kennedy HMO

bill is the provision for creation of a "Commission
on Quality Health Care Assurance." That would
be the mechanism by which government would
exercise control over physicians-setting standards
of practice, determining "accessibility, availability,
and acceptability of health care provided by
health maintenance organizations and other providers of health care" (meaning private physicians, hospitals, nursing homes), setting criteria
for reviewing medical practice, punishing physicians who don't comply with government orders
and even setting standards for the qualification
, I
of personnel, the composition of medical groups

and the adequacy of facilities and equipment.
TO DO
Members of AAPS and all other
physicians would be well advised to
contact their congressmen immediately
to voice their objections to this latest
threat to medical freedom in America.
THIS IS URGENT!
IS AMA MISLEADING MEMBERS?
The following item in the May 21, 1973, issue

of Medical News Report, published by F.J.L. Blasingame, M.D., is worthy of note.
"IS AMA MISLEADING ITS MEMBERS on question of suing the federal gov't to try to invalidate
the controversial Professional Standards Review
Organization law? On strength of editorial in
May 7 issue of Americon Medical News, that
would appear to be the case.
"Apparently AMA has been receiving questions & criticism from members because Assn of
Physicians & Surgeons, not AMA, is preparing to
challenge constitutionality of PSRO law by suing
federal government.
''Thrust of AMA editorial is that federal courts
would not be likely to entertain such a suit unless
law had been applied & physician or someone
else had been damaged, either suffering financial
loss or deprivation of his rights.
"Said editorial: 'No matter what anyone tells
you, federal courts would not be likely to consider such a case until the law has been appliedwhich meant until (HEW) has developed regulations & put them into effect & begun administering
the PSRO (law). HEW has until Jan. 1, 1974, to
do that.
" 'Once the law has been implemented & has
resulted in alleged damages to one or more individuals, a suit might be possible. First, however,
the affected physician generally would have to
exhaust all administrative appeal procedures before court would accept case.
" ' ... In general, laws & regulations that appear to be illegal cannot be contested in the
courts on a hypothetical basis. Not until they are

enforced or applied can the process of contesting
such laws & regulations begin.'
''This is to say that in the American system of
justice a law cannot be challenged in court on
constitutional grounds until the rights of one or
more individuals have first been trampled on by
the enforcement of the law. This is indeed an interesting notion. It has the effect of denying the
existence of such legal procedures as injunction
& declaratory judgment.
"A law dictionary defines declaratory judgment
as: 'One which simply declares the rights of the
parties or expresses the opinion of the court on
a question of law, without ordering anything
to be done. Its distinctive characteristics are that
no executory process follows as of course, nor is
it necessary that an actual wrong, giving rise to
action for damages, should have been done or be
immediately threatened.' (Emphasis MNR)
"Question arises-if PSRO does go into effect
without legal challenge from AMA & one or more
of its members are damaged & their rights violated, will AMA continue to collaborate with gov't
to enforce the law or will it seek relief for its
members by challenging law in court?
"AMA editorial declared MDs are more likely
to find effective relief in political legislative &
regulalory arena than in court. And editorial
suggests members put faith in effectiveness of
AMA & AMPAC.
"Isn't PSRO a product of political & legislative
process?
WHY IS QAP SO IMPORTANT?
What is there about the American Hospital

Association's so-called Quality Assurance Program that makes it so important to the AHA that
one of its high-level executives will indulge in
veiled threats in an attempt to force members of
a hospital's medical staff to adopt QAP against
their desires?
Is it because QAP is the mechanism chosen by
AHA leadership to gain domination over the medical profession by capturing effective control over
PSROs throughout the nation? If this isn't its purpose, QAP doesn't make a great deal of sense. As
we understand it, QAP simply spreads a top
layer of committee control over already established peer review programs in the hospital. The
important thing to remember about QAP is that
it is intended to function as the PSRO mechanism
in participating hospitals, thereby transferring
PSRO authority from medical society to hospital.
(See AAPS February 1973 News Letter _"is AMA
girding for AMA showdown on PSRO?")
Otherwise, there would be little reason for the
feverish resolution with which AHA is pushing
QAP onto member hospitals. Otherwise, there
would be no reason for writing the kind of letter
that was written to the medical staff of a midwestern hopital by Thomas Ainsworth, M.D., associate director of the AHA. Here is the pertinent
portion of that interesting epistle.
cian's planned care of the patient within the institution for medical reimbursement. It is also our understanding that the Medicare requirements for
a hospital to be considered having exercised 'due care' in surveying the admission will require these same elements if this hospital wishes to be ~xempt from. retospective denial of payment.
"Since probably 50% of your hospital admissions are for ~ither Medicare or Medicaid admissions, perhaps
you should re-evaluate QAP in the
light of these two situations.
"If I can be of any further help to
you in explaining howvthe QAP, as a
positive educational program, can save
your medical staff from th!e negative,
punitive aspects of a PSRO-type of review, I will be most happy to do so."
Inducing physicians to accept QAP as a device

for saving them from PSRO strikes us as the same
as tossing an anchor to a drowning man.
"I notice on the letterhead ( of letter

notifying AHA of rejection of QAP'
that you are accredited by the JCAH.
You should be aware that th!e new
standards for accreditation do require
the documented evidenoo of the effectiveness of your utilization review and
medical audit committ~s within your
institution. While the Quality Assurance Program (QAP) is certainly not
the only way to do this, it has been
endorsed by th!e Joint Commission as
meeting all the accreditation requirements.
Food for Thought: Every time you tackle a major

project, and try to take a "short-cut," the project
gets cut, and you end up short.
For Freedom,
"You probably should also be aware

that th!e implementation of Sections
207, 237, 238, and 239 of Public Law
92-603 will require, after July 1, 1973,
admission certification, length of stay
review, and the statement of the physi-
President
P.S. See enclosed "Emergency Bulletin" calling for
action to curb bureaucratic authority to interfere
in medicine.
FLASH
HEW has drafted pre-PSRO hospital rules for intermediaries paving the
way for pre-admissio'l certification of all applications for admission of Medicare beneficiaries.

PRIVATE DOCTORS INSTITUTE, APRIL 18-20, 1974, OAK BROOK, ILLINOIS

312/325- 7911
Index No. 9
July, 1973, Volume 27, No. 7
AAPS vs. Weinberger
AAPS Welcomes Support
AMA Policies Contradictory
AAPS vs. WEINBERGER
AAPS, joined by three physicians, filed suit

in U.S. District Court in Chicago June 26 challenging the constitutionality of the Professi~
Standards Review Organization Law (P.L. 92603, Paragraph 8, Section 249F .) The a c t i o n
is intended to prevent the Secretory of HEW from
activating the PSRO law which empowers agents
of government to interfere with and overrule the
professional judgment of a physician in determining what is "medically necessary" for his
patient.
The suit a s k i n g for declaratory judgment
points out that physicians who treat Social Security beneficiaries (some 80 million aged, poor
and disabled) will be required to conform to
pre-set "norms of care, diagnosis and treatment," even though such "norms" conflict with
the Jnique needs of individual patients. As a
consequence of this and other provisions of the
PSRO law, those Social Security beneficiaries
who need medical care will be denied the high
quality care they have been promised by politicians.
The suit asks the court to declare
unconstitutional the P S R O part of
Public Law 92-603 and to enjoin the
Secretary of HEW, named as the defendant, fro m enforcing the PSRO
law against doctors and patients.
Destroy Confidentiality
The suit to overthrow the PSRO law states that
it will:
+ Destroy the confidential relationship between doctor and patient
by authorizing government agents to
examine office and hospital records
of all patients of all physicians whose
care "may be paid in whole or in part
by Social Security."
+ Allow govemment a g en ts to
compile dossiers f r om the medical
records of U.S. citizens and to use the
information in any manner the Secretary of HEW chooses in administering the law.
+Undermine the trust and rapport between physicians and their patients that are essential to high quality medical care.
The suit was filed by the Chicago law firm of
Lord, Bissell and Brook. Besides AAPS, the plaintiffs ore:
- George E. Shambaugh, Jr., M.D., Professor
of Otolaryngology at Northwestern University
Medical School in Chicago, a member of the attending staff of Northwestern Memorie1I Hospital,
and a member of the consulting staff of Henrotin
Hospital, Chicago;
- Roy R. Grinker, Sr., M.D., Chairman of the
Department of Psychiatry at Michael Reese Hospita I and Medical Center in Chicago, Professor
of Psychiatry at the University of Chicago, and
Director of the Institute for Psychosomatic and
Psychiatric Research and Training at Michael
Reese; and
- Edward A. Wolpert, M.D., Director of Clinical Services at the Institute for Psychosomatic
and Psychiatric Research and Training, Clinical
Associate Professor of Psychiatry at the University of Chicago's Pritzker School of Medicine,
and consultant to Sonia Shankman Orthogenic
School at the University of Chicago.
None of ,the three physician plaintiffs is a
member of AAPS.
Robert 5. Jaggard, M.D., AAPS President, said
"the Association is prepared to carry the case to
the United States Supreme Court if necessary."

"This a vicious, punitive law which will force
physicians to practice medicine by averages,"
Dr. Jaggard said. "The aged, poor and disabled
in America will suffer because they will be denied the best medical care their doctors can give
them. It will force physicians to practice in a
climate of fear-fear that they will be punished
if they don't adhere to standards dictated by
government; fear that if their medical judgment
is overruled by government functionaries, their
patients will be hurt. The PSRO law in certain
cases will even permit a government agent to
tell a patient he cannot go to a particular doctor or that he must go to a nursing home instead
of a hospital, even though his own doctor prescribed hospitalization. This is a bad law that injects politics into medicine where it has no place
We believe that political medicine is bad medicine regardless of all the propaganda to the
contrary."
The complaint in the suit charged
that -enforcement of the provisions of
the PSRO law will violate the First,
Fourth, Fifth, S event h and Ninth
Amendments to the U.S. Constitution.
"Plaintiffs' ability to render, and their patients'
ability to receive health care in accordance with
the highest standards of medical practice will be
seriously impaired if plaintiffs are required to
conform their medical judgments to a system of
pre,-set 'norms' of diagnosis, t r e a t m e n t and
care," said the complaint. "Proper medical practice demands that, in diagnosing and treating a
patient, a physician take into consideration a
host of often-changing factors that are unique
to each patient, and inherently incapable of reduction to 'norms.' Superimposition of a system
of norms of diagnosis and treatment upon the
judgments of medical practitioners will have a
chilling effect on the case-by-case practice of
medicine and a depressing effect on innovation
and progress in medical practice, to the ultimate
detriment of plaintiffs and their patients."
PSRO Can Deny Care
The complaint also pointed out that. "in certain categories of cases, plaintiff physicians ~ill
be required to obtain approval from a PSRO before they may hospitalize a patient, or enter upon a particular course of treatment, and the
PSRO is empowered to deny approval if it deems
the hospitalization or treatment medically un-
necessary ... or if it concludes that the particular physician seeking approval would not render
services in conformity with the norms of the law.
Under these provisions, plaintiffs' patients could
be denied treatment plaintiffs judge to be necessary, or they could be required to obtain such
treatment from a physician other than the one of
their choice."
The complaint further pointed out that "pro
files" of physicians' services will be required, and
PSROs to keep profiles will have authority to examine all patient re,cords and to inspect physicians' offices. It states:
"If plaintiffs are required to supply
information concerning their patients
to PSROs fot use in creating physician and patient profiles, and maintain and disclose information necessary to convince a PSRO that they are
complying with the law, plaintiffs -will
no longer be able to afford their patients the privacy and confidentiality
in their relationship that is necessary
to foster the full and candid communication essential to diagnosis and
treatment."
And the complaint added: "Plaintiffs will be

deterred and hindered in advising and treating
their patients as a direct consequence of the
coercive effect of the provisions of this legislation. Plaintiffs will be exposed to irreconcilable
conflicts between their professional obligations to
their patients and their legal obligations under
the law in instances where their best judgment
concerning the needs of their patients would not
be acceptable to a PSRO upon prior or subsequent review. Such conflicts will have the further
collateral effect of undermining the mutual trust
and rapport between physicians and their patients that is essential to optimum treatment."
Deny Physicians Rights
The suit said that enforcement of the PSRO
law will deprive physicians of their right to practice their profession in violation of the Fifth
Amendment, and likewise it will deprive patients
of their rights under the Fifth Amendment by
denying them the right to receive medical care
from physicians of their choice in accordance
with the highest standards of medical practice
and their physicians' best professional judgment.
The complaint also charged that the law transgresses the Constitution in these particulars:
+ It will
deprive physicians and patients of
the right of privacy in the physician-patient

relationship.
It will force physicians to comply with

"governmentally imposed 'norms' of diagnosis,
treatment and care," a provision which "constitutes on its face an arbitrary, irrational~
overbroad interference w i t h fundamental
rights of plaintiffs and their patients, unjustified by any legitimate and compelling legislative interest."
It "imposes burdens of justification concerning plaintiffs' conduct that are inconsistent

with, and negate, the presumption of competence, good moral character and regularity
of conduct and motive created by plaintiffs'
licensure."
"The duties and obligations imposed upon plaintiffs under penalty of sanctions by
Sec. 1160 of said law are stated in such vague
and uncertain terms that plaintiffs must necessarily guess at their meaning, contrary to due
process of law."
The law "empowers private organizations that are inherently biased against plaintiffs by their contractual relationship with defendant (Secretary of HEW) and their economic self-interest to exercise quasi-judicial
authority over plaintiffs."
Congress does not have constitutional

authority to grant legal immunity against common law tort liability the PSRO law attempts
to grant (Sec. 1167). Such immunity granted
to practitioners and other providers violates
the rights of federal health care recipients. If
grant of immunity is unconstitutional, the PSRO
law deprives physicians of the right, freedom
and ability to order their conduct in accordance with common law standards of due care
and imposes duties and obligations upon them
compliance with which may expose them to
civil liability to their patients.
AAPS WELCOMES SUPPORT

This Association, in addition to notifying
medical publications throughout the country of
the lawsuit filed June 26, has specifically invited
more than 30 other medical organizations to
join in the general effort to have the courts rule
the PSRO law unconstitutional. The organizations which have been invited include the American Medical Association, Council of Medical
S ta f f s, American Physicians Guild, American

Physicians' Union, and The American Academy
of Family Physicians.
The specialty groups from which cooperation
is sought are: The American Academies of Allergy, Dermatology, Opthalmology a n d Otolarngology, Orthopaedic Surgeons, Pediatricians, Physical Medicine and Rehabilitation; The
American Association, of C I i n i c a I Urologists,
Neurological Surgeons, Public Health Physicians,
Thoracic Surgery; The American Colleges of legal Medicine, Physicians, Psychiatrists, Obstetricians, and Gynecologists, Radiology, Surgeons;
The American Societies of Abdominal Surgeons,
Anesthesiologists, Internal Medicine, Plastic and
Reconstructive Surgeons; The American Proctologic Society; The American Psychiatric Association; The American Urological Association; and
The College of American Pathologists.
AAPS proposed no specific manner of cooperation in these invitations and remains open
to suggestions. Please do what you can to enlist
the support of any medical organization.
AMA POLICIES CONTRADICTORY

Physicians in the private practice of medicine
who attended the AMA Meeting in New York
and who sat in on the PSRO discussions would
be confused about what they heard at the meeting and what finally came out in the American
Medical News.
A resolution from Texas called for repeal of
the law. Another from Oklahoma called for opposition "on the b a. s is of its incompatibility
with goals and ideals of the AMA and contrary
to its Code of Ethics as well as the pledge of
every practicing physician to his patients." Another from California called for identifying and
publicizing the deleterious effects of the law and
"assign (ing) the 'highest priority' to developing
and pursuing appropriate amendments to P.l.
92-603."
The reference committee report admitted that
there was considerable support of these resolutions and strong criticism of the PSRO approacli
to reviews. It went on to call the attention of the
House of Delegates of the AMA to the fact that
the association's policy expresses concern "whether a government operated program of mandatory peer review geared in large part to cost
control could be effective without reducing the

quality of patient care."
Finally, the House passed a Resolved which
recognizes that repeal or modification of PSRO
may be required.
In the face of all of this, the American Medical
News for July 2 and 9, 1973, tn its lead article
says: "The official American Medical- Association
policy on Professional Standards Review Organizations (PSROs) now includes the word 'repeal.' But the reference is hedged, and the central AMA policy of cooperative leadership in
PSRO development remains intact."
Medical freedom might be_ safer if the American Medical Association was as concerned about
the freedom from danger of government as it is
from the American Hospital Association.
The majority of AMA policymakers,
having chosen the road of collaboration with government, e x p r e s s e d
alarm that the AHA's so-called Quality
Assurance Program (QAP) would "subjugate physicians to control of hospital
administration." The House adopted a
resolution directing AMA officers to
notify AHA of AMA's "grave reservations" about QAP "because of its potential for -lay control of medical practice.''
No one at the AMA convention bothered to
point out the startling contradiction between
AMA's collaborationist position on PSRO and its
criticism of QAP. Yet the parallel between what
PSRO really is and what AMA sees in QAP is
obvious.
QAP resolution adopted by House said that
under the AHA program:
"Independent judgment of the physician would
be completely controlled and supplanted by a
salaried, in-hospital physician coordinQtor, reporting and responsible to a utilization review
body appointable by the hospital administrator

under the guise of promoting continuing medical
education.
"Under this plan, hospital-employed personnel, including physicians, would decide whether
the private doctor's patient should be admitted,
based on a review of the doctor's office records,
and would further have the authority to decide
on methods of care, length of stay and type of
treatment and care after discharge."
If that does not sound familiar, you have not
read the PSRO law.
The adopted resolution also described QAP
as a "scheme to destroy doctor-patient mutual
responsibility and confidence," a scheme that
would "subvert the principles of voluntarism as
a basis for discipline, dedication and self-evaluation and non-interference by third parties" and
would ultimately, totally replace. the physician's
responsibility for the medical care of his hospital patients with lay control."
Both QAP and PSRO would constitute unjustifiable interference in the practice of medicine.
LOYAL AAPS MEMBER DIES
Dr. Walten H. McKenzie of Fort Worth, Texas,

a member of the original Tarrant County Texas
AAPS recruiting committee (approximately 1945,
on which he served with the late Doctors West
and T.C. Terrell) died of a heart attack on July
14,. 1973. His many friends in AAPS will mourn
the loss of this loyal dvocate of freedom.
r Freedom,
Enclosures: Medical Staff Bulletin

PSRO Legal Defense Fund Pledge
Card
"PSRO: Anathema"
Application for Membership

PRIVATE DOCTORS INST1TUTE, APRIL 18-20, 1974, CHICAGO, ILLINOIS

2111 Enco Drive. Suite N-51 5. Oak Brook . Illinois 60521
31 2/325 7911
Association of American Physicians and Surgeons
UL E IN
July
19, 1973
Lay Control and Interference in the Practice

of Medicine is a Real Danger at this Time
Watch out .for these DANGER SIGNALS in your area:
1.
A change in your Hospital Medical Staff Constitution

and By-Laws
2.
The submission to the staff of a new Constitution and

By-Laws written by the administration rather than by
the staff
3.
Inclusion in Medical Staff By-Laws of phrases such as

"I agree to abide by administrative policies"
4.
Specific delineation of privileges, getting into

minutiae and lengthy lists of specific procedures for
which the individual physician is supposed to submit
evidence of competency in performance
5.
Any other changes in Medical Staff By-Laws or other rules

of the hospital -- or even any change in the tone of the
relationship between physicians and lay administrators -that tend to inject persons who are not physicians into
areas of medical/clinical judgment.
Index No. 10
August, 1973, Volume 27, No. 8
9
AAPS Meeting Offers Rare Treat
Resolution Deadline September 20th
HEW Policy is Control of Medicine
e
e
Film Strip Project Approved

Florida Chapter Meeting Successful
AAPS Urges Challenge of HEW Authority
Committee Approves HMO Bill
Briefly In The News
AAPS MEETING OFFERS RARE TREAT

No one in recent years has put together a
definitive comparison of the invidious state control of medicine in socialized Europe with controls that exist or are anticipated in the United
States. Therefore, AAPS members who attend
the Association's 30th Annual Meeting at the
Mark Hopkins Hotel, San Francisco, October
11-13, will have the rare opportunity of hearing a comparison of patterns of political control in Europe and the United States. The comparison will be made by a panel of physicians
who know both European and American medical care systems because they have practiced in
both.
But that's not the only treat in
store for AAPS members and guests
attending the meeting - besides the
treat of just being in the fabulous
city of San Francisco.
Two outstanding and knowledgeable members of Congress, Rep. David Satterfield, Virginia Democrat, and Sen. Jesse Helms, North
Carolina Republican, will headline what promises to be one of the Association's best Annual
Meeting programs. Mr. Satterfield will evaluate
The Mood of Congress as it relates to health
legislation, particularly nationalization of medicine. Senator Helms, a former radio and television commentator, has accepted an invitation
to deliver the banquet speech Friday night,
October 12. His provocative subject will be:
Are Freedom and Dignitx Luxuries?
Members attending the meeting will get an

up-to-the-minute status report on the injunction
suit filed by AAPS in federal court challenging
constitutiona.lity of the iniquitous PSRO law.
The report on the suit will be made by one of
the AAPS attorneys via a long-distance telephone hookup from Chicago.
Theme of the meeting is: A Worldwide View
of Big Brother Medicine.
RESOLUTION DEADLINE SEPT. 20

All resolutions to be considered at the Annual Meeting October 11-13 must be received
at the Association's headquarters office on or
before September 20, 1973. That is the absolute deadline so that they may be processed in
time for the meeting.
-T h r e e amendments to the AAPS By-Laws
adopted by the House of Delegates at this
year's Private Doctors Institute will be submitted
to the Assembly at San Francisco for approval.
One is designed to facilitate nomination and
election of delegates by extending the time for
filing nominations, voting, tallying votes, and
certifying results. Another provides that regular or emeritus members in good standing may
become life members of the Association with
payment of $1,000 spread over 4 years. There
is now no provision for extended payment. The
third amendment sets up a By-Law provision for
nomination and election in a state to fill a
House of Delegates vacancy in the state, provided there is sufficient time.
HEW POLICY IS CONTROL OF MEDICINE

Whenever Charles C. Edwaras, M.D., Assistant HEW Secretary for Health, holds out a
carrot to the medical profession, doctors would
be well advised to watch for the club. Dr. Edwards is given to such soporific statements as
PSRO is "self-regulation" by physicians, or "we
don't propose to carry out government responsibilities (over health care) by imposing a set of
rules on doctors." But what he really believes
comes out as he talks .. Last month's White House
conferences for medical writers was one of
those occasions when he talked - he and his
boss, HEW Secretary Caspar Weinberger. With
some comments by Melvin Laird, President Nixon's aide for domestic affairs, Weinberger and
Dr. Edwards clarified the Administration's official position on medicine. Here's what it adds
up to:
Medicine is plagued with problems - maldistribution, shortages,

inefficiency, rising costs, inequality of care and inaccessibility of
care - and only government can
set things right.
Doctors a re inherently dishonest
and cannot be trusted to give their
patients the best possible medical
care at the most reasonable cost.
A significant number of Am.ericans are denied the medical care
that they need because ph&sicians'
fees are too },,igh and because they
won't practic~ in areas where these
deprived people live.
Health care providers, particularly physicians - not government are responsible for rising medical
care costs. Their excesses in Medicare and Medicaid must be curbed.
Medical quality is not improving,
therefore government must step in
to see that it does.
Medical News Report, weekly newsletter

published by F. J. L. Blasingame, M.D., noted
all this denotes an incredibly arrogant assumption-that politicians possess a higher standard of morals and ethics than p_hysicians.
Attack Private Medicine
The whole tone of the White House conference was an attack on private medicine, directly or by implication. Weinberger, for example, harped on the allegation that substantial numbers of Americans are denied medical
care and asserted that government has a duty
to redress this inequity. Dr. Edwards also toyed
with this allegation, using it as a basis for saying there is "increasing support'' for nationaliz-
ing medicine. This raises a pertinent question

which, by the way, was not asked by medical
writers: "If substantial numbers of Americans
are not receiving needed medical care because
they can't afford it, isn't this a confession that
two of the most ambitious government health
Rrograms - Medicare and Medicaid - are
multibillion dollar failures?"
Neither Weinberger nor Dr. Edwards is
averse to skirting the truth to bolster their assertion that government must exert greater control over medicine-how it is practiced, how it
is .delivered and by whom, and where doctors
will practice. Both, for example, repeated one
of Dr. Edwards' favorite propaganda gaffs,
that the public is so fed up with all the things
that are wrong with medicine they are demanding wholesale reforms. The eublic is demanding
no such thing. On the contrary, all the public
opinion polls indicate the public is tolerably
well satisfied with American medicine and hold
doctors in high esteem-practicing doctors, that
is, not political doctors.
And even worse, Dr. Edwards is
now saying t h at physicians thems e l v e s uAant government-imposed
standards of m e d i c a l practice as
well as government-dictated restraints
on utilization. The suggestion that
private doctors are asking for government control over the practice of
private medicine is so patently false
it needs no further comment here.
Interesting "Edwards-isms"
Here are some interesting - and occasionally
startling - "Edwards-isms" from the W h i t e
House conference for medical writers.
e Government should act to bring
"supply and demand into balance"
in the field of health, setting priorities and developing "strategy"
that will "direct" dollars and other
resources where they can do the
most good.
(Comment: Government effort to
balance supply and demand can
end only in disaster, whatever the
"strategy". It is not difficult to
perceive that ideas like these would
result in medical regimentation if
carried out.)
By comparing number of surgical
operations per 1,000 population in
England and the U.S. (fewer in
England), Dr. Edwards is clearly
critical of U.S. doctors and imp_lies medicine in England is better because U.S. doctors are not
controlled. He said: "I think with
a national health system, if we put
into e ff e c t proper utilization review, if the PSRO concept really
gets underway and really works, I
think much of the problem that I
alluded to by using these figures
can be corrected. I think we can

bring the utilization p r o g r am
under proper control."
"It is clearly up to the health professions to monitor their own activities" and that is "the w h o l e
thrust of the PSRO movements.'.:.
(Right out of Orwell - "government control i~ freedom.")
w h e n it comes to organization
and delivery of health services, I
think there is no doubt that we
have to pursue alternatives to the
traditional fe~for-service concept."
(No one asked him why and he
didn't say.)
Pursue HMOs
Dr. Edwards also had a few things to say

about so-called Health Maintenance Organizations (HMOs).
'We - the Administration - are committed
to major support of the HMO concept because
we think it gives ~hy:sicians an opportunity to
practice more 7fectively, make betteruse-if
their allied health professional supeort, extend
the reach of medical care to under-served areas
and to provide quali~ health care to more
peoP.le at reduced cost. It is not our intention to
impose a single system of health care on anyone, but we do intend to support a major effort to demonstrate the value of HMOs and to
allow HMOs to compete equally for the health
care dollar. They should grow according to the
way the public accepts them."
Com me n t: If everything Dr. Edwards said about the v i r t u e s of
HMOs is provably true, why is the
Administration limit in g its HMO
program to demonstration projects
aimed at finding out whether they
are all they are touted to be? Beyond
this, how does a federal subsidy
translate into competitive equality?
How does a federal subsidy to an
HMO equalize opportunity for the
solo practitioner and the fee-for-service group? It should be noted that
HMOs have been competing equally
for more than a generation and have
appealed to only about 7 m i l l i o n
Americans (some 3.5% of the total
U.S. population) and most of them
have been forced to join HMOs because of union contracts. Dr. Edwards did not see fit to note that
members of labor unions in California are becoming disenchanted with
the Kaiser plan and are dropping out
in favor of fee-for-service doctors nor
did he see fit to comment on the
HEW rep o r t on the comparative
costs per v i s i t recently printed in
Medical Economics.)
FILM STRIP PROJECT APPROVED

The AAPS Public Relations Committee, head-
ed by William M. Komanetsky, M.D., St. Louis,

Mo., is anxious to have a film strip prepared
on socialized medicine for use by physicians
or other interested citizens in their offices or in
making speeches to various audiences. After
discussing the proposal, the Board of Directors
approved the following resolutions:
" . . . the Board accepts the progress
report of the Public Relations Committee and encourages them to go
ahead w i t h further development of
their project with the help of a News
Letter statement which will inform the
membership of the progress and the
amount of money needed."
The Public Relations Committee has selected
a producer who has submitted a preliminary
o u t I i n e with probable costs. The committee
said, however, that another $9,000 is needed
to cover costs before a contract can be negotiated. Please make y:our checks to AAPS Film
Strip Fund. Donors of $50 or more will be supplied with progress reports on production and
distribution, plus a copy of the film strip when
completed.
FLORIDA CHAPTER MEETING SUCCESSFUL

The Florida Chapter of AAPS counted its
first Annual Meeting an unqualified success.
An enthusiastic membership pledged the chapter to activities aimed at preserving medical
freedom, and officers indicated a major goal
for the chapter's second year will be recruitment of new members. AAPS Executive Director,
Frank Woolley, addressed the meeting, reminding the Florida doctors there is nothing more
worthwhile "than standing up and fighting in
telligently for. your own freedom."
"I know," said Woolley, "we are right, we
are honest, our cause is just, we are not trying
to police anybody and we are not trying to use
government to aggrandize ourselves."
Woolley traced the so rd i d history of the
struggle to socialize medicine in the U.S. from
the Murray-Wagner-Dingell Bill during the Truman Administration t h r o u g h Medicare-Medicaid to the PSRO law enacted last year. He
noted that the socializers, ha vi n g failed to
achieve full..scale sociatized medicine in the
l 940's, adopted the policy of gradualism. The
PSRO law, he said, is one more stee for the
socializers in the process of attaining their goal
~y_ gradualism.
-
MAIL SENT TO OLD ADDRESS

Some mail is still being sent to the old Chicago address of AAPS. The U.S. Post Office
has been forwarding this mail to the Oak Brook
office, but the Chicago Postmaster has notified

AAPS that forwarding orders are good for one
year only. After that, mail will be returned to
sender. Please check your records to be sure
they are changed to show the Association's
new Oak Brook address. (See address at the
bottom of this News Letter.)
AAPS URGES CHALLENGE OF

HEW AUTHORITY
Following testimony by HEW officials on July
30 at Oversight Hearings of the House Subcommittee on Public Health, AAPS submitted a
strong statement urging further challenge of
authority for HEW plans and programs-especially the apparent presumption that HEW is
authorized to expend funds in a "preparatory
process" for National Health Insurance.
The AAPS statement cited testimony on H.R.
7274 vigorously opposing expansion of HEW
health.,systems research designed to promote

National Health Insurance schemes - and the
AAPS lawsuit challenging the constitutionality
of PSRO provisions of Public law 92-603. These
concluding comments in the statement may be
meaningful to many members of Congress:
"AAPS intends to step up and sustain actions
to preserve the practice of private medicine. As
indicated in previous testimony to this Committee, our actions are based on conviction that
the proper role of private doctors and patients
is not one of being spectators at games in which
our system of medical cc;ire becomes a political
football.
'We are determined that the practice of private medicine shall not be destroyed by default
of private doctors and patients - nor by lack
of aggressive actions by our Association on be~
half of private doctors and their patients."
COMMITTEE APPROVES HMO BILL

The H o u s e Commerce Committee has approved for House consideration a bill to subsidize development of HMOs. The bill is a compromise and is obviously intended to get the
principle of government subsidy of HMOs established. The bill would authorize expenditure
of $240 million on the project. A Senate-passed
bill, sponsored by Senator Kennedy, w o u I d

authorize $805 million. Senator Kennedy and
his colleagues reportedly are hoping that a
conference committee will recommend a $500
million program.
The compromise version of H. R. 7974 would
establish a 5-year program of grants, loans
and loan guarantees for planning and development of HMOs. Money would not be provided for operations, however, except HMOs in
w h a t the legislation calls medically underserved areas, and the bill does not provide
construction funds. It also does not contain a
provision of the original bill to override state
laws which prohibit or restrict development of
HMOs.
BRIEFLY IN THE NEWS

Financial support for AAPS' lawsuit to overturn PSRO continues to come in. R e c e n t I y,
groups of physicians at hospitals have made
contributions and sent them in in lump sums
. . . AAPS headquarters has also received a
number of inquiries on how to proceed to join
PSRO lawsuit as amicus curiae . . . Those stalwart friends of the people in HEW are now
cooking up a deal in connection with national
health scheme whereby all employees will be
required to pay income taxes on value of health
insurance purchased for them by their employers. HEW planners claim this tax ploy will yield
$6.8 billion a year to help finance their national health program.
LEAVE IT TO GOVERNMENT
One way to make it perfectly clear that
crime does not pay would be to let federal
government run it.
(!J
Jaggard, M.D.
Enclosures: Annual Meeting Brochure
April, 1973 Resolutions

PRIVATE DOCTORS INSTITUTE, APRIL 18-20, 1974, CHICAGO, ILLINOIS
RESOLUTIONS DEADLINE - SEPTEMBER 20, 1973

Frank K. Woolley Executive Director
312/325-7911
Index No. 11
September, 1973, Volume 27, No. 9
Another Attack on Freedom
Here's How PSRO Will Work
Florida MDs Oppose PSRO
Dr. Bauer Resigns PSRO Post
Dr. Doenges Death Mourned
Reprinting "Medicine And The State"
Filmstrip
Congressman Opposes Medicredit
Lawsuit Gains Support
ANOTHER ATTACK ON FREEDOM

On Sept. 12 the U. S. House of Representatives
drove another attack on medical freedom. On
that date, by a lopsided vote of 369 to 40, members of the House passed a bill authorizing the
use of federal tax funds to subsidize by direct
grant and by loans the development of closed
panel prepaid group practice, sometimes erroneously called, Health Maintenance Organizations
(HMOs).
The bill, a compromise offered by Rep. James
F. Hastings (R., N.Y.) and accepted by the House
Interstate and F o re i g n Commerce Committee,
authorized expenditure of $240 million over a
five-yem period to finance planning and development, and in some cases operation, of l 00 or more
HMOs across the nation.
It has been pointed out for many
!J ears by AAPS that HM Os are just
another poorly disguised mechanism

intended to capture control of physicians and patients. By eliminating feef or-service, thereby forcing physicians
to become salaried employees, physicians become subservient to lay employers.
HMO legislation (Hastings Bill) passed by the

House was sent to a conference committee to resolve differences between the House bill and a
vastly more ambitious HMO program previously

passed by the Senate. The Senate bill, authored
by one of medical freedom's notorious antagonists,
Sen. Edward M. Kennedy (D., Mass.), proposes to
spend $805 million in three years (originally $5
billion) to subsidize planning, development and
operation of a massive network of governmentcontrolled HMOs. Sen. Kennedy is so anxious to
get a foot in the door that he obviously is willing
to compromise to any extent. He seems to be a
devotee of inevitability of gradualism.
There's lots of political trading stock
in each bill - money, for one thing and power over people. It is a tragic
commentary on the moral climate of
the times that the members of the Congress did not hear from home in sufficient volume early enough to prevent
passage of at least one of these bills.
Patients, not doctors, will be the big
losers when the controls inherent in
these bills become fact.
Sen. Kennedy's willingness to compromise suggests that a conference bill offering $400 to $500
million may result.
There is some indication, however, that even
this kind of a bill might collide with a Presidential
veto. In a recent message to Congress, President
Nixon obliquely criticized the Senate bill on the
grounds that it proposed too much too soon. He
indicated he might support a bill close to the

House version if sent to him by Congress.
Political Control
Even the House bill, as pointed out by repre~
sentatives of AAPS, contains provisions which will
result in political control of medicine. Efforts have
been made to conceal these provisions. They are
buried in the bill and in the Commerce Committee
report on the measure (H.R. 7974). Controls are
there-in Sec. 1206 (b) (1) (D). This provision requires every successful applicant for an HMO
subsidy to have:
" ... organizational arrangements, in
accordance with regulations of the Secretary ( of HEW), for an ongoing quality
assurance program which provides review by physicians and other health professionals of: 1. The process followed
in the delivery of health services; and
2. The quality of the results of such
services."
This really is a guarantee that the political controls, already written into law in the PSRO ~rogram, will extend to government subsidized HMOs.
The provision reflects calculated collaboration
between some members of Congress and the HEW
bureaucracy to destroy freedom in the practice
of private medicine through controls exercised by
an inherently politically oriented federal agencyHEW.
You can be absolutely certain that these PSROHMO controls over medical care will be incorporated, either directly or by reference, in any program that may be enacted by Congress for nationalization of medicine.
HERE'S HOW PSRO WILL WORK
treat the woman outside the hospital. The hospital

administrator, the Rev. William F. Siemers, also
protested and declared she would not be discharged.
How did this come about?
In Illinois, there is a program known
as Hospital Administrative Surveillance
Program (the acronym is HASP). It is a
program in which the Illinois Foundation For Medical Care (Illinois State
Medical Society) contracted with the
state to review Medicaid hospital cases,
ostensibly to shorten stays and save public money. HASP is controversial.
Under HASP, a nurse coordinator at
each hospital keeps tab on hospitalized
Medicaid patients, matching length of
stay with computerized national norms
-just like PSRO. In the case of the cancer patient, the nurse coordinator discovered that the patient's stay had exceeded the norm. She so informed the
HASP medical adviser and the decision was made to terminate financial
aid - a bureaucratic decision wholly
unrelated to the obvious medical needs
of the patient.
Dr. Louis was crisply advised he could appeal

the decision to a HASP committee if he didn't like
it. He declined to appeal, pointing out there was
no one on the committee with the specialized
knowledge of chemotherapy necessary to judge
the case. There appeares to be a pattern in this
program that hospitalization is denied if improvement in the patient's condition cannot be expected.
This is the kind of bureaucratic activity that
will certainly_ ~rvade PSRO. It seems to be the
attitude of government agents that if your case
doesn't match the norms established by government you and the hospital can pay the bill, or as
far as they are concerned, your patient can be
thrown into the street.
As this story unfolds, keep in mind that under

PSRO, hospitalization will be controlled by federal bureaucrats, even though it is made to appear
on the surface that physicians are in control.
FLORIDA MDs OPPOSE PSRO
In Chicago recently, a 57-year-old female Medicaid patient lay terminally ill of disseminated
breast cancer in a bed at Christ Community Hospital.
By almost a 2 to 1 vote, members of the Orange

County Medical Society, Orlando, Fla., have expressed opposition to participation in Professional
Standards Review Organizations. And because of
the vote, non-participation is the official policy of
the medical society.
Suddenly, a bureaucratic decision was made by

a nurse to shut off public aid, a decision that
meant discharging her from the hospital, unless, of
course, the hospital picked up the tab for her continued care. Her physician, John Louis, M.D., strenuously objected, pointing out there wa'S no way to
A resolution was adopted at a society meeting

calling for referendum of members on the question: "Do you favor participation in Professional
Standards Review Organizations?" Of 347 ballots
mailed, 299 marked ballots were returned.
Total of 194 voted no and 105 voted

yes. The resolution provided that "a majority of the ballots cast shall establish
the official position of the Orange County Medical Society." It further provided
that "the Orange County Medical Society shall not actively participate in the
establishment of a Professional Standards Review Organization if the majority vote of the referendum is unfavorable to participation."
Results of the referendum were announced at
the regular meeting of the society Sept. 19. Notice
was also sent to the Florida Medical Association,
the American Medical Association, and Caspar
Weinberger, Secretary of Health, Education and
Welfare.
Congratulations to the officers and members of
the Orange County Medical Society are certainly
in order, including the AAPS National Membership
Chairman Dr. Francis Coy.
DR. BAUER RESIGNS PSRO POST

The vicious and constant struggle for power that
characterizes government life in Washington, D. C.,
and the endless bureaucratic frustration that is
also a hallmark of the nation's capital, apparently
were too much for William I. Bauer; M.D., the
Greeley, Colo., internist said to have been handpicked by HEW Secretary Caspar Weinberger to
ramrod development of the government's PSRO
program.
Dr. Bauer unexpectedly resigned as director of
the PSRO office, with a slap at his boss, Charles
C. Edwards, M.D., Assistant HEW Secretary for
Health. He accused Dr. Edwards of failing to
translate into action the Administration's "Commitment to the PSRO program."
There's no doubt that Dr. Bauer's was

a classic case of bureaucratic frustration. He complained that money to run
the office came from at least three different sources in HEW and that operational decisions were made in one office but policy pronouncements came
from another. He implied that all of it
should have come from Dr. Edwards'
office, where he was assigned.
It is also pretty obvious that Dr. Bauer's 17
years as a practicing physician did not equip him
to cope with the kinds of political games that are
played in Washington. Anyone familiar with
Washington knows that those games are deadly
serious, and the ultimate ~rize is ~wer. It's an
open secret in the capital that the Social Security
Administration's veteran politicians want the PSRO
prize because its power potential is enormous control over expenditure of untold millions of dollars, control over the way private doctors practice
medicine, control over patient care in thousands
of hospitals and other health care institutions, control over the quality and quantity of care received
by an estimated 80 million Medicare and Medicaid
patients and ultimately control over the medical
destiny of every American.
That is POWER!
With the Social Security Administration's hierarchy of liberals who are veterans of internecine
political warfare in Washington and who know
the meaning and uses of power, Secretary Weinberger will have to appoint a hardnosed, toughminded Washington veteran to succeed Dr. Bauer
if he intends to keep PSRO in a separate office.
There was some speculation in Washington that Dr. Bauer may have been
emotionally shredded also by the sizzling conflict between AMA officials,
Sen. Wallace Bennett (R., Utah), congressional sponsor of PSRO, and Senate
Finance Committee staff members over
the issue of statewide PSROs. AMA has
been applying all kinds of pressure on
HEW trying to force the agency to
make a decision permitting medical
associations to organize statewide "umbrella" PSROs. Sen. Bennett and Mr.
Jay Constantine of the Finance Committee staff have been angrily demanding that HEW resist AMA pressure tactics. Dr. Baiter is a member of the AMA
who quickly found out how powerful
Sen. Bennett and Mr. Constantine really are when it comes to putting the
screws on officials of HEW.
DR. DOENGES DEATH MOURNED

Members of AAPS were saddened to learn of
the death in late July of Dr. James l. Doenges, one
of the early leaders of the association. Dr. Doenges
will long be remembered for his work in advancing the AAPS Freedom Programs. He was a President of the Association and served on the Board
of Directors for 10 years. A native of Oklahoma
and a graduate of Washington University School
of Medicine, St. Louis, Dr. Doenges died in his
sleep at his home in Anderson, Ind. He was 58.
REPRINTING "MEDICINE.AND THE STATE"

One of the most definitive documents on subversion of medicine by government-Medicine and
the State by Lynch and Raphael-will be reprinted
by AAPS. Copies will be available at the Annual
Convention next month in San Francisco. They will
also be available from AAPS headquarters in

Oak Brook, Ill. Single copy price will be $4.95 for
the reprints. Quantity discounts will be offered,
ranging to $99 for 50 copies.
FILMSTRIP
The AAPS Public Relations Committee is actively
engaged in the development of a filmstrip that
will expose the dangers of g o v e r n m e n t medicine, including i n c re a s e d costs for reduced
quality of care. This strip will be suitable for
showing to patients in the waiting room, civic
groups, conventions, and so forth. A 25 minute
showing is planned, with 5 segments of 5 minutes
each, designed so that each 5-minute segment
could be used as a separate program in and of
itself. The total cost for this project will be approximately $10,000, and the Committee solicits
your support. Those who donate $50.00 or more
will be given progress reports on the development
of the project, plus a copy of the filmstrip when
completed. Send your contribution today to AAPS
Freedom Film Fund at the home office in Oak
Brook, Illinois.
It was good to hear from a doctor who

has the courage to break away from the
AMA and stand on principle against
any state welfare scheme. I hope to
hear from you again.
"Yours for a free society,
"Steve Symms"
LAWSUIT GAINS SUPPORT
The AAPS suit challenging constitutionality of
the PSRO Law continues to generate interest and financial help - from physidans, even nonmembers of AAPS, and others. A group of physicians in Texas, who are not members of the Association, but are nevertheless in sympathy with purposes of the lawsuit, sent AAPS $1,600 to assist in
financing the suit.
Even hospitals are becoming interested in aiding AAPS as their officers become aware of the
threat posed by the PSRO Law to normal hospital
operations.
Lutheran General Hospital, Park Ridge, Illinois,
is such a hospital. Lutheran General contributed
$1,000 to help in pursuing the legal action.
CONGRESSMAN OPPOSES MEDICREDIT

Congressman Steven D. Symms (R., Idaho) has
been identified by AMA as a sponsor of its Medicredit Bill. When I wrote him that some physicians
do not agree with the AMA on this because what
they call "voluntary" is "involuntary." In reply
Congressman Symms wrote me as follows:
"Dear Dr. Jaggard,
"Thanks very much for your recent
leUer and for the information on the
American Medical Associqtion. The clipping that you enclosed was quite interesting ( I sent him the clipping out of
the AMA News .] My name was added
by mistake as a co-sponsor of the Medicredit bill and it has become a matter
of public record that I am not a cosponsor, even though my name still appears at the top of the printed bill. I
agree completely with your view that
the voluntary medicine program could
well be voluntary with a question mark.
FOOD FOR THOUGHT

Every time you tackle a major project, and try
to take a "short cut," the project gets cut and
you end up short.

President
Enclosure: Order form for "Eulogy of the Doctor"

PRIVATE DOCTORS INSTITUTE, APRIL 18-20, 1974, CHICAGO, ILLINOIS

2111 Enco Drive, Suite N-515. Oak Brook , Illinois 60521
Frank K. Woolley, Executive Director
312/325- 7911
Index No. 12
October, 1973, Volume 27, No. 10
AAPS Opposes Military HMOs

TMA Ends Prudential Pact
Another Association Asks PSRO Repeal
PSRO Repeal Bill Introduced
AMA's PSRO Meeting Challenged
Cohen Represents Whom ? ?
AAPS Not Involved with NAPST
Woodcock Figures it Out
long Introduces Catastrophe Bill
Third Parties Don't Bother Me
AAPS OPPOSES MILITARY HMOs
ony other medical organization appeared to testify. Apparently some subcommittee members did
An AAPS spokesman appeared before a subcommittee of the House Armed Services Committee Sept. 20 to oppose legislation (H.R. 7480
and companion bills} which would authorize the
Defense Department to pay HMOs to provide
health care to dependents of military personnel.
The legislation is largely the product of efforts of
Group Health Association of America to make
some 7 million people eligible for treatment under
prepay group practice plans.
Mernbers of the subcommittee, supported by
labor unions, greeted the AAPS testimony with
hostility, particularly since the AAPS was the only
organizational opposition. Neither the AMA nor
not like the AAPS statement that what appeared

to be an innocent provision of an option (joining
HMO would be voluntary under the bills} was in
reality pa.rt of the gradual encroachment of government into the private sector of medicine.
AAPS testimony also noted that the

bill would prohibit the Secretary of Defense from entering into a contract
which would result in a total cost to
the government and beneficiary of an
amount greater than the estimated
average annual cost produced by the
present C H A M PU S cost-sharing arrangements. "Such a cost ceiling would,
of course, require rationing of medical
care services," he said. "We respectfully question whether the committee
has fully explored all of the implications and ramifications of such rationing, and we urge you to do so before
acting on these bills."
HEW Assurance Misleading

Frank K. Woolley, Executive Director, who was
the spokesman for AAPS, told the subcommittee
that "any glib assurances that HEW will take care
of the problems of quality control are misleading." "HEW," he said, "is now ,.embroiled in a
so-called quality assurance program that threatens the practice of private medicine and is of very
doubtful constitutionality. The subcommittee will
be interested to know, I'm sure, that the Association of American Physicians and Surgeons has
filed suit in federal court challenging the constitutionality of the so-called PSRO provisions of
Public Law 92-603, and enjoining the Secretary of
HEW from enforcing them ago.inst doctors and
patients.
"Some of the quality-control prov1s1ons of the
HMO-subsidy bill that passed the House on Sept.
12 have far-reaching implications to the practice
of private medicine. Efforts of Rep. Satterfield of
Virginia and Rep. Rarick of Louisiana to get clar-
He also pointed out that on the West

Coast, where prepay plans have been
vigorously promoted, they are running
into serious difficulty. E v i d e n c e
gathered by labor organizations indicate people go out in white uniforms,
pretending to be doctors or nurses, to
sign up families for newly organized
prepay plans. Prospects have been told
they have to sign up or lose their MediCal b en e fit s. One plan has been
charged in a 21-count indictment with
fraudulent activities.
TMA ENDS PRUDENTIAL PACT

The executive Board of the Texas Medical Association, acting on authority of the House of
Delegates, has ordered termination of TMA's business relationship with Prudential Insurance Co.
Prudential has been the carrier for TMA's membership insurance program. Reason for the termination is that Prudential actively supported legislation in the Texas Legislature to permit formation of lay-controlled HMOs with authority to hire'.
salaried physicians. TMA said legislation would
have "voided long-skmding statutory and common
law prohibition against corporate practice of
medicine." TMA said that relations with Prudential
had been cordial except for the company's political activities.
ification of some of these provisions were not very

successful. Knowing that this subcommittee weuld
not condone any covert collaboration designed
to destroy the private practice of medicine, we
ANOTHER ASSOCIATION
ASKS PSRO REPEAL
Another medical organization - the Kentucky
urge it to study carefully the implications of the
Medical Association -
has decided to work for
quality-control provisions of the House-passed
repeal of the Professional Standards Review Or-
bill."
ganization provisions of P.L. 92-603. KMA House

of Delegates adopted a resolution resolving "that
The bill authorizing HMOs for military depend-
this House of Delegates request and petition the
ents would interject a third party into the treat-
Kentucky congressional delegation, every member
ment of these patients. ''You cannot improve the
of both houses of the United States Congress, and
quality and quantity of medical care by interpos-
both houses of the Kentucky Legislature to work
ing a third party controlled by laymen between
for the repeal of PSRO, and that copies of this
physicians and their patients," the AAPS spokes-
resolution be forwarded to the aforementioned
man said.
individuals and legislative bodies." The resolution
also instructed Kentucky delegates to the AMA
not, we suggest that they give their constituent
House of Delegates to introduce a similar resolu-
physicians a full explanation as to why they do
tion in that body.
not.
In voting for PSRO repeal, the KMA

House rejected a recommendation of
the KMA Board of Trustees that the
association go on record in favor of the
official position of the AMA, which is
collaboration with HEW in putting
PSRO into effect.
AMAs PSRO MEETING CHALLENGED

Composition of an AMA-appointed panel to
conduct what AMA bills as a "full-scale discussion
of Professional Standards Review Organizations
(PSROs)" has prompted strong protest from the
In addition to establishing official policy to
lntraprofessional Council of Louisiana and others
work for repeal, the KMA House resolved that its
because all eight members of the panel are pro-
members as individual physicians, working through
PSRO. The discussion is booked for Dec. l, the
the association's Public Relations and Legislative
opening day of the AMA's Clinical Convention in
Activities Committees, should develop a program
Anaheim, California.
to inform the public and Kentucky legislators

about the "potential deleterious effects of this law
"This panel is made up of men more dedicated
on the quality and confidentiality and cost of
to attempting to see that PSROs work than work-
medical care."
ing for repeal of this nefarious legislation," said

S. R. Abramson, M.D., Chairman of the lntrapro-
Last June, the Texas Medical Association's dele-
fessional Council, in a letter to AMA officials. Dr.
gates asked the AMA House to change its policy
Abramson urged AMA to add to the panel physi-
and direct the association to work for repeal of
cians knowled~eable about PSRO who are also
PSRO. The request was rejected. The American
against the law and favorable to its repeal.
Medical News in the July 29, 1973, issue reported

the House decision this way: "As for future legislative activity, the AMA indicated that efforts to repeal or modify the PSRO law might be necessary,
but only if and when it becomes clear that PSROs
are undermining the quality of patient care."
(Underscoring ours}.
PSRO REPEAL BILL INTRODUCED

Congressman John R. Rarick (D-La.} has intro-
Makeup of the panel was also criticized by AAPS Executive Director Frank
Woolley during a discussion of PSROs,
HMOs and other forms of government
intrusion into medicine at a recent
meeting of the South-Central section
of the American Urological Association
in Houston, Texas. Woolley asked how
a discussion can be full-scale if all the
participants are on the same side of
the issue. AMA President Russel.l Roth,
M.D . who was on the panel with Woolley, did not respond to the criticism.
duced H.R. 9375, calling for repeal of the PSRO

provisions of P.L 92-603. It is urged that every
Woolley also pointed out that conservatives
member do what they can to get their local and
have long been dismayed that enemies of medi-
state medical societies to endorse this legislation.
cine frequently have been invited to speak at
The AMA has been requested to support it. Your
AMA meetings where their propagandizing against
state AMA delegates should be urged to ask the
medical freedo"' has invariably received practical-
AMA to endorse the Rarick bill and in case they do
ly all the publicity at the meetings. Now, he said,
an entire program has been turned over to sup-
AMA's PSRO Committee.
porters of a law that is designed to destroy the

rights and freedoms of physicians and their patients.
AAPS NOT INVOLVED WITH NAPST

Physicians throughout the United States have
The oll-pro-PSRO team, billed by the AMA as
been receiving communications from an organiza-
"leading authorities in the field," include: Charles
tion called the National Association of Physicians
C. Edwards, M.D., HEW's Assistant Secreter/ fer
and Surgeons Trust. Since there is a similarity in
Health; Willem I. Bauer, M.D., Director of HEW's
names with the Association of American Physicians
Office of Professional Standards Review, who re-
and Surgeons, some may wonder whether there is
signed in frustration at federal bureaucracy as of
a connection. There is not. AAPS is in no way re-
Oct. 1; Robert B. Hunter, M.D., AMA Board mem-
lated to this NAPST, headquartered in Montclair,
ber and chairman of AMA's PSRO Committee;
N. J.
John D. Porterfield, M.D., Director of the Joint

Commission on Accreditation of Hospitals; Carmault B. Jackson, M.D., Chairman of AMA's PSRO
WOODCOCK FIGURES IT OUT
Task Force on Data Collection, Processing and
If Congress nationalizes medicine, it could cost
Storage; Claude E. Welch, M.D., Vice Chairman
the American people a bundle of tax dough - as
of AMA lnterspecialty Committee and Chairman
much as $100 billion the first year if it is the
of AMA PSRO Task Force on Guidelines; Howard
labor-backed Kennedy-Griffiths bill. Although lab-
Hassard, legal counsel for California Medical As-
or leaders like United Auto Workers' Leonard
sociation; Ernest W. Soward, M.D., Chairman of
Woodcock have been vigorously pushing the Ken-
Social Medicine at University of Rochester School
nedy-Griffiths bill, rank-and-file union members
of Medicine and Chairman of Group Health As-
have been cool to the scheme because of the
sociation of America.
enormous increase in taxes it would cost them and

everyone else.
COHEN REPRESENTS WHOM ? ?
But Woodcock has figured out a way to con-
An awful lot of people aren't going to believe
vert UAW members into supporters of this brand
the billing given Wilbur J. Cohen, one of the na-
of socialized m e d i c i n e. He has "persuaded"
tion's most durable advocates of government in-
Chrysler to include in the contract with UAW a
tervention in the people's private affairs, by the
provision guaranteeing that Chrysler will pay the
Michigan State Medical Society. News release
tax for UAW members if Congress enacts any
said Cohen, now Dean of the University of Michi-
national health program requiring added taxes.
gan School of Education, was invited for program
Undoubtedly, UAW will also "persuade" other
on health care delivery to "speak for the people."
auto makers to include a simlilar provision in new

contracts. Other unions have already expressed
Whoever put the program together also chose
interest in the UAW ploy.
Robert B. Hunter, M.D. to speak "for the medical

profession." Dr. Hunter spends most of his time
What this means is that union members would
these days promoting PSRO as Chairman of
pay a fraction of their share of a tax increase to
finance nationalized medicine - the amount add-
Second phase of the program would, in effect,
ed to the cost of goods or services made or of-
federalize Medicaid, a program for the indigent
fered by unionized companies. Their share would
which is administered by the states and whose
be spread among all of us.
benefits vary from state to state. The Long bill

would set up a uniform nationwide standardized
But the majority of Americans who

are not members of unions would pay
twice-the full tax plus the amount
added to those goods and services.
package of benefits, covering the 22 million now

on Medicaid and another 12 million low-income
workers who are not now eligible for Medicaid.
That may win the enthusiastic support of union
Benefits of this program would be extended to
members, but it's not likely to tickle the fancy of
single persons with less than $2,400 a year in-
the rest of the American people who may well
come, two-member families with less than $3,600,
feel they are once again victimized by a scheme
three-member families with less than $4,200 and
of labor bosses.
four-member families with less than $4,800, with

a $400 eligibility standard for each additional
LONG INTRODUCES CATASTROPHE BILL

Sen. Russell B. Long (D-La.), Chairman of the
Senate Finance Committee, made good on a longstanding promise and introduced a bill to establish
a nationalized program to cover the cost of cat-
member. Benefits would include physicians' services, hospitalization, nursing home care, laboratory tests, medical exams for children under 18,
prenatal and neonatal care, and birth control
services.
astrophic illness for every American. He was joined in the introduction of the bill - which would
also federalize Medicaid - by Sen. Abraham Ribicoff (D-Conn.), Sen. Hugh Scott of Pennsylvania
the Senate Minority Leader, and Rep. Robert Dole
Third phase would create a program of private

health insurance at group rates to cover first 60
days of hospitalization and first $2,000 of medical
costs for everyone not eligible for the nationalized
Medicaid program.
of Kansas, former GOP National Chairman.

Basic provision of the bi-II is a proposal to protect every American against financially devastating impact of catastrophic illness or injury. This
protection would be available to anyone covered
by Social Security - about 95% of the population. Under this provision, a federal fund would
pay all hospital costs over 60 days and all medi-
Long calculated that the total cost of

first and second phases of his program
would be $8.9 billion. "This is about
the best that can be done for the country now," said Long. He said the $8.9
billion was more than the Nixon Administration wants, but it is far less
than the estimated $80 billion cost of
Kennedy-Griffiths bill to completely
nationalize medicine in U.S.
cal expenses above first $2,000. The fund would

be built up by a Social Security tax increase of
Long said he will seek to get the bill passed by
3/lOs of l % levied on both employee and em-
Senate "in early spring" by piggy-backing it to a
ployer. This ignores the fact that catastrophic cov-
House-passed revenue bill. By this scheme he
erage is available from a large number of insur-
hopes to get the bill over a constitutional hurdle.
ance compCtnies at present - and at a nominal
Revenue bills can originate only in the House and

the Long bill is a revenue measure because it in-
price!
creases taxes. However, the Senate can amend
government programs are based primarily on the
revenue bills that have originated in the House.
use of force. Poor persons are asked to pay me as
How Rep. Wilbur Mills (D-Ark.), Chairman of
much each week as they spend in that time for
the House Ways and Means Committee, will feel

about this procedure was not immediately known.
beer and cigarettes, and they are even told that if

they stop drinking and smoking they owe me noth-
What is known is that Mills is very touchy about
ing.
prerogatives of the House and his committee.

In 1965, I voted for the AAPS Program of Non-
THIRD PARTIES DON'T BOTHER ME

Third parties don't bother me because I deal
directly with the patient, only with the patient, in
willing exchange for mutual advantage and profit.
As a general practitioner, I do not limit my practice for any reason, and I see all patients who
seek my services. I see patients in the office, in
the home, at the hospital - any day or night of
the week. I have to render service to my patients
or I won't be paid, and I can't fool my patients
like some guys can fool a clerk in Des Moines or
Washington. If the patient has insura.nce forms he
wants completed, I will do them as a service, but
just above my signature on the form I place the
following rubber stamp:
participation in Medicare and Medicaid. I have

carried out this program. I have never signed any
certifications or recertifications for these programs, have never completed any utilization review certificates or other papers designed to help
these programs, and I have continued to give
good care to my patents with no loss of benefits
or lack of good medical care for any of my patients as a result of my participation in this AAPS
program.
In 1965, I recommended to my local hospital
and to my colleagues that they stay out of the
governmental health programs. That recommendation still stands and applies equally well to the
latest government fiasco, PSRO.
'This form is completed only as a

service to my patients, and no real or
implied contracts exists between me
and the inurance company."
As long as I can continue to practice medicine,

I will do so -
For Freedom,
If there is any conflict between the pa.tient and
the insurance company, that's their problem, not
mine. I do not complete government papers, as I
Jaggard, M.D.
have no desire and no intention of initiating the

use of force against any honest person, and all
President
PRIVATE DOCTORS INSTITUTE, APRIL 18-20, DRAKE HOTEL, CHICAGO, ILLINOIS

312/325-7911
Index No. 14
December, 1973, Volume 27, No. 12
Error
Senator Bennett ID
AAPS President, Donald Quinlan, M.D., in a move to keep the record straight on the PSRO law,
sent members of the AMA House of Delegates a copy of the AAPS pamphlet on PSRO, the most exhaustive evaluation published by anyone of the provisions of the low and their actual meaning and the clear
intent of the PSRO authors. Dr. Quinlan's action wo s prompted by a speech delivered by Sen. Wallace
TRANSLATE POSITIVE AAPS

PROGRAMS INTO MEMBERSHIP
More and m o r e physicians and physician
organizations are recognizing that AAPS is the
only nationwide medical organization devoting
its energies to a constant attempt to preserve the
practice of private medicine. AAPS, for example,
was the first to talk about repealing the PSRO
law, and it is the only medical organization to
tile suit to have the PSRO law declared unconstitutional.
AAPS has lighted the spark that has ignited
an ever-increasing opposition to PSRO among
doctors and medical societies and was instrumental in reversing AMA's policy against PSRO
J'..epeal.
T h e s e are constructive achievements that can be translated into
membership so important to AAPS if
tt is to expand its programs to benefit
doctor and patient alike.
F. D. Winter, M.D., Burlington, Iowa, member
of AAPS, has picked up more than 20 new members for AAPS by sending to Iowa physicians at
his own expense a brochure describing the programs and accomplishments of the Association,
with an invitation to join.
If Dr. Winter can do it, you can. If every AAPS
merriber duplicated Dr. Winter~s feat, the cause
of medical freedom in America would be advanced immeasurably.
Bennett (R-Utoh) to the Essex County (N.J.)

Medical Society. His speech was on angry denunciation of PSRO critics, including A A PS ,
which has filed suit in federal court to overturn
the law on constitutional grounds.
In the speech, Senator Bennett made some
erroneous statements about this law which he is
supposed to have authored. Although he was the
chief sponsor our information denies his authorship of the bill.
The Senator is quoted as saying

in his New Jersey speech that the "entire thrust" of PSRO "was to provide
an opportunity for physicians themselves, on a voluntary basis and in an
appropnate organization, to undertake
the review of the quality of care and
INSIDE
Federal Officials Rate Low
PSRO Repeal Plea to Senator .Ervin
Private Medicine Saves Lives
services provided under Medicare and

Medicaid programs" ... "and do this
without being second-guessed by lay
bureaucrats.. . . . "Each PSRO would
develop and apply its own regional
parameters of care.. . . . and "the
members of each PSR,O would have
the sole power to determine the acceptability of the parameters applicable in the area ... (Emphasis added.)
Senator Bennett also disputed statements that the confidentiality of patient records would be destroyed by
the enforcement of provisions of the
PSRO law.
WHAT ARE THE FACTS? The facts are that

the PSRO law is compulsory on the individual
doctor who takes care of Medicare and Medicaid patients and that control will be exercised
from Washington by lay bureaucrats in HEW.
It is also a fact that enforcement of PSRO will
destroy confidentiality.
PSROs initially serve a period of probation,

during which their performance will be judged
by the Secretary of HEW by whatever standards
t,e cares to establish. These "conditionally designated" PSROs must perform to the satisfaction
of the Secretary or they will be dropped. He
can terminate a PSRO agreement if he determines (after a hearing) "that such organization
is not substantially complying with or effectively
carrying out the provisions of such agreement."
The conclusion is unavoidable by
the lucid language of the law that no
PSRO will be able to escape dictation
by lay bureaucrats.
Furthermore, the language of the law makes

it abundantly clear that the National Council
will serve merely as the agent of the Secretary
of HEW in helping to administer the law to such
extent as the Secretary alone decides, including
development and enforcement of norms of diagnosis and treatment.
Council Prepares Norms
Senator Bennett need only study Section 1156

of the PSRO law to discover that norms of
diagnosis, care and treatment which physicians
will be required to follow shall be prepared
and distributed, tha.t "approval" of norms by
the Council shall be based on its analysis of
"appropriate and adequa.te data," and that if
there "is reasonable basis" for different norms,
only those will be permitted "as are approved
by the National Professional Standards Review
Council." (Emphasis added.)
That language is clear. There is
no way it can reasonably be interpreted as conferring "s o l e power" on
PSROs to set their "own regional parameters of care ...
It should also be pointed out that Section 1152

of the PSRO law forcefully contradicts the contention that PSROs will be autonomous. That
section contains a mandatory requirement that
If Senator Bennett has any illusions that PSRO

will destroy confidentiality, he should study the
direct language and the implications of Section
1155 of the PSRO law. Section 1155(a)(4) obligates PSROs to establish and maintain "profiles
of care and services received and provided with
respect to patients" ... and requires that "profiles shall also be regularly reviewed on an
ongoing basis with respect to each health care
practitioner and provider to determine whether
the care and services ordered or rendered are
consistent with the criteria" specified in the law.
(Emphasis added.)
Government Snoop Game
Section 1155 also empowers PSROs to review

a professfonal decision before or after, or both
before and after, it is made, to "examine pertinent records of any practitioner or provider
of health care services" and to "inspect facilities
in which care is rendered or services provided
. . . of any practitioner or provider." (Emphasis

added.)
A third leg of this government snoop game
was written into Section 1155(f)(l)(B). It directs
each PSRO to "collect such data relevant to its
functions and keep and maintain such records in such form. as the Secretary may require
to carry out the purposes of this part (of the
Social Security Act) and to permit access to
and use of a.ny such records as the Secretary
may require for such purposes." (Emphasis added.)
of this horrendous law. But if he will

honestly and objectively examine the
law, he will find that it clearly em.;
powers federal bureaucrats to
subvert his stated intentions.
On the other hand, violation of confidentiality

may not be a matter of particular concern of
Senator Bennett. It was reported recently that the
Senator was one of three Republicans and three
Democrats who teamed to sidetrack a bill tha.t
would have helped curb credit company snooping into private lives of U.S. citizens. ("Snooping in U.S.; It's a Way of Life"-published in
PRIVATE MEDICINE SAVES LIVES

One of the bitterest complaints of physicians
who practice under the restraints of socialized
medicine is that they are forced to see so many
patients that there is insufficient time to properly
diagnose illnesses. As a consequence, it is argued,
lives are lost from illnesses undiagnosed or mis
diagnosed.
That was brought home to Israeli officials in
dramatic fashion recently when doctors there
went on "strike" against the country's program
of nationalized medicine, according to an item
in the Columbus Dispatch. It said Israel's death
rate dropped 20 per cent because of the higher
quality of care provided.
Doctors did not refuse to take patients; they

just refused to cooperate with the government
program and took patients willing to pay a
fee for service. As a result, the physicians each
saw substantially fewer patients by eliminating
many time-consuming free-loaders among the
80 to 100 a day under socialized medicine. For a
welcome change, doctors had adequate time for
diagnosis and for more reliable judgment about
their patients.
Israel health officials are said to be giving
serious consideration to adopting a schedule of
charges by the state to patients to lighten the
case-load burden on the country's physicians.
The infamous action of highly placed government bureaucrats in burglarizing the office of
Daniel Ellsberg's psychiatrist is eloquent testi-
Chicago Daily News and other newspapers Dec.

5, 1973.)
mony to the fact that confidentiality cannot be
AAPS MEMBER ELECTED
entrusted to those who wield political power.

Perhaps Senator Bennett intended
that local PSROs should be autonomous, as he says, and exercise independent control of norms of diagnosis and treatment, and perhaps he did
not intend that confidentiality be subject to political abuse as a consequence of enforcement of the provisions
William M. Sherrill, M.D., Houston, Texas,

family doctor, has been elected President of the
Harris County (Texas) Medical Society. Dr. Sherrill, 60, a long-time member of AAPS, is a graduate of Tulane University School of Medicine. He
has been a member of AAPS since 1959 and
has served as the Association's Membership Chairman for Texas.
FEDERAL OFFICIALS RATE LOW
HEW Secretary for Health, or Sen. Edward Kennedy (D-Mass.) argue that medicine has to be
Members of a Senate subcommittee paid pollster Louis Harris $25,000 to find out that the
American people have far more confidence in
doctors than they do in members of Congress.
They also found out that health care is far down
the list of things that trouble Americans-so far
down the list, in fact, that it is almost out of
sight.
restructured because the people demand it, you

might want to suggest that he read the Harris poll
commissioned by the Subcommittee on Intergovernmental Relations of the Senate Committee on
Government Operations. Dr. Edwards is now
mailing to all physicians, at government expense, a disarmingly misleading explaination of
PSRO.
This information is not new. Public opinion
Health Care No Problem
polls over the past dozen or more years have

yielded similar results.
That poll shows that in September, 1973, only

3 per cent of the American people considered
But since this poll was commission-
health care among the two or three biggest
ed by members of Congress, perhaps
problems facing the country. In contrast, 72 per
it may occur to them there is a glar-
cent listed inflation, a product of government
ing anomoly here-members of Congress, who consistently flunk public

popularity tests, just as consistently
profligacy, as the top problem and, thanks to

Watergate, 43 per cent said integrity in govern-
propose legislation to control and reg-
ment was a major problem. In 1972, only 5 per
ulate the professional lives of doctors,
cent considered integrity in government a big
who consistently rank highest in pub-
problem. That was the same percentage that
lic esteem.
listed health care first in 1972.
lt may also strike home to members

of the subcommittee, and every other
member of Congress who sees the
poll, that the argument that the people
The poll also sought the degree of confidence

the people have in other institutions of government, and it must be disheartening to the com-
are demanding health care reform is
mitteemen and other members of Congress that
an obvious fraud.
the people have more confidence in trash collectors than they do in senators and representatives.
The Harris organization conducted the poll in

September. It showed that only 30 per cent of
And, it would seem, the fegal profession could

use a crash public relations program. Only 24
the American people have confidence in U.S.
per cent of the people said they have a great
Senators and only 29 per cent have confidence
deal of confidence in people running Jaw firms.
in members of the U.S. House of Representatives.

On the other hand, 57 per cent said they have
confidence in doctors.
The White House is at the bottom of the list

in generating public confidence, just one percentage point behind the executive branch of the
This poll afso should be heeded by those

politicians in and out of Congress who keep up
federal government, listed as a separate entity

trom the White House.
the harangue that there is great public clamor

tor congressional action to reform the nation's
It is also interesting to note that the most vocal
health care system. The next time you hear a poli-
propagandist for socialized medicine-organized
tician like Charles C. Edwards, M.D., Assistant
labor-has the confidence of only 20 per cent
of the people, only a percentage point ahead of

the executive branch of the federal government.
individual Americans into help in repealing the

the PSRO law.
ECONOMICS REPORT AVAILABLE
Dr. Quinlan, in a letter to Senator Ervin, pointed out that during the Watergate hearings, he
"expressed concern that Congress had been giv-
A number of requests have been received for

copies of the report of the AAPS Committee on
Medical Economics. The report was read by
Frank A. Rogers, M.D., AAPS President-Elect, at
the Annual Meeting in San Francisco. It is now
available from Association headquarters on request.
ASSAULT ON MEDICAL FREEDOM
House and Senate conferees reportedly have

agreed on a $375 million HMO subsidy bill to
finance development of a medical program which
will give labor union leaders among other, almost complete dictatorial power over the practice of medicine.
Physicians, because of the PSRO law, already
face the prospect of not being able to use their
own judgment in determining what is medically
necessary for their Medicare and Medicaid patients. The HMO bill, if it becomes law, will have
the effect of extending the obnoxious PSRO
controls to all priva.te patients who participate
in HMOs and will authorize still more lay interference in the exercise of professional judgment.
It is another step toward complete nationalization of medicine.
You and your pa.tients had better remonstrate
with your congressman and senators to try to
block this legislation before it is too late.
PSRO REPEAL PLEA TO SEN. ERVIN
AAPS President Donald Quinlan, M.D. has

asked Sen. Sam J. Ervin (D-N.C.) to translate
his concern for preservation of the privacy of
ing the executive branch of the federal government regulatory power which encouraged corruption such as was being exposed by the hearings."
Sen. Ervin was referring to the statement of an
airline president that he had contributed corporate funds for the 1972 political campaign out of
fear of injury by a federal regulatory agency.
And in the November 9, 1973, Congressional
Record, Senator Ervin said:
t . havt: for many years been concerned about the dangers government
computers and record keeping systems
pose to individual privacy. Many of
my colleagues here in the Senate share
this concern and have joined in calling for increased protection of individual pri,vacy from the actual and potential abuses of record keeping systems."
Pointing out the danger to confidentiality, of

private patient records in doctors' offices and
in hospitals, contained in the PSRO law, Dr. Quinlan solicited Senator Ervin's support for legislation introduced in the House (the Rarick BillH.R. 9375) and requested that the senator introduce identical legislation in the Senate.
In his reply, Senator Ervin did not agree
to introduce a PSRO repeal bill in the Senate.
He implied he did not know what was in the
PSRO legislation, either when it was passed by
Congress or now. He said that since PSRO was
okay with Sen Russell Long (D-La.), Chairman of
the Senate Finance Committee, it was okay with
him. This helps to confirm what AAPS has charged repeatedly - that few members of either
House were aware of the contents of H.R. 1 when
the Baptist for holding up the light of truth of
they voted for what became PL 92-603.
God against the darkness of expedient compromise. As John opposed the mighty Herod,
WATCH FOR CHAMPUS HMOs

Several weeks ago, representatives of AAPS
even though the odds were great, let us eschew

the easy path of compromise with its built-in
testified before a congressional committee in
assurance of defeat. Instead, let us courageously
opposition to legislation to permit the military
continue to uphold the truth without compromise
to subsidize HMOs by using tax funds to finance
and practice in harmony with the noble principles
prepayment HMO expenses for dependents of
of the GREAT HEALER.
military personnel. The legislation has not been

enacted.
If AAPS members have knowledge of a campaign among officials of any branch of the
military to promote HMOs by turning over to
them the Group Health Association of America
(Labor Union sponsored) lists of military personnel
and their dependents or by incurring expenses in
other ways to help HMOs, please notify AAPS
For Individual Liberty and Responsibility
Donald Quinlan, M.D.
~~~
President
headquarters.
CHRISTMAS MESSAGE
Christ, whose birth we celebrate, extraordinarily admired the courage and fortitude of John
Enclosure: Letter from Public Relations Committee
PRIVATE DOCTORS INSTITUTE, Chicago, Illinois, April 18-20, 197.4

ANNUAL MEETING, New Orleans, Louisiana, October 31-November 2, 197.4

312/325- 7911

AAPS News 1973

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1973 INDEX

AAPS NEWS LETTERS and BULLETINS

AAPS Cotostrophe Major Medical Insurance

AAPS Chapter Organization Manual Order

AAPS Florida Chapter

AAPS Private Doctors Institute

AMA Code of Ethics

American Medical Political Action

Amer.icon Physicians Guild

American Physicians Union

American Urological Association South

Association of American Medical Colleges

Association of American Medical Society

Anthony, E. E., M.D.

AAPS Opens Washingtan Office

American Medical News

AMA Board of Trustees

AAPS Annual Meeting

Bauer, Alfred W., M.D.

Bauer, William I., M.D.

Bennett, Wallace, Senator

AAPS Washington Bulletin

AAPS Woman's Auxiliary

Ainsworth, Thomas, M.D.

Blasingame, F.J.L., M.D.

American Academy of Family Physicians,

Blue Cross Blue Shield

Breslow, Lester, M.D.

Buerger, Walter, M.D.

Caine, Curtis W., M.D.

-cCalifornia Chapter of AAPS

California Council for Health Plan

California Medical Association

Cohen, Harold M., M.D.

Federal Register Reprint FDA

Columbus (Ohio) Dispatch

Cooper, John A. D., M.D.

Council of Medical Staffs

Coy, Francis, M.D.

Crane, Phil, Repr.

Cullum, Mrs. Albert G. J.

Florida Medical Association

Gitlitz, Benjamin 0., M.D.

Group Health Association of America

Hampton, H. Phillip, M.D.

HASP (Ill. State Med. Soc.)

Health Insurance Plan of Greater

Health Maintenance Organization (HMO)

Helms, Jesse, Senator

Holy Family Hospital

House Commerce Committee

Debauching The Currency

Deitrick, John E., M.D.

Dingell, John, Jr., Repr.

Dingell, John, Sr., Repr.

Dept. of Health, Education, and Welfare

Doenges, James L., M.D.

House Subcommittee on Public Health

Dole, Robert, Repr.

Hunter, Robert B., M.D.

Dorrity, Thomas G., M.D.

Edgecombe-Nash Medical Society (N.C.)

Group Health and Welfare News

England, Mrs. Robert G.