50.000 CONTINUING MEDICAL EDUCATION:
(See also Education, 85.000)
50.986 Partnership on Continuing Medical Education
When the Medical Society of the State of New York provides continuing medical education programs jointly with county medical societies, MSSNY will offer county medical societies a discounted rate of 50% for joint provider fees and the per-credit fees, with the understanding that the jointly providing county medical society will be responsible for the labor associated with meeting the Accreditation Council for Continuing Medical Education (ACCME) accreditation requirements and policies. The annual fee for MSSNY-accredited CME providers that are academies shall be the same as the charge that ACCME charges MSSNY per provider accredited. (HOD 2018-169; Council January 24, 2019)
50.987 Increase Free Online CME for Members
The Medical Society of the State of New York, in cooperation with the county medical and specialty societies, will promote MSSNY’s online CME program, and working with the county medical and specialty societies, will identify and develop courses for MSSNY’s CME website for the added value of society membership. (HDO 2018-168)
50.988 Prevention of Unintended Consequences of the Physician Payments Sunshine Act (PPSA)
The Medical Society of the State of New York reaffirms its support for the current ACCME Standards for CME and Commercial Support.
The Medical Society of the State of New York supports the position of the AMA and Alliance for CME: that regulations implementing the Physician Payment Sunshine Act assure that manufacturers not be required to report payments made for a program where the topic, the speakers, and educational materials are independently chosen and have no relationship with a manufacturer which might be supporting the CME activity. (HOD 2012-64)
50.989 Continuing Medical Education for Maintenance of Certification (CME for MOC):
MSSNY is to support:
- the current Continuing Medical Education (CME) accrediting system which provides high quality CME activities, thus ensuring continuous professional development as well as educational and practice improvement tools and resources;
- the position of the Alliance, which opposes the American Board of Medical Specialties (ABMS) plan as stated because it would undermine the existing interdisciplinary approach to education and would also redirect important resources away from existing educational programs;
- the position of the Accreditation Council for Continuing Medical Education (ACCME), which opposes the creation of new systems that would impose unnecessary burdens upon ACCME-accredited providers, Recognized Accreditors, intrastate providers and physician learners. (HOD 2011-168)
50.990 CME Accreditation:
Programs offered by the Medical Society of the State of New York are to be considered, when appropriate, for American Medical Association (AMA) Category 1 credit for all physician participants when applicable under AMA Guidelines. (HOD 2011-167)
50.991 CME Credits for Attending MSSNY House of Delegates:
SUNSET HOD 2019
50.992 Continuing Medical Education Application Forms:
MSSNY approved revised Continuing Medical Education application forms to be consistent with new standards and accreditation criteria mandated by the Accreditation Council for Continuing Medical Education (ACCME). (Forms are available from MSSNY’s Office of Continuing Medical Education.) (Council 12/13/07; Reaffirmed HOD 2017, Update and revised forms approved by Council 4/15/21)
50.993 Continuing Medical Education Mission Statement:
The Office of Continuing Education of the Society of the Medical Society of New York (MSSNY) is committed to support a statewide system of effective continuing medical education which provides all physicians with broad learning opportunities to increase their skills. The goal of this system is to upgrade medical care by maintaining, augmenting, and updating physicians’ medical knowledge, skills and attitudes in order to facilitate delivery of optimal medical care to their patients. The CME program will address the professional practice gaps of physician learners as identified in their scope of practice and professional requirements. This is done by providing educational programming and accreditation of providers of Continuing Medical Education (CME) throughout the state.
The Continuing Medical Education Program of MSSNY strives to provide educational activities relevant to the practice of all recognized medical disciplines and include forums for public health, socio-economic, ethical and legal issues, quality improvement, liability risk reduction, enhancement of the practice environment; impaired physician awareness and treatment; and legislative and regulatory issues related to the provision of quality healthcare. To implement this most effectively, MSSNY, in addition to the education it provides directly, shall also serve as an accredited joint provider with non-accredited providers of continuing medical education to promote public health goals and an awareness of the public health resources available to physicians and their patients throughout New York State.
Target audiences include physicians residing or practicing in New York State. Although MSSNY’s CME program primarily will serve New York physicians, some activities may be extended to a national audience when justified by need.
Type of Activities:
MSSNY”s CME offerings will promote high quality educational programs delivered in a cost effective and accessible manner. These events take the form of didactic presentations, seminars, symposia, workshops, and grand rounds; enduring print, audio, and video material; interactive, live internet and web casting activities. The educational design, instructional method and learning format for each event is chosen to best serve the educational needs and learning objectives of the planned educational activity.
Expected Outcomes of the Program:
Improvements to MSSNY’s CME Program shall be made by evaluation of CME activities and self-assessment of the overall program. Following an educational activity, MSSNY expects learners to report enhanced or reinforced knowledge upon evaluation. MSSNY expects that learners will report an increased confidence in approaching clinical challenges or commit to changing behavior by applying newly acquired strategies in their practice. MSSNY expects that learners will be able to demonstrate competence and an effective use of specific and specialized skills. MSSNY expects performance parameters within the setting of clinical practice to show improvement or a favorable impact on targeted patient outcomes. (Council 1/25/07; Reaffirmed HOD 2017; Amended and adopted Council 6/22/17)
50.994 MSSNY’s Task Force on Quality Medical Care:
The Medical Society of the State of New York supports regulatory or legislative efforts to require physicians to complete a certain number of continuing medical education credits periodically as evidence of competence and diligence in medical practice. (Council 11/17/05; Reaffirmed HOD 2015)
50.995 Standards for Integrity and Independence in Accredited Continuing Education
The health professions are not only defined by expertise, but also by a dedication to put service of others above self-interest. When individuals enter the healthcare professions, they commit to upholding professional and ethical standards including acting in a patient’s best interests, protecting the patient from harm, respecting the patient, fostering informed choices, and promoting equity in healthcare.
While the interests of healthcare and business sometimes diverge, both are legitimate, and collaboration between healthcare professionals and industry can advance patient care. Since healthcare professionals serve as the legally mandated gatekeepers of medications and devices, and trusted authorities when advising patients, they must protect their learning environment from industry influence to ensure they remain true to their ethical commitments.
As the stewards of the learning environment for healthcare professionals, the accredited continuing education community plays a critical role in navigating the complex interface between industry and the health professions. Organizations accredited to provide continuing education, known as accredited providers, are responsible for ensuring that healthcare professionals have access to learning and skill development activities that are trustworthy and are based on best practices and high-quality evidence. These activities must serve the needs of patients and not the interests of industry.
This independence is the cornerstone of accredited continuing education. Accredited continuing education must provide healthcare professionals, as individuals and teams, with a protected space to learn, teach, and engage in scientific discourse free from influence from organizations that may have an incentive to insert commercial bias into education.
The Accreditation Council for Continuing Medical Education (ACCME®) acts as the steward of the Standards for Integrity and Independence in Accredited Continuing Education, which have been drafted to be applicable to accredited continuing education across the health professions. The Standards are designed to:
- Ensure that accredited continuing education serves the needs of patients and the public.
- Present learners with only accurate, balanced, scientifically justified recommendations.
- Assure healthcare professionals and teams that they can trust accredited continuing education to help them deliver safe, effective, cost-effective, compassionate care that is based on best practice and evidence.
- Create a clear, unbridgeable separation between accredited continuing education and marketing and sales.
Terms used for the first time are written in blue italics, followed by the definition for the term.
|The ACCME is committed to ensuring that accredited continuing education (1) presents learners with only accurate, balanced, scientifically justified recommendations, and (2) protects learners from promotion, marketing, and commercial bias. To that end, the ACCME has established the following guidance on the types of organizations that may be eligible to be accredited in the ACCME System. The ACCME, in its sole discretion, determines which organizations are awarded ACCME accreditation.
Types of Organizations That May Be Accredited in the ACCME System
Organizations eligible to be accredited in the ACCME System (eligible organizations) are those whose mission and function are: (1) providing clinical services directly to patients; or (2) the education of healthcare professionals; or (3) serving as fiduciary to patients, the public, or population health; and other organizations that are not otherwise ineligible. Examples of such organizations include:
|• Ambulatory procedure centers
• Blood banks
• Diagnostic labs that do not sell proprietary products
• Electronic health records companies
• Government or military agencies
• Group medical practices
• Health law firms
• Health profession membership organizations
|• Hospitals or healthcare delivery systems
• Infusion centers
• Insurance or managed care companies
• Nursing homes
• Pharmacies that do not manufacture proprietary compounds
• Publishing or education companies
• Rehabilitation centers
• Schools of medicine or health science universities
• Software or game developers
|Types of Organizations That Cannot Be Accredited in the ACCME System
Companies that are ineligible to be accredited in the ACCME System (ineligible companies) are those whose primary business is producing, marketing, selling, re-selling, or distributing healthcare products used by or on patients. Examples of such organizations include:
|• Advertising, marketing, or communication firms whose clients are ineligible companies
• Bio-medical startups that have begun a governmental regulatory approval process
• Compounding pharmacies that manufacture proprietary compounds
• Device manufacturers or distributors
|• Diagnostic labs that sell proprietary products
• Growers, distributors, manufacturers or sellers of medical foods and dietary supplements
• Manufacturers of health-related wearable products
• Pharmaceutical companies or distributors
• Pharmacy benefit managers
• Reagent manufacturers or sellers
Owners and Employees of Ineligible Companies
The owners and employees of ineligible companies are considered to have unresolvable financial relationships and must be excluded from participating as planners or faculty and must not be allowed to influence or control any aspect of the planning, delivery, or evaluation of accredited continuing education, except in the limited circumstances outlined in Standard 3.2.
Owners and employees are individuals who have a legal duty to act in the company’s best interests. Owners are defined as individuals who have an ownership interest in a company, except for stockholders of publicly traded companies, or holders of shares through a pension or mutual fund. Employees are defined as individuals hired to work for another person or business (the employer) for compensation and who are subject to the employer’s direction as to the details of how to perform the job.
Ineligible companies are prohibited from engaging in joint providership with accredited providers. Joint providership enables accredited providers to work with nonaccredited eligible organizations to deliver accredited education.
The ACCME determines eligibility for accreditation based on the characteristics of the organization seeking accreditation and, if applicable, any parent company. Subsidiaries of an ineligible parent company cannot be accredited regardless of steps taken to firewall the subsidiaries. If an eligible parent company has an ineligible subsidiary, the owners and employees of the ineligible subsidiary must be excluded from accredited continuing education except in the limited circumstances outlined in Standard 3.2.
Standard 1: Ensure Content is Valid
Standard 1 applies to all accredited continuing education.
Accredited providers are responsible for ensuring that their education is fair and balanced and that any clinical content presented supports safe, effective patient care.
- All recommendations for patient care in accredited continuing education must be based on current science, evidence, and clinical reasoning, while giving a fair and balanced view of diagnostic and therapeutic options.
- All scientific research referred to, reported, or used in accredited education in support or justification of a patient care recommendation must conform to the generally accepted standards of experimental design, data collection, analysis, and interpretation.
- Although accredited continuing education is an appropriate place to discuss, debate, and explore new and evolving topics, these areas need to be clearly identified as such within the program and individual presentations. It is the responsibility of accredited providers to facilitate engagement with these topics without advocating for, or promoting, practices that are not, or not yet, adequately based on current science, evidence, and clinical reasoning.
- Organizations cannot be accredited if they advocate for unscientific approaches to diagnosis or therapy, or if their education promotes recommendations, treatment, or manners of practicing healthcare that are determined to have risks or dangers that outweigh the benefits or are known to be ineffective in the treatment of patients.
Standard 2: Prevent Commercial Bias and Marketing in Accredited Continuing Education
Standard 2 applies to all accredited continuing education.
Accredited continuing education must protect learners from commercial bias and marketing.
- The accredited provider must ensure that all decisions related to the planning, faculty selection, delivery, and evaluation of accredited education are made without any influence or involvement from the owners and employees of an ineligible company.
- Accredited education must be free of marketing or sales of products or services. Faculty must not actively promote or sell products or services that serve their professional or financial interests during accredited education.
- The accredited provider must not share the names or contact information of learners with any ineligible company or its agents without the explicit consent of the individual learner.
Standard 3: Identify, Mitigate, and Disclose Relevant Financial Relationships
Standard 3 applies to all accredited continuing education.
Many healthcare professionals have financial relationships with ineligible companies. These relationships must not be allowed to influence accredited continuing education. The accredited provider is responsible for identifying relevant financial relationships between individuals in control of educational content and ineligible companies and managing these to ensure they do not introduce commercial bias into the education. Financial relationships of any dollar amount are defined as relevant if the educational content is related to the business lines or products of the ineligible company.
Accredited providers must take the following steps when developing accredited continuing education. Exceptions are listed at the end of Standard 3.
- Collect information: Collect information from all planners, faculty, and others in control of educational content about all their financial relationships with ineligible companies within the prior 24 months. There is no minimum financial threshold; individuals must disclose all financial relationships, regardless of the amount, with ineligible companies. Individuals must disclose regardless of their view of the relevance of the relationship to the education.
Disclosure information must include:
- The name of the ineligible company with which the person has a financial relationship.
- The nature of the financial relationship. Examples of financial relationships include employee, researcher, consultant, advisor, speaker, independent contractor (including contracted research), royalties or patent beneficiary, executive role, and ownership interest. Individual stocks and stock options should be disclosed; diversified mutual funds do not need to be disclosed. Research funding from ineligible companies should be disclosed by the principal or named investigator even if that individual’s institution receives the research grant and manages the funds.
- Exclude owners or employees of ineligible companies: Review the information about financial relationships to identify individuals who are owners or employees of ineligible companies. These individuals must be excluded from controlling content or participating as planners or faculty in accredited education. There are three exceptions to this exclusion—employees of ineligible companies can participate as planners or faculty in these specific situations: a. When the content of the activity is not related to the business lines or products of their employer/company.
- When the content of the accredited activity is limited to basic science research, such as pre-clinical research and drug discovery, or the methodologies of research, and they do not make care recommendations.
- When they are participating as technicians to teach the safe and proper use of medical devices, and do not recommend whether or when a device is used.
- Identify relevant financial relationships: Review the information about financial relationships to determine which relationships are relevant. Financial relationships are relevant if the educational content an individual can control is related to the business lines or products of the ineligible company.
- Mitigate relevant financial relationships: Take steps to prevent all those with relevant financial relationships from inserting commercial bias into content.
- Mitigate relationships prior to the individuals assuming their roles. Take steps appropriate to the role of the individual. For example, steps for planners will likely be different than for faculty and would occur before planning begins.
- Document the steps taken to mitigate relevant financial relationships.
- Disclose all relevant financial relationships to learners: Disclosure to learners must include each of the following:
- The names of the individuals with relevant financial relationships.
- The names of the ineligible companies with which they have relationships.
- The nature of the relationships.
- A statement that all relevant financial relationships have been mitigated.
Identify ineligible companies by their name only. Disclosure to learners must not include ineligible companies’ corporate or product logos, trade names, or product group messages.
Disclose absence of relevant financial relationships. Inform learners about planners, faculty, and others in control of content (either individually or as a group) with no relevant financial relationships with ineligible companies.
Learners must receive disclosure information, in a format that can be verified at the time of accreditation, before engaging with the accredited education.
Exceptions: Accredited providers do not need to identify, mitigate, or disclose relevant financial relationships for any of the following activities:
- Accredited education that is non-clinical, such as leadership or communication skills training.
- Accredited education where the learner group is in control of content, such as a spontaneous case conversation among peers.
- Accredited self-directed education where the learner controls their educational goals and reports on changes that resulted, such as learning from teaching, remediation, or a personal development plan. When accredited providers serve as a source of information for the self-directed learner, they should direct learners only to resources and methods for learning that are not controlled by ineligible companies.
Standard 4: Manage Commercial Support Appropriately
Standard 4 applies only to accredited continuing education that receives
financial or in-kind support from ineligible companies.
Accredited providers that choose to accept commercial support (defined as financial or in-kind support from ineligible companies) are responsible for ensuring that the education remains independent of the ineligible company and that the support does not result in commercial bias or commercial influence in the education. The support does not establish a financial relationship between the ineligible company and planners, faculty, and others in control of content of the education.
- Decision-making and disbursement: The accredited provider must make all decisions regarding the receipt and disbursement of the commercial support.
- Ineligible companies must not pay directly for any of the expenses related to the education or the learners.
- The accredited provider may use commercial support to fund honoraria or travel expenses of planners, faculty, and others in control of content for those roles only.
- The accredited provider must not use commercial support to pay for travel, lodging, honoraria, or personal expenses for individual learners or groups of learners in accredited education.
- The accredited provider may use commercial support to defray or eliminate the cost of the education for all learners.
- Agreement: The terms, conditions, and purposes of the commercial support must be documented in an agreement between the ineligible company and the accredited provider. The agreement must be executed prior to the start of the accredited education. An accredited provider can sign onto an existing agreement between an accredited provider and a commercial supporter by indicating its acceptance of the terms, conditions, and amount of commercial support it will receive.
- Accountability: The accredited provider must keep a record of the amount or kind of commercial support received and how it was used, and must produce that accounting, upon request, by the accrediting body or by the ineligible company that provided the commercial support.
- Disclosure to learners: The accredited provider must disclose to the learners the name(s) of the ineligible company(ies) that gave the commercial support, and the nature of the support if it was in-kind, prior to the learners engaging in the education. Disclosure must not include the ineligible companies’ corporate or product logos, trade names, or product group messages.
Standard 5: Manage Ancillary Activities Offered in Conjunction with Accredited Continuing Education
Standard 5 applies only when there is marketing by ineligible companies or
nonaccredited education associated with the accredited continuing education.
Accredited providers are responsible for ensuring that education is separate from marketing by ineligible companies—including advertising, sales, exhibits, and promotion—and from nonaccredited education offered in conjunction with accredited continuing education.
- Arrangements to allow ineligible companies to market or exhibit in association with accredited education must not:
- Influence any decisions related to the planning, delivery, and evaluation of the education.
- Interfere with the presentation of the education.
- Be a condition of the provision of financial or in-kind support from ineligible companies for the education.
- The accredited provider must ensure that learners can easily distinguish between accredited education and other activities.
- Live continuing education activities: Marketing, exhibits, and nonaccredited education developed by or with influence from an ineligible company or with planners or faculty with unmitigated financial relationships must not occur in the educational space within 30 minutes before or after an accredited education activity. Activities that are part of the event but are not accredited for continuing education must be clearly labeled and communicated as such.
- Print, online, or digital continuing education activities: Learners must not be presented with marketing while engaged in the accredited education activity. Learners must be able to engage with the accredited education without having to click through, watch, listen to, or be presented with product promotion or product-specific advertisement.
- Educational materials that are part of accredited education (such as slides, abstracts, handouts, evaluation mechanisms, or disclosure information) must not contain any marketing produced by or for an ineligible company, including corporate or product logos, trade names, or product group messages.
- Information distributed about accredited education that does not include educational content, such as schedules and logistical information, may include marketing by or for an ineligible company.
- Ineligible companies may not provide access to, or distribute, accredited education to learners.
(Council 3/14/05; Updated/Adopted Council January 15, 2015; Updates Adopted by Council, April 15, 2021)
55.996 Guidelines for Funding County Medical Society Meetings with Legislators:
MSSNY’s Board of Trustees developed the following guidelines in response to requests by county medical societies to be reimbursed for monies expended at county medical society sponsored meetings with their local legislators to discuss socio-economic and/or political issues of concern to the medical profession and issues affecting health care delivery in New York State:
(1) Before any reimbursement is made from the Society’s funds, the county medical society must write the Medical Society of the State of New York for prior approval of the anticipated project and include a fiscal note with the request.
(2) After the function takes place, the county medical society is requested to inform MSSNY of the amount of actual expenses incurred, the nature of the meeting, and the number of physicians and legislators in attendance. The Trustees will determine the amount of reimbursement on the basis of this information.”
(3) The Board also recommended that MSSNY be identified as a co-sponsor and be consulted in the development of a county medical society program, since MSSNY will be reimbursing the county medical societies for part of their expenses in these legislative activities. (Board of Trustees 10/25/89; Reaffirmed HOD 2013)
NB: The MSSNY Board of Trustees recommends that the new legal guidelines concerning monies allocated to legislative activities be communicated to county medical societies and the MSSNY continue the policy of reimbursing counties for 50% of the costs incurred for such activities, with a cap of $1,000.
55.997 Health Care Coalitions for the Needy
SUNSET HOD 2013
55.998 Litigation – Legal Fee Aid Plan:
The following policies shall govern the administration of the MSSNY legal fee aid plan:
Guidelines to be Followed by County Medical Societies in Requesting Financial Assistance from the Medical Society of the State of New York in Connection with Legal Fees for Litigation or Administrative Hearings Concerning the County Medical Society or its Members
(1) The County Medical Society shall promptly advise the Executive Vice-President of the contemplated litigation or administrative hearing giving full details of the matter involved. The County Medical Society shall give an estimate of the amount of legal fees involved and a specific request for the financial assistance requested.
(2) Aid will be provided for legal fees only in matters clearly redounding to the benefit of the Medical Society of the State of New York and its membership at large.
(3) The final decision as to whether legal fee aid will be granted will be made by the Council of MSSNY with the concurrence of the Board of Trustees.
(4) In the event that MSSNY wishes to participate in legal action initiated by a county medical society, it shall be understood that there may be a requirement for county medical societies to participate financially.
(Council 11/20/80; Amended Council 4/16/81; Reaffirmed HOD 2013)
60.996 Survey: New York Physicians’ Attitudes toward Medical Aid in Dying
The Medical Society of the State of New York will conduct a membership/physician survey to determine attitudes toward medical aid-in-dying with a report of findings to be forwarded to the MSSNY Council or House of Delegates. MSSNY will involve its Bioethics Committee in the development of an unbiased survey on this issue. (HOD 2017-163)
60.997 New York State Department of Health’s Task Force on Life and the Law:
MSSNY to seek to have more representation on the New York State Department of Health’s existing Task Force on Life and the Law; and MSSNY’s representatives to: (1) make an effort to set guidelines on discontinuing or not initiating treatment, which might then be used to aid treating physicians on a voluntary basis in discussion with a patient and/or his/her family; and (2) advocate that an appropriate mechanism for adjudication in end-of-life questions in the hospital setting be available for treating physicians. (HOD 2007-261; Reaffirmed HOD 2017)
60.998 Determination of Death: SUNSET HOD 2013
65.000 DRUG ABUSE:
65.976 AMA to Analyze Benefits/Harms of Legalization of Marijuana
MSSNY will forward to the AMA a request for it to review pertinent data from States that have legalized marijuana. (HOD 2019- 174 and 175)
65.977 Benzodiazepine and Opioid Warning
The Medical Society of the State of New York will raise the awareness of its members about the increased use of illicit sedative/opioid combinations leading to addiction and overdose death. The Medical Society of the State of New York bring this resolution to the House of Delegates of the American Medical Association so that it may warn members and patients about this public health problem. (HOD 2019-163)
65.978 Workforce Development for Addiction Treatment by Physicians
The Medical Society of the State of New York supports the use of State funding to establish and support addiction medicine fellowships in New York State. (HOD 2018-107)
65.979 Substance Use Disorders (SUD) Medical Treatment Requirement
The Medical Society of the State of New York will encourage all licensed drug treatment programs to offer treatment for Substance Use Disorders and that staff employed at these facilities be trained in the referral and provision of Medicated Assisted Treatment (MAT). (HOD 2018-160)
65.980 Safe Injection Facilities Pilot Studies in New York State
The Medical Society of the State of New York supports pilot studies to assess the role of Safe Injection Facilities in New York State as a component of expansion of drug user health programs and that any pilot study include New York City and two other areas outside of New York City. Such pilot studies on Safe Injection Facilities should include a publicly disclosed report of outcomes and should provide screening, support and referral for treatment of substance use disorders, co-occurring medical and psychiatric conditions, and also provide education on harm reduction strategies including, but not limited to, Naloxone training. (HOD 2018-154; Reaffirmed in lieu of HOD 2020-152)
65.981 Supervised Injection Facilities
MSSNY will forward a resolution to the A-17 AMA meeting requesting a comprehensive study of Supervised Injection Facilities in the United States. (HOD 2017-160)
65.982 Treatment of Opioid Overdoses in the Emergency Department
The Medical Society of the State of New York strongly encourages all physicians and hospitals to advocate substance use treatment options, including buprenorphine, available to patients in treating addiction. MSSNY encourages collaboration with multi stakeholders for integrated Medicated Assistance Treatment (MAT) for the management of addictions and physicians and other medical staff voluntarily become certified to prescribe buprenorphine. (HOD 2017-159)
65.983 Medication Assisted Therapy
The Medical Society of the State of New York supports legislation/regulation which will allow access to Medication Assisted Therapy and psychosocial strategies for substance use disorders and that insurance companies be required to provide coverage for these programs including in the primary care physician, non-psychiatric, non-addiction specialist setting. (Adopted Council, June 2, 2016; Reaffirmed in lieu of HOD 2020-160)
65.984 Kratom and Its Growing Use within the United States
The Medical Society of the State of New York supports legislative or regulatory efforts which will prohibit the sale or distribution of Kratom in New York State but also do not inhibit proper scientific research.
This resolution will be transmitted to the American Medical Association. (HOD 2016-156)
65.985 MSSNY Opposes Recreational Marijuana Legalization
The Medical Society of the State of New York opposes recreational marijuana legalization. (HOD 2015-166; Reaffirmed HOD 2019 in lieu of res 173)
65.986 Treatment Rather than Arrest for Marijuana Possession
The Medical Society of the State of New York supports promotion of drug treatment to those arrested or fined for marijuana related offenses and encourages communities to develop programs that emphasize drug treatment and rehabilitation rather than criminalization of marijuana. (HOD 2015-165; HOD reaffirmed in lieu of 2017-152; Reaffirmed HOD 2019 in lieu of res 173)
65.987 Increasing Access to Care for Patients with Opioid Use Disorders
The Medical Society of the State of New York will encourage primary care physicians and psychiatrists to voluntarily complete appropriate training which would best increase access to care for opioid use disorders, and which would include, but not be limited to:
a) CME courses on screening, brief intervention, prescribing of medications for substance use disorders and referral for specialized care,
b) CME courses on opioid use disorders and
c) CME which meets the requirements for certification to become licensed to prescribe buprenorphine.
The Medical Society of the State of New York will support policies and initiatives to provide adequate compensation for primary care physicians and psychiatrists for the treatment and counseling of patients with opioid use disorders, as well as efforts to end the limitation of 100 patients per certified physician treating opioid dependence after the second year of treatment as currently mandated by the Drug Addiction Treatment Act
A copy of this resolution will be transmitted to the AMA House of Delegates for its consideration. (HOD 2015-163)
65.988 Availability of Treatment Slots for Substance Abusers
The Medical Society of the State of New York will urge the New York State Department of Health to commission a study analyzing the projected substance abuse treatment slots needed from drug crime sentencing to ensure the system will be equipped to handle the increased volume and if there is a shortage of substance abuse treatment slots projected, the Medical Society of the State of New York will lobby to increase the number of treatment slots available to meet the need. (HOD 2014-114)
65.989 Driving While Intoxicated, Impaired or Distracted by All Substances
The Medical Society of the State of New York will advocate to ensure that when the ability to drive is impaired by recreational intake of drugs which are not listed as controlled substances under New York’s Public Health Law, those persons are still subject to penalties under New York law which prohibits driving while intoxicated or driving while ability impaired. The Medical Society of the State of New York will continue to support programs that educate the public on the dangers of driving while intoxicated, or impaired. (HOD 2014-62)
65.990 Use of Naxolone to Prevent Drug Overdoses
MSSNY supports the use of intra-nasal Naxolone in the prevention of drug overdoses. (Council 3/10/2014)
65.991 Recommendations to Address the Prescription Drug Abuse and Diversion Issue
The Medical Society of the State of New York adopted the following consensus statement:
There have been several New York State legislative proposals from state legislators and officials to combat the abuse of prescription drugs. The Medical Society of the State of New York and the above referenced specialty societies believe that any solution to the abuse of prescription drug problem must be multipronged.
This approach includes increased law enforcement efforts to prevent and punish inappropriate diversion of prescription medications. It includes the need for increased accessibility of treatment for patients suffering addictions so as to reduce the likelihood of inappropriate diversion of prescribed medications. It includes improvement in and better use of the existing database that is currently maintained by the New York State Health Department on all controlled substance prescriptions. And it includes the need for additional resources for associations representing prescribers so that they can educate their members about the existence of the database and the circumstances of patients presenting themselves in health care settings that should trigger a prescriber to check the database.
New York State has for many, many years collected information on prescription drugs and has a Prescription Monitoring Program (PMP)—an electronic monitoring system that is operated by New York State’s Department of Health Bureau of Narcotics Enforcement (BNE). The issue is not the need to create a new database. The issue is how the information that already exists within the database can be best used and improved upon in order to inform physicians and other non-physician prescribers, as well as pharmacists dispensing these medications, so as to prevent or reduce “doctor-shopping,” diversion and abuse. Physicians have indicated that the present system which is operated on the Health Commerce System (HCS) is very difficult to use, has a significant lag in the reporting of such data, and requires a password that expires if the physician does not go onto the HCS within a certain period of time. In addition, no information at all is given about an individual patient unless their prescription usage hits a too high threshold of obtaining multiple prescriptions from multiple doctors and filling them at multiple pharmacies in a short timeframe. Specifically, no information at all is available unless a patient has two or more prescriptions written by two or more physicians that are filled at two or more pharmacies over the last couple of months or so. Finally, since pharmacy data may be entered on a monthly basis, often the prescription information for the most recent few weeks is incomplete.
The Medical Society of the State of New York and the above referenced specialty societies note that as the State looks to identify ways to prevent misuse and inappropriate diversion, it will need to be careful that it does not “over correct” this problem. In fact, there is a body of recognized expertise that has concluded that physicians are not actually prescribing pain medications enough. As such, the medical community has serious concerns with proposals that would mandate reporting and checking a database each and every time a controlled substance prescription is written. The Medical Society and the above referenced specialty societies are greatly concerned that such proposals would add to the already tremendous administrative burden facing physician practices and worse, would potentially discourage physicians from writing prescriptions for controlled substances in situations where they are necessary. In addition, strict mandatory reporting may result in the unintended consequences of preventing patients with substance use disorders or chronic pain from seeking or staying in treatment or prevent them from reporting such behaviors to their treating physicians.
Therefore, the Medical Society of the State of New York and the above referenced specialty societies recommend that the following changes be made via regulation and/or statute:
E-Prescribing of Narcotics
- The Medical Society and the above referenced specialty societies support the implementation of E-prescribing for all controlled substances.
- The Medical Society and the above referenced specialty societies support the implementation of connecting the PMP Database with Health Information Exchanges.
Improving the PMP Database
- The Medical Society of the State of New York and the above referenced specialty societies support physicians having access to the PMP for ANY controlled medication prescriptions as far back as database will allow.
- The Medical Society and the above referenced specialty societies are supportive of allowing a physician’s designee to have access to the PMP. The Medical Society and the above referenced specialty societies support authorizing pharmacists to have access to the existing PMP database which would better enable pharmacists to provide relevant information to the prescribing physician.
- The Medical Society and the above referenced specialty societies support the use of improved technology to allow easier usage of the PMP.
Physician Access to PMP and Physician Education
- MSSNY and the above referenced specialty societies support the principle that if a physician believes a patient is attempting to access a prescription for any reason other than treatment of an existing medical condition such physician has the obligation to decline to write the prescription or check the current data base before a script is written or submitted electronically.
- The Medical Society and the above referenced specialty societies support developing regulatory guidance with the input of appropriate physician organizations to treat acute pain and for chronic pain management care provided that this guidance is developed in consultation with physicians and appropriate physician organizations and that such guidance is mindful of the need for individualized medical evaluation and decision making. Such guidance may include information relative to the clinical conditions which would indicate physician recourse to the PMP database.
- The Medical Society and the above referenced specialty societies support voluntary education programs for providers on pain management, substance abuse and dependence, diversion and on the use of the PMP as a tool for prescribing, with the caveat that the prescribing authority remains independent of any educational requirement.
- The Medical Society and the above referenced specialty societies believe it is imperative that NYS educate the public regarding the dangers of prescription misuse and diversion and the requirement to inform all prescribers of any controlled drugs they are taking.
- The Medical Society and the above referenced specialty societies support elevating Hydrocodone to Schedule II and Tramadol to Schedule III. Importantly, this will limit the duration of Hydrocodone prescriptions to 30 days.
- The Medical Society and the above referenced specialty societies support data sharing of information through the PMP with other states.
- The Medical Society of the State and the above referenced specialty societies support drug take-back programs for all prescriptions.
Additionally, the Medical Society of the State of New York opposes any legislation requiring physicians to do patient background checking prior to prescribing controlled substances.
The Medical Society of the State of New York submitted a resolution to the AMA House of Delegates opposing federal legislation which would require physicians to do background checking prior to prescribing controlled substances. (HOD 2012-161 and 162)
65.992 Preventing Overdose Deaths – Community-based Naloxone Programs:
MSSNY and its respective specialty societies will continue to work with the New York State Department of Health to reduce overdose deaths and to expand Naloxone programs as part of its comprehensive overdose prevention programs. (HOD 2011-155)
65.993 Preventing Overdose Deaths – “911 Good Samaritan”:
MSSNY supports efforts that would enact a “911 Good Samaritan” law that would provide immunity from arrest, charge, prosecution and conviction for drug and drug paraphernalia possession and for certain alcohol-related offenses for individuals or victims of a health-related emergency which resulted due to consumption or use of a controlled substance or alcohol and who have contacted 911 in good faith to receive emergency medical treatment for themselves or another individual. (HOD 2011-154)
65.994 Dextromethorphan Abuse in Adolescents:
MSSNY supports policy that dextromethorphan-containing products be placed behind pharmacy counters to prevent abuse in adolescents. (HOD 2007-150; Modified and Reaffirmed HOD 2017)
65.995 Opioid Dependent Patients: Changes in Treatment Venue of Stable Patients:
MSSNY supports efforts of federal and state agencies to permit properly trained and qualified practicing physicians to engage in the independent treatment of opioid dependent patients who have attained behavioral and social stability under standard treatment. (Council 9/7/00; Modified and reaffirmed HOD 2014)
65.996 Marijuana Alert 2000:
SUNSET HOD 2014
65.997 Hypodermic Needle and Syringe Exchange Program:
SUNSET HOD 2014
65.998 Drug Dependency as a Clinical Illness:
It is the policy of MSSNY that drug dependency should be treated as a clinical illness. (HOD 1998-90; Reaffirmed Council 9/11/03; Reaffirmed HOD 2013)
65.999 Testing in the Work Place for Drug and Alcohol Abuse:
MSSNY recognizes the right of employers to require drug and alcohol testing within certain limitations, as follows: (1) Drug and alcohol testing of applicants for employment in order to prevent drug and alcohol abusers from entering the work place. Patients taking medication which artificially triggers a positive test should have due process to be retested to exclude illegal drug or alcohol. (2) Drug and alcohol testing of employees for cause, provided that such testing is done under qualified medical supervision and that economic and other assistance is given in the rehabilitative process. (3) Random drug and alcohol testing of employees whose jobs may have an impact on public safety, under conditions as in number 2 above. (4) Drug and alcohol tests must be performed by New York State certified laboratories where adequate quality control processes are in effect and where a full chain of custody procedure is maintained on each specimen. In addition, each positive test result must be confirmed by means of gas chromatography/mass spectrometry or an equally accurate test. (5) Confidentiality must be maintained at all stages of the process. (6) Drug testing is appropriate when implemented in conjunction with a program for rehabilitation and treatment of employees who are psychologically or physically dependent. (Council 12/21/89; Reaffirmed HOD 2014)
70.000 DRUG DISPENSING: (See also Children and Youth, 30.000)
70.930 Ensuring Correct Drug Dispensing
The Medical Society of the State of New York will request that the New York State Education Department work with the pharmaceutical and pharmacy industries to facilitate the ability of pharmacies to ensure that when a prescription is dispensed, a color photo of the prescribed medication and its dosage is attached to the receipt, ensuring that the drug dispensed is that which has been prescribed. MSSNY will forward a similar resolution to AMA to request similar action by the FDA. (HOD-Late A, referred to and adopted by Council, 3/1/21)
70.931 Pharmacy Benefit Managers and Drug Shortages
The Medical Society of the State of New York will seek an investigation by the New York State Legislature, Department of Health and regulators into the role of pharmacy benefit managers in drug shortages. This will be sent to AMA for investigation as well. (HOD 2020-109)
70.932 Access to Medications
MSSNY will seek regulations that prohibit pharmacy benefit plans from limiting patient access to medications based on a prescription placed initially by mail order and additionally that pharmacies be required to offer patients access to their prescribed medications without undue delay. This resolution will be sent to AMA for national support. (HOD 2020-108; referred to Council, adopted 9/17/20))
70.933 Payment for Brand Medication When the Generic Medication is Recalled
MSSNY will seek passage of state regulation and/or legislation that mandates that third party payers as well as Centers for Medicare and Medicaid Services allow reimbursement for brand medications at the lowest copayment tier so that patients can be effectively be treated until the medication manufacturing crisis is resolved. MSSNY will send a resolution requesting the AMA petition CMS as well as third party payers to allow reimbursement for brand medications at the lowest copayment tier so that patients can be effectively treated until the medication manufacturing crisis is resolved. (HOD 2019-263)
70.934 Restricting FAXes from Pharmacy Benefit Managers
The Medical Society of the State of New York will ask the American Medical Association to support limitations on the use of faxes sent to physicians by Pharmacy Benefit Managers (PBMs) and large pharmacy systems (such as Express Scripts, OptumRx, Humana). MSSNY is committed to the goal of finding cost effective strategies for physicians and will suggest that the AMA work with MSSNY to convene a work group of stakeholders (physicians, health plan associations, health insurers, large pharmacy systems and their pharmaceutical benefit managers) to develop cost effective alternatives for contacting physicians for prescriptions and requests for prior authorization electronically (rather than by FAX) whenever possible. (HOD 2018-106)
70.935 Covered Drugs during Insurance Enrollment Year
The Medical Society of the State of New York will urge the American Medical Association to seek federal legislation or regulation which would prevent Medicare and HMO plans from changing covered drugs during the enrollment year. MSSNY will seek legislation or regulation preventing Pharmacy Benefit Mangers (PBMs) and large pharmacy systems from asking prescribers to change prescriptions during the year unless there was medical evidence that the change would benefit the patient and further that no changes could be imposed on prescribers during the enrollment year (such as a change from brand to generic or from one brand to another). (HOD 2018-104)
70.936 High Drug Prices and Pharmacy Parity
The Medical Society of the State of New York will urge legislation prohibiting pharmacies from charging higher prices (from pharmacy benefit managers or insurance plans) than the actual pharmacy price of the medication. MSSNY will further advocate for patients to have a choice of receiving maintenance prescriptions from either a mail order pharmacy or a brick-and-mortar pharmacy without any financial penalty. (HOD 2018-102 and 105)
70.937 Pharmacy Benefit Managers Medical Necessity Criteria for Prescribed Medications
MSSNY will seek regulation or legislation limiting Pharmacy Benefit Manager requests for information to pertinent and relevant information which demonstrates that a patient meets medical necessity for prescribed medications. (HOD 2017-103)
70.938 Changes in Insurance Accepted by Pharmacies
The Medical Society of the State of New York will seek legislation that will require pharmacies to contact all physicians and patients affected by the pharmacy’s cessation of participation in a specific health insurance plan and also require the transfer, with notice to the patient, of all new and pending prescription refills to a pharmacy that accepts the patients’ insurance. MSSNY will seek through regulation or legislation the creation of a prescription clearing house that would reduce the existing hassles of the current system for patients, pharmacies and physicians. (HOD 2017-263)
70.939 Partial Fill of Schedule II Controlled Substances
The Medical Society of the State of New York supports legislation/regulations allowing partial fill of Schedule II controlled substance medications similar to partial prescription fills permitted under regulations for Schedule III and IV medications. (Adopted Council, June 2, 2016)
70.940 Medications Return Program
The Medical Society of State of New York (MSSNY) supports medication disposal which provides daily access to safe, convenient, and environmentally sound medication return for unwanted prescription medications and that such a medication disposal program should be fully funded by the pharmaceutical manufacturers, including costs for collection, transport and disposal of these materials as hazardous waste.
MSSNY supports change in New York State law or regulation that would allow a program for medication recycling and disposal to occur.
The New York Delegation to the American Medical Association will encourage the AMA to pursue the same efforts. (HOD 2016-157; Reaffirmed HOD 2018 in lieu of 162)
70.941 Resolving E-Prescribing Problem
The Medical Society of the State of New York (MSSNY) will urge the New York State Health Department’s Bureau of Narcotic Enforcement (BNE) to issue rules permitting physicians to prescribe via paper/fax/phone in situations where the patient needs to comparison shop among pharmacies and to make regulatory changes to enable pharmacies that do not have a particular medication in stock the ability to transmit the prescription to another pharmacy that has the needed medication in stock.
The Medical Society of the State of New York (MSSNY) will urge the AMA to work with the DEA and other appropriate federal agencies to enable the use of tokens in multiple care settings.
MSSNY will encourage member physicians to record incidents in which a patient is harmed by the law’s ban on prescribing via paper/phone/fax and provide that data showing evidence of patient harm which has occurred as a result of e-prescribing to MSSNY for its ongoing dialogue with the New York State Health Department’s Bureau of Narcotic Enforcement (BNE) and the New York State Legislature on e-prescribing issues.
MSSNY will support legislation which (1) removes the requirement that all paper/fax/phone prescriptions be reported to the BNE, allowing instead that the prescription be recorded in the patient’s medical record and (2) ensures that a physician not be subjected to criminal charges, or other ramifications from the Department of Health or the Department of Education for having written a medically appropriate paper prescription.
The NYS DOH BNE shall provide prescribers and patients with educational materials that satisfy the HIPAA requirement of knowing where electronic data goes, who can access it and why, and how it is used. (HOD 2016-115)
70.942 Require Alternative Medication List after Denial
The Medical Society of the State of New York will advocate for ensurance that health insurers provide physicians an alternative list of medications when coverage for such medication is denied, instead of directing them to their website; and that health insurers create interfaces between physician e-prescribing systems and the insurer’s prescription formulary. (HOD 2016-68)
70.943 Regulation of Pharmacy Benefit Management Companies
The Medical Society of the State of New York will continue to advocate for legislation which will regulate the practices of Pharmaceutical Benefits Managers (PBMs); and for legislation which ensures that physicians have the final say in choosing which medications his or her patients should receive, and which would limit the ability of PBMs to interfere with the treatment recommendations of a physician prescribing medications for their patient. (HOD 2016-67)
The Medical Society of the State of New York will press for legislation or regulation that would allow patients’ requests for paper prescription and pharmacy choice to be honored and permit any patient to request opting out of electronic prescribing by requesting same in writing to a physician, who will then be permitted to issue a paper prescription in person or by fax. (Council 1/21/2016)
70.945 Federal Agency Compliance with State Laws on Controlled Substances Databases
In order to better coordinate controlled substance prescribing with other physicians, the Medical Society of the State of New York, working with the AMA, will request that the Veterans Administration and other federal health programs comply with applicable State laws which require checking databases of controlled substance prescriptions and that they additionally comply with state laws with regard to respective requirements for entering data on prescription fills into controlled substance tracking databases.
MSSNY will work with the NYS Department of Health to address any technological obstacles that exist to impede the transfer of data from VA practitioners and other federal health programs to the NYS Prescription Monitoring Program. (HOD 2015-100)
70.946 Generic Drug Pricing
The Medical Society of the State of New York (MSSNY) recognizes that generic drugs are not identical to their brand name precursors. MSSNY will advocate to ensure that a patient’s physician has final decision-making authority regarding which prescription medications are necessary for that patient’s well-being and it will further advocate to ensure the availability of affordable prescription medications for patients, including opposition to sudden unjustified price increases in prescription medications.
The Medical Society will continue to work with the Department of Financial Services, Department of Health and Attorney General’s office to expedite reviews of situations where insurers and their agents improperly delay responding to requests for pre-authorization of needed medications and further, MSSNY will advocate for sufficient fines to be imposed on insurers who fail to respond to pre-authorization requests in a timely manner. (HOD 2015-52; Reaffirmed HOD 2019 in lieu of res 53)
70.947 Physical Appearance of Generic Drugs
The Medical Society of the State of New York will work with the pharmaceutical industry to help educate patients and physicians regarding the numerous online databases that help provide tools to enable the easy identification of medications. (HOD 2015-51)
70.948 Point of Care Dispensing
The Medical Society of the State of New York will seek legislation that permits in-office physician dispensing of prescription medication to the patients. (HOD 2014-113)
70.949: Insurance Coverage For A 90 Day Supply Of Maintenance Medications
Insurance plans should be required to fill prescriptions as written up to a 90 day supply for all maintenance medications at a pharmacy or by mail order. (HOD 2013-155)
70.950: E-Prescribing for Controlled Substances
MSSNY supports use of e-prescribing for controlled substances with the ability to screen for multiple prescribers of controlled substances. (HOD 2013-107)
70.951: Electronic Prescription for Controlled Substances
MSSNY supports use of electronic prescriptions for controlled substances and termination of the requirement for “hard copy” prescriptions, unless an exception to the e-prescribing mandate applies. (HOD 2013-106)
70.952 E-Prescribing of Class III-Narcotics and Other Controlled Substances
MSSNY will urge the New York State Department of Health to work proactively with all appropriate authorities on the state and federal level to make it possible for physicians to e-prescribe all medications including Class-III narcotics and other controlled substances. (HOD 2012-102 )
70.953 Inappropriate Export of Pharmaceutical Services:
MSSNY will work with the pharmacists of New York and their Professional Organizations to maintain the option of patients to have their prescriptions dispensed at a local pharmacy and be counseled face-to-face by their pharmacist. (HOD 2011-211)
70.954 Electronic Submission of All Prescriptions:
MSSNY will work proactively with the Department of Health to implement regulations that will permit the electronic submission of all prescriptions in New York State. (HOD 2011-101)
70.955 Unused Prescription Drug Drop-off Programs:
MSSNY to work with government, the pharmacy and pharmaceutical industry as well as the hospital associations to advocate for the creation of a statewide program to facilitate the installation of appropriately secured “unused prescription return” boxes in various locations across the State. (HOD 2011-67)
70.956 Return of Unused Medications in Long Term Care Facilities:
MSSNY adopted as policy the existing AMA Policy H-280.959, “Recycling of Nursing Home Drugs.”
Recycling of Nursing Home Drugs
Our AMA supports the return and reuse of medications to the dispensing pharmacy to reduce waste associated with unused medications in long-term care facilities (LTCFs) and to offer substantial savings to the health care system, provided the following conditions are satisfied: (1) The returned medications are not controlled substances. (2) The medications are dispensed in tamper-evident packaging and returned with packaging intact (e.g., unit dose, unused injectable vials and ampules). (3) In the professional judgment of the pharmacist, the medications meet all federal and state standards for product integrity. (4) Policies and procedures are followed for the appropriate storage and handling of medications at the LTCF and for the transfer, receipt, and security of medications returned to the dispensing pharmacy. (5) A system is in place to track re-stocking and reuse to allow medications to be recalled if required. (6) A mechanism (reasonable for both the payer and the dispensing LTC pharmacy) is in place for billing only the number of doses used or crediting the number of doses returned, regardless of payer source.
Also, MSSNY is to communicate this policy to appropriate Federal and State governmental agencies to urge its immediate adoption. (HOD 2010-250; Reaffirmed HOD 2020)
70.957 List of Patients’ Medications Provided by Pharmacists:
MSSNY will encourage all pharmacies licensed in New York State to provide individuals with a complete listing of all their medications each time a prescription is filled. This list of medications provided by the pharmacist to a patient would include the name of the drug (brand and generic, if appropriate), dosage and any other identifying information which will assist the individual in recognizing and understanding the medications they are taking. (HOD 2010-103; Reaffirmed HOD 2020)
70.958 Use and Acceptance of E-Prescription: SUNSET HOD 2020
70.959Pharmacy Benefit Managers’ or Payors’ Interference with the Course of Good
Treatmentand Requiring the Provision of Dangerous Quantities of Medicine:
MSSNY is to:
a) seek legislation and/or regulation prohibiting a payor or Pharmacy Benefit Manager (PBM) from either requiring a prescription to be filled with a quantity greater than that which is prescribed by a patient’s treating physician, or imposing significant additional cost-sharing responsibilities on patients for filling prescriptions with smaller quantities;
b) work with the State Insurance, Health and Education Departments to assure that patients can obtain prescription drugs consistent with the dosage, frequency and duration as prescribed by the physician;
c) continue to seek legislation and/or regulation that permits a patient to obtain a denied prescription drug pending an internal or external appeal of a denial by a health insurance company at the insurer’s expense; continue to advocate for legislation that would prevent insurance companies from coercing patients through financial disincentives to change a medication upon which a patient is stabilized, simply due to a change in formulary, change in plan or change in insurer. (HOD 2010-61; Reaffirmed HOD in lieu of 2017-103)
70.960 Cancellation or Rescission of Renewals after the Prescriptions Have Been Delivered to the Pharmacy:
MSSNY will seek appropriate measures including, if necessary, legislation to assure the ability of a physician to cancel or rescind a prescription for a patient if deemed warranted by the patient’s treating physician. (HOD 2010-60, Reaffirmed HOD 2020)
70.961 NYS Prescription Pads:
MSSNY opposes any effort present or future to require physicians to pay a fee for the official prescription forms supplied by the state; and work to assure that an adequate supply of prescription forms are provided to each physician or licensed allied medical practitioner. (HOD 2005-97; Reaffirmed HOD 2015)
70.962 Two-Part Official Prescriptions:
SUNSET HOD 2015
70.963 Electronic Prescription System:
SUNSET HOD 2014
70.964 Pharmacies Should Be Required to Accept Faxed Prescriptions for Non-controlled
MSSNY will work for legislation requiring all New York State pharmacies to accept faxed or electronically-transmitted prescriptions for non-controlled substances, when in the pharmacist’s professional judgment that faxed or electronically-transmitted prescription is legible and valid. (HOD 2002-76; Reaffirmed HOD 2013)
70.965 Coverage for Brand Name Medications as Prescribed by Physicians:
MSSNY must aggressively pursue enactment of MSSNY Policies 70.974 (Restrictive Formulary Medication Benefit Plans); 70.976 (Continued Coverage for Prescription Medications from Health Plan Drug Formularies); 70.977 (Restrictive Formulary Drug Prescription Sanction Through Managed Care); and 165.941 (Coordination of Pharmacy Benefit Into Existing Health Plans).
Enactment of the aforementioned MSSNY Policies should become a top priority during the upcoming legislative session in Albany.
Legislation will be sought to ensure that patients are not financially penalized for the prescription of a “non-preferred” drug by either: (a) seeking legislation to mandate that any “non-preferred” agent for which no bio-equivalent “preferred” agent exists in that plan be covered as a “preferred” agent; or (b) seeking legislation to mandate that the insurer provide a credit towards the cost of the “non-preferred” agent in the amount equal to that which would have been paid had a similar “preferred” agent been prescribed. (HOD 2002-57; Reaffirmed HOD 2013)
70.966 Mandatory Acceptance of the Currently Utilized Physician
Prescription Form by Pharmacy Benefit Plan Administration:
SUNSET HOD 2013
70.967 Public Notification of Expired Pharmaceuticals:
MSSNY will aggressively pursue legislation which would mandate the placement of expiration dates on prescription drug labels as stipulated in Resolution 95-62, 96-60, reaffirmed in Resolution 99-63 and as currently provided for in the MSSNY 2002 Legislative Agenda.
MSSNY will remind all physicians through their usual publications, i.e. News of New York, EVPgram, that all prescribed medications are to be utilized within a reasonable period of time so as to avoid the possibility of patients having unsafe or ineffective medications.
MSSNY will call upon the American Medical Association to encourage the Food and Drug Administration and/or other appropriate agencies to undertake a comprehensive study to determine how certain factors, including but not limited to time, storage and handling will affect the efficacy and safety of prescription drugs. (HOD 2002-53; Reaffirmed HOD 2013)
70.968 Single Dose Labeling of Medication in a School Setting by
Registered Professional School Nurses:
Sunset HOD 2011
70.969 Removing DEA Documentation from Uncontrolled Prescription Pad:
MSSNY adopted as policy the existing AMA Policy H-100.972 “Misuse of the DEA License Number.”
Misuse of the DEA License Number
MSSNY affirms its opposition to use of the Drug Enforcement Administration (DEA) license number for any purpose other than for verification to the dispenser that the prescriber is authorized by federal law to prescribe the substance; and will explore measures to discourage or eliminate the use of physicians’ DEA license numbers as numerical identifiers in insurance processing and other data bases, either through legislation, regulation or accommodation with organizations which currently insist on collection of this sensitive data.
MSSNY will seek through legislation or regulation limitation of the use of DEA numbers to those federal and state entities that use the number to oversee and enforce the law regarding the manufacture, distribution, and dispensing of controlled substances.
MSSNY will advocate for adoption of the AMA’s Medical Education number as the unique identifier for physicians. (HOD 2001-154; Reaffirmed HOD 2011)
70.970 Drugs with Narrow Therapeutic Index:
MSSNY supports the passage of State legislation requiring third party carriers to cover patient’s costs for brand name drugs contained on the list of narrow therapeutic index drugs at the same cost as if generic substitution were permitted. (HOD 2001-56; Reaffirmed HOD 2011)
70.971 Administration of Prescription Drug Programs Insuring Patient Access to Necessary Medication:
- express its concern to the New York Department of Health and the Department of Health and Human Services that the programs concerning prescription drugs be administered in such a way that patients will not be denied access to necessary medication; and
- oppose any third party payer reducing reimbursement beyond or below a physician’s and/or other health care practitioner’s cost; and
- support activity to ensure that all fair administrative costs be considered for reimbursement; and
- coordinate with the Pharmacists Society of the State of New York in a concerted effort to insure proper access to pharmaceutical drugs for all patients in New York State. (Council 1/25/01; Reaffirmed Council 1/22/04)
- vigorously advocate for fair and reasonable reimbursement for chemotherapy and other vaccines. (Council 1/22/04 addition) Policy 70.971 Reaffirmed HOD 2014
70.972 Require Pharmacies to Print the Expiration Dates of Medications On All Prescription Labels:
MSSNY will support legislation to require that expiration dates of prescribed drugs be listed on the package for consumers, and to provide for enforcement of such provisions by the New York State Attorney General, and MSSNY will ask its delegation to propose a similar resolution to the American Medical Association. (HOD 2000-162; Reaffirmed HOD 2014-65)
70.973 Insurance Companies, Pharmacies and Pharmaceutical Benefits Management
Companies (PBMs) Should Not Require a Diagnosis in Order for the Patients
Prescription to be Filled:
MSSNY will advocate for legislative/regulatory relief, requiring pharmacies, any health plan and pharmaceutical benefits managers to fill prescriptions even if their patient’s diagnosis is not divulged to them. (HOD 2000-83; Reaffirmed HOD 2014)
70.974 Restrictive Formulary Medication Benefits Plans:
MSSNY supports enactment in the State of New York of a pharmacy benefits management law that will regulate managed pharmacy benefit plans to prohibit interference in the doctor-patient relationship, to prevent interruption of ongoing medical care treatment and to promote access to medication that is consistent with accepted standards of appropriate medical care and treatment, to provide patients with advance notice of benefit limits and the right to pursue external review of medications denied due to formulary restrictions.
MSSNY supports legislation that requires that where a prescription is denied due to formulary restrictions the prescription drug must be dispensed to the patient for the pendency of the internal or external appeal process.
MSSNY will educate physicians and patients regarding the right to pursue external review when patients are denied or provided unequal access to medications because of formulary restrictions. (HOD 00-78; Reaffirmed HOD 2001-53; Reaffirmed HOD 2011; Reaffirmed HOD 2016-67)
70.975 Continued Coverage for Prescription Medications From Health Plan Drug Formularies:
MSSNY will seek appropriate legislation that would allow a patient suffering from a chronic condition to continue to be reimbursed for medically necessary prescription drugs subsequently removed at the discretion of a health plan from its drug formularies provided that the patient’s physician believes that there is no appropriate alternate drug on the formulary. (HOD 1998-74; Reaffirmed HOD 2001-53; Reaffirmed HOD 2011)
70.976 Restrictive Formulary Drug Prescription Sanction Through Managed Care:
MSSNY will develop and propose legislation or regulation requiring (a) pharmacists to contact the prescribing physician if a prescription written by the physician violates the managed care formulary under which the patient is covered, so that the physician has an opportunity to prescribe an alternative drug, which may be on the formulary; (b) which prohibits managed care entities, and other insurers, from disciplining, or withholding payment from physicians because they have prescribed drugs to patients which are not on the insurer’s formulary or have appealed a plan’s denial of coverage for the prescribed drug; (c) which ensures that all pharmacy benefit management companies and insurers which use restrictive drug formularies be required to impanel an independent group of physicians to determine the composition of the drug formulary; (d) will request the American Medical Association to examine the feasibility of establishing a standardized process for formulary development applicable to all managed care plans. (HOD 1998-55; Reaffirmed HOD 2001-53; Reaffirmed HOD 2011)
70.977 Sanctioning More Than One Non-Controlled Substance To Be Prescribed On The Same Prescription Blank:
SUNSET HOD 2014
70.978 Contact Lens Prescription, Expiration Date for:
MSSNY has adopted the position that there is danger to the public health and safety by allowing prescriptions for contact lenses to be filled without time limitation and without any requirement for proper ophthalmic follow-up care and that the same strict standards that regulate the dispensing of oral and topical medications, medical devices and appliances also apply to the dispensing of contact lenses to the residents of New York, and that contact lens prescriptions have an expiration date of one year after the date they are written. (HOD 1996-180; Reaffirmed HOD 2014)
70.979 Expiration Date on Medicine Containers:
SUNSET HOD 2014 See 90.972
70.980 Generic Drug, Use of ‘A’ Rated:
SUNSET HOD 2014
70.981 Generic Substitutions:
MSSNY will seek legislation to provide that where there is generic substitution because the physician has not designated “DAW” the pharmacist filling the prescription include on the label the words “Substituted for (brand name).” (HOD 1994-152; Reaffirmed 2010-97; Reaffirmed HOD 2014)
70.982 Optometrists Prescribing Drugs
MSSNY opposes legislation which would permit optometrists to administer or prescribe drugs for treatment of patients. (HOD 1992-39; Reaffirmed HOD 2014)
70.983 Triplicate Prescription Program: SUNSET HOD 2014
70.984 Expiration Date and Control Number on Prescription Drugs: SUNSET HOD 2014 see 90.972
70.985 Opposition to Legalization of Non-Prescriptive Drugs Such as Heroin and Cocaine:
MSSNY physicians oppose the legalization of the use of non-prescriptive, potentially dangerous drugs such as heroin and cocaine. Use of such drugs poses a serious threat to the health of the individual and society. Use of potentially dangerous drugs frequently leads to limited reasoning ability, unproductive and antisocial behavior, an increase in the development of neurologic, psychiatric, infectious and other medical diseases and fetal health problems. These health considerations outweigh any potential reduction in crime or reduction in the transmission of infection which might be anticipated from the legalization of such drugs. (Council 12/13/90; Modified and reaffirmed HOD 2014)
70.986 New Medications – Testing: SUNSET HOD 2014
70.987 Generic Drug Prescription: SUNSET HOD 2014
70.988 Opposition to Legalization of Drugs for Non-Medically Indicated Uses:
MSSNY is opposed to the legalization for non-medically indicated uses of the following substances: hallucinogenics, narcotics, and cocaine and its derivatives. (Council 1/25/90; Reaffirmed HOD 2014)
70.989 FDA ‘A’ Generic Drug Prescribing: SUNSET HOD 2013
70.990 Political Pressure and Release of New Medications: SUNSET HOD 2013
70.991 Physician’s Right to Dispense Drugs and Devices:
MSSNY supports the position taken by the AMA House of Delegates in June, 1986 to support the physician’s right to dispense drugs and devices when it is in the best interest of the patient and consistent with the AMA’s Ethical Guidelines. (Council 4/23/87; Reaffirmed HOD 2013)
70.992 Marijuana: SUNSET HOD 2013
70.993 “Look-Alike” Drugs:
MSSNY encourages federal legislation prohibiting the manufacture, sale, distribution or gift of substances which look like controlled substances (“Look-alikes”). MSSNY supports stricter legislation controlling the advertising and sale of “Look-Alike” medications. (Council 12/13/84; Reaffirmed HOD 2013)
70.994 Qualitative Labeling of All Drugs:
MSSNY strongly supports efforts to promote qualitative drug labeling of all drugs, requiring the active and inactive ingredients of all drugs (over-the-counter as well as prescription) to be listed on the label or package insert for the drug. (Council 12/13/84; Reaffirmed HOD 2013)
70.995 Generic Drug Labeling:
All generic medications should have an identifying number or symbol. (Council 12/13/84; Reaffirmed HOD 2013)
70.996 Heroin for Pain Relief:
MSSNY opposes the use of heroin for pain relief in patients because there are sufficient pain medications available for treatment. (Council 6/21/79; Reaffirmed HOD 1984-57; Modified and Reaffirmed HOD 2013)
70.997 Generic Drug Substitution Statement on “Physician” Prescription Blanks:
MSSNY supports the position that Doctors of Medicine and Doctors of Osteopathy be permitted to use the word “Physician” on their own personal prescription blanks and that those with D.D.S. degrees be permitted to use the word “Dentist,” those with D.V.M. degrees use the word “Veterinarian,” etc. (HOD 1983-8; Reaffirmed HOD 2015)
70.998 Generic Drug Substitution:
The members of the Medical Society of the State of New York are as interested as any other group of citizens in the State, if not more so, in eliminating unnecessary costs in the delivery of health care and are actively engaged in developing measures that will lead to the most effective use of the dollars expended on health care, provided that none of these measures results in a lowering of the quality of medical care available to and afforded the public. Two measures that could lead to a wider use of generic drugs should be considered:
(1) The first is to conduct controlled, scientifically valid studies to conclusively establish that generic drug substitutes are equivalent in bio-availability and therapeutic equivalence. Disturbing reports have appeared in scientific medical literature that seriously question whether generic drugs approved by the FDA do, in fact, satisfy these criteria. In the face of such doubts, it is understandable that physicians will be reluctant to authorize drug substitutes for medications with which they are familiar by experience. The necessary studies do entail expenditure of money and delays, but these are small prices to pay when one is primarily concerned with providing the very best available drug to an ill patient.
(2) A second major deterrent to physicians readily agreeing to generic drug substitution is the question of their liability if a substitute, of which they have insufficient knowledge and no control in choice, should prove to be ineffective for the purpose intended and the patient suffers thereby. Our Society has had correspondence with both the State and Federal governments to determine the limitations of a physician’s liability and the responses have been equivocal. It is our interpretation, as the Law now stands, that the physician may still be liable. An unequivocal statement of acceptance, of complete liability, by either the Federal or State government, in the event of untoward effects developing solely from the use of a generic drug substitute such as was promulgated for the swine flu immunization program, would remove this anxiety from the physician’s mind and encourage wider use of generic substitution.
There is a basic principle to be stressed in the consideration of this subject, namely, that no law should curb the professional judgment of a physician in the treatment of his patient. Years of intensive schooling and training mark the education of a physician and his licensure. It is such training that establishes the physician as the one best able to determine the most effective means of therapy for the individual problems of a particular patient. It is most earnestly hoped that no inadequate substitute for this professional judgment, based solely on cost, will ever be enacted. (HOD 1983 Reaffirmed HOD 2013)
70.999 Generic Drug Prescription Forms:
MSSNY is in favor, whenever possible, of reducing the cost of care to the patient. Understanding that the freedom of the physician to specify a brand name remains inviolable and accepting the value of the freedom from liability incorporated in a 1982 generic drug substitution legislative proposal, The MSSNY adopted the position of not opposing a bill so long as the method of specifying brand name drugs on prescription forms remains simple, such as D.A.W. (in place of “Dispense as Written”) or checking one of two boxes. (HOD 1982; Reaffirmed HOD 2013)
75.000 DRUGS AND MEDICATIONS: (See also Abortion and Reproductive Rights, 5.000; Drug Dispensing, 70.000; Home Health Care, 135.000; Pharmaceutical Advertising, 227.000; Public Health & Safety, 260.000; Reimbursement, 265.000; Sports and Physical Fitness, 290.000)
75.971 Pharmacy Benefit Managers
The Medical Society of the State of New York will urge the NYS Department of Financial Services to ensure that medications used in the hospital to stabilize palliative and hospice patients for pain and delirium continue to be covered by pharmacy benefit plans after patients are transitioned out of the hospital. This resolution will be transmitted to the American Medical Association for consideration at its next House of Delegates meeting. (HOD 2019-75)
75.972 Pharmaceutical Shortages of IV Bags
The Medical Society of the State of New York will ask the American Medical Association to urge legislation and/or regulatory flexibility to allow for the safe expansion of purchasing medical supplies, equipment and pharmaceuticals from various countries abroad at a time of shortage. (HOD 2018-103)
75.973 Appeals Process for Medications with Proscribed Dosing
The Medical Society of the State of New York will seek regulation and/or legislation to ensure that Medicare, Medicaid and insurance plans in New York State allow physicians to make dosing adjustments for approved medications to allow the patient to achieve therapeutic levels regardless of their body mass index, as well as differing metabolic considerations. The dose administered should be within the purview of the treating practitioners based on clinical parameters, documented in the medical record. (HOD 2015-263, referred to Council, substitute resolution adopted 1/21/2016)
75.974 Pharmaceutical Practices
All pharmaceutical insurers must operate with complete transparency so as not to monopolize the industry. MSSNY shall take action to immediately refer to the New York State Attorney General any evidence of collusion within the pharmaceutical supply chain. (HOD 2015-103)
75.975 Availability of Pharmaceuticals
The Medical Society of the State of New York will work with the New York State Department of Health and the American Medical Association to ensure that the Food and Drug Administration (FDA) appropriately uses its statutory power to aggressively investigate, remediate and prevent drug shortages, including imposing significant penalties on pharmaceutical manufacturers who fail to timely report shortages or discontinuances of medications. (HOD 2015-50)
75.976 Cannabis for Seriously Ill Patients
The Medical Society of the State of New York (MSSNY) adopts as policy the following principles:
1) That the use of cannabis may have a role in treating patients who have been diagnosed with serious, debilitating illnesses, when all other treatments have failed; or when clinical trials have shown to demonstrate comparable efficacy to currently accepted treatments.
2) The Medical Society of the State of New York recognizes the risk of smoking cannabis and encourages the use of alternate delivery systems.
3) Physicians who recommend cannabis for patient use, subject to the conditions set forth above, shall not be held criminally, civilly or professionally liable.
The Medical Society of the State of New York supports continued high quality clinical trials on the use of cannabis for medical purposes. (HOD 2014-161)
75.977: Reducing Cost of Prescription Drugs to Low Income Seniors
AMA should engage in a dialogue with appropriate stakeholders (i.e., state medical associations, national specialty societies, consumer organizations, patient advocacy groups, etc.) in support of the concepts in the “Senior Protection Plan” that would reduce excessive costs of prescription drugs incurred by low income seniors. (HOD 2013-270)
75.978: Oppose Legislature Approval of Smoked Medical Marijuana
MSSNY reaffirms the process in which medications in the USA are regulated and approved by the FDA and not by state legislative action; opposes any process that entrusts the state legislature with the function of approving medications; reaffirms the fact that medication preparation needs to be strictly regulated by the FDA to assure safety, purity and effectiveness; and opposes, except for the terminally ill, any smoking formulation for medical marijuana as a delivery system for medication unless the FDA approves that delivery system. (HOD 2013-157; Reaffirmed HOD 2019 in lieu of res 172)
75.979 Medical Marijuana:
MSSNY will take a leadership role in the development of any regulations resulting from the passage of state legislation pertaining to medical marijuana and also request the American Medical Association’s assistance in seeking a reversal of the Executive Order pertaining to the prosecution of physicians who prescribe or advise medical marijuana, legally under state statute. (HOD 2009-173; Reaffirmed with amendment HOD 2019)
75.980 Inappropriate Incentives for Recommending Generic Drugs over Brand Name Drugs:
MSSNY will introduce a resolution at the June 2009 Annual Meeting of the American Medical Association (AMA) calling upon the Centers for Medicare & Medicaid Services to abolish the provision of providing incentives for pharmacists to “push” generic drugs over brand name drugs; and, through the AMA, to urge the Centers for Medicare & Medicaid Services to assure that there be greater transparency between the use of generics vs. brand name medications so as to enable patients to make informed and intelligent decision. Also, MSSNY to seek passage of legislation similar to that passed in Maine in 2003 and, subsequently, in other states, that would allow for the regulation of Pharmacy Benefit Management plans by imposing contract transparency and conflict of interest requirements and would require that savings based on drug volume discounts be passed on to client health plans and consumers. (HOD 2009-103; Reaffirmed HOD 2019)
75.981 “Pay for Delay” Arrangements by Pharmaceutical Companies:
MSSNY will forward a resolution to the American Medical Association exhorting that organization to support the Federal Trade Commission in its efforts to stop these “pay for delay” arrangements. (HOD 2008-207; Reaffirmed HOD 2018)
75.982 Extend Phase-out Period for Proven CFC Inhalers: (HOD 2008-170; SUNSET HOD 2018)
75.983 Limiting Coverage for Psychiatric Drugs:
MSSNY will urge the appropriate state agency and/or State Legislature to prohibit the practice of health insurance companies restricting access to psychiatric drugs by (1) requiring failure of a generic drug prior to permitting coverage for a non-generic drug; (2) limiting doses by number of pills per day; or (3) limiting coverage to certain formulations.
MSSNY also will seek legislation or other appropriate remedies to assure that patients who switch insurance companies be able to continue on their existing chronic drug therapies. (HOD 2008-54; Reaffirmed HOD 2018)
75.984 Medical Use of Marijuana/Synthetic Cannabinoids:
MSSNY encourages additional research on the use of cannabinoid products in the treatment of illness and the relief of human suffering without penalty. (HOD 2007-151; Modified and Reaffirmed HOD 2017; Reaffirmed HOD 2018 in lieu of res 166; Reaffirmed HOD 2019 in lieu of res 172)
75.985 Availability of Nicotine Replacement:
MSSNY supports the sale of nicotine replacement products in settings where cigarettes are sold and will work with the NYS Department of Health to make free nicotine replacement products available in physicians’ offices. (HOD 2006-161; Amended HOD 2016; Reaffirmed HOD 2019 in lieu of res 250)
75.986 Herbal Supplements:
(1) MSSNY will work with the American Medical Association to educate physicians and the public to report potential adverse events associated with dietary supplements and herbal remedies to help support FDA’s database of adverse event information on these forms of alternative/complementary therapies;
(2) MSSNY, in conjunction with the AMA, supports efforts to modify the Dietary Supplement Health and Education Act to require that (a) dietary supplements and herbal remedies including the products already in the marketplace undergo FDA approval for evidence of safety and efficacy; (b) meet standards established by the United States Pharmacopeia for identity, strength, quality, purity, packaging, and labeling; (c) meet FDA post-marketing requirements to report adverse events, including drug interactions; and (d) pursue the development and enactment of legislation that declares metabolites and precursors of anabolic steroids to be drug substances that may not be used in a dietary supplement;
(3) MSSNY will work with the AMA to support enforcement efforts based on the FTC Act and current FTC policy on expert endorsements;
(4) That the product labeling of dietary supplements and herbal remedies contain the following disclaimer as a minimum requirement: “This product has not been evaluated by the Food and Drug Administration and is not intended to diagnose, mitigate, treat, cure, or prevent disease.” This product may have significant adverse side effects and/or interactions with medications and other dietary supplements; therefore it is important that you inform your doctor that you are using this product;
(5) That in order to protect the public, manufacturers be required to investigate and obtain data under conditions of normal use on adverse effects, contraindications, and possible drug interactions, and that such information be included on the label; and
(6) MSSNY will continue its efforts to educate patients and physicians about the possible ramifications associated with the use of dietary supplements and herbal remedies. (HOD 2004-151; Modified and reaffirmed HOD 2014)
75.987 Medical Marijuana: SUNSET HOD 2020
75.988 Medicare and ‘Off Label’ Uses of Drugs:
MSSNY confirms its strong support for the autonomous clinical decision-making authority of physicians to prescribe medications for ‘off-label” use. (HOD 2004-67; Modified and reaffirmed HOD 2014; Reaffirmed HOD 2015-53)
75.989 Unregulated Sympathomimetic Amines:
MSSNY will work closely with the AMA to urge the FDA to formulate a definitive policy regarding the under-regulated sale of over-the-counter (OTC) Sympathomimetic Amines (SMAs) in medications (with particular emphasis on weight control supplements that contain SMAs) as a means of preventing morbidity and mortality. MSSNY will encourage the FDA to reconsider the appropriateness of providing SMAs OTC, or as a prescription medication, while also investigating the onslaught of excessive advertising by companies that market and promote these products to the general public. MSSNY will recommend the FDA, and other appropriate governmental agencies, perform clinical studies as to the potential parallel adverse effects of pseudoephedrine and ephedrine to the PPA experience with central nervous system events in women, as well as the potential effects all of the products have on hypertension in our population. Also, MSSNY will work towards educating physicians and the public on the potential adverse events to the use of supplements through its website, news articles, and other avenues. (HOD 2003-164; Reaffirmed HOD 2013)
75.990 Opposition to Bill Mandating Electronic Submission of Prescriptions:
MSSNY opposes any bill that would mandate physicians type or electronically submit prescriptions and that instead, MSSNY supports legislation that encourages that prescriptions be legible and supports a state funded pilot program that studies the efficacy of the use of electronic prescribing technology in hospitals and physicians’ offices as a means to reduce medical errors involving prescriptions. (Council 11/8/01; Reaffirmed 2011 HOD)
75.991 Herbal Substances: SUNSET HOD 2014
75.992 Prohibition of Inappropriate Pill Splitting:
It is the position of MSSNY that the New York State Insurance Department and all other appropriated state agencies prohibit insurance companies from requiring pill splitting. (HOD 2000-160; Reaffirmed HOD 2014)
75.993 Schedule I Drug Butyrolactone (GBL or 2G3H)-furanone dihydro):
SUNSET HOD 2014
75.994 Enhanced Funding for ADAP (Aids Drug Assistance Program), including Drug Availability and Post Exposure Prophylaxis): SUNSET HOD 2014
75.995 Payment for Medications Containing Estrogen and Progesterone:
SUNSET HOD 2014
75.996 Use Of Marijuana For Treatment of Glaucoma:
SUNSET HOD 2014
75.997 Serialized Prescriptions:
SUNSET HOD 2014
75.998 Diet Pills:
MSSNY endorsed the banning of over-the-counter diet pills entirely until such times as there is sufficient proof of their safety and effectiveness. (Council 12/13/84; Reaffirmed HOD 2013)
Amphetamines: SUNSET HOD 2013
80.989 Ethical Protection of Physicians
MSSNY will continue to support legislation that protects physicians from any retaliatory acts by employers, insurance companies, and other payers when they act in the best interest of their patients and in a manner consistent with their ethical obligations and consistent with state and federal laws. MSSNY will educate physicians regarding existing legal protections that limit retaliatory acts by employers, insurance companies and other payers when they act in the best interest of their patients in a manner consistent with their ethical obligations and consistent with state and federal laws. (HOD 2019-73)
80.990 Pardon Dr. John Natale
The Medical Society of the State of New York will petition President Donald J. Trump for the purpose of obtaining a pardon for Dr. Natale, offering some solace for the loss of his career and good name. (HOD 2019-204)
80.991 Free John Natale, MD
The Medical Society of the State of New York sent a letter to the Natale Family outlining MSSNY’s opposition to the criminalization of good faith errors in medical judgment and record keeping. The Council approved a resolution to the AMA which was adopted and amended AMA policy H-160.954 to read: (1) Our AMA continues to take all reasonable and necessary steps to insure that errors in medical decision-making and medical records documentation, exercised in good faith, does not become a violation of criminal law. (2) Henceforth our AMA opposes any future legislation which gives the federal government the responsibility to define appropriate medical practice and regulate such practice through the use of criminal penalties. (Council 4/14/13)
80.992 Proposal for a “Two-Tier” Pain and Suffering System in Medical Liability Cases:
MSSNY will seek legislation creating a two-tier pain and suffering award system for medical liability cases whereby
- the jury’s award for pain and suffering would be capped at $250,000;
- if the plaintiff’s attorney considered the award insufficient, he/she would be permitted to file a motion with the judge for a post-verdict modification;
- the judge would be permitted, in the interests of justice, to adjust all aspects of the award, including pain and suffering; and
- the judge’s decision regarding any pain and suffering award would not be limited to the $250,000 cap. (HOD 2010-63; Reaffirmed HOD 2019 in lieu of res 102)
80.993 Collaboration with the Bar Association on Apology Legislation:
-support collaborative efforts with the American Bar Association (ABA) and the New York Bar Association to pursue legislation to protect statements of apology, confessions of regret, or admission of errors to patients and/or their families regarding less than anticipated clinical outcomes from being admissible as admission of liability;
-ask the American Medical Association to support collaborative efforts with the American Bar Association and its affiliates to pursue legislation to protect statements of apology, confessions of regret, or admission of errors to patients and their families regarding less than anticipated clinical outcomes from being admissible as admission of liability;
-utilize this collaboration and the American Bar Association policy that supports enactment of apology legislation to facilitate movement toward medical liability reform. (HOD 2009-55; Reaffirmed HOD 2019)
80.994 Expungement of Record of Liability:
MSSNY will seek legislative, regulatory or other appropriate means to eliminate the requirement for a physician to report any information regarding a medical liability claim brought against him or her that has been concluded without monetary or other pecuniary relief being paid on behalf of that physician. (Council 11/20/08; Reaffirmed HOD 2018)
80.995 Support the “Sorry Works” Program:
MSSNY supports the “Sorry Works” Program which also protects against the use of the physician’s admission against interest in a subsequent lawsuit as long as it is accompanied with meaningful tort reform and also urge the American Medical Association to support the Program. (HOD 2008-97; Reaffirmed HOD 2018)
80.996 Bifurcation of Trial:
MSSNY will seek legislation to require bifurcation of trial in all medical liability cases. (HOD 2007-53; Reaffirmed HOD 2017)
80.997 Use of Expert Testimony:
MSSNY continues to advocate for meaningful reform regarding the use of expert testimony, including but not limited to: (1) requiring pre-trial disclosure of the identity of experts; (2) requiring the deposing of experts; (3) requirements that experts have a similar specialty, clinical background, and be in active practice similar to that of the physician whose care is the subject of the action; or (4) through the establishment of programs where expert testimony can be pre-approved by appropriate medical experts. (HOD 2007-52; Reaffirmed HOD 2017)
80.998 Medical Courts for Medical Liability Cases:
MSSNY seeks the creation of medical courts which are composed of judges who have undergone specialty training and have been certified to hear medical liability cases. (HOD 2007-51; Reaffirmed HOD 2010-64; Reaffirmed HOD 2020)
80.999 Professional Conduct Review:
The basic principles of a fair and objective hearing should be accorded to the physician whose professional conduct is being reviewed. These basic guarantees are: a specific charge, adequate notice of hearing, and opportunity to be present and to hear the evidence, and to present a defense. These principles apply whether the hearing body is a medical society tribunal or a hospital committee composed of physicians. (Council 12/16/76; Reaffirmed HOD 2013)
85.944 Medical Education Debt Cancellation in the Face of a Physician Shortage During the COVID-19 Pandemic
MSSNY will seek through legislation, regulation, or executive order to obtain this one-time COVID-related $50,000 reduction in debt from accrued federal loans for all medical students, training physicians, and early career physicians.
MSSNY will forward this resolution to the AMA asking for study of the issue of medical education debt cancellation and to consider the opportunities for integration of this in a broader solution addressing debt for all medical students, physicians in training, and early career physicians. (HOD-2021 AMA #4, referred to Council, adopted 4/15/21)
85.945 Defining What Constitutes Appropriate Use of Terms Residency and Fellowship
MSSNY will work with all relevant organizations/parties to ensure that the terms “residency” and “fellowship” are reserved for designation by programs that train physicians. (HOD 2020-217)
85.946 Promoting Addiction Medicine during a Time of Crisis
The Medical Society of the State of New York endorses and supports the incorporation of addiction medicine science into medical student education and residency training. This resolution will be transmitted to the American Medical Association, Liaison Committee on Medical Education, Commission on Osteopathic College Accreditation, American Osteopathic Association, and the Accreditation Council of Graduate Medical Education. (HOD 2019-164)
85.947 Reducing Barriers to Mental Health Service Utilization in Medical Students
MSSNY will encourage all medical schools in the State of New York to:
-assign a mental health provider to every incoming medical student and provide an easy way for medical students to select a different provider at any time;
-require each student’s mental health provider or related staff to contact the student once per semester to ask if the student would like to meet with their mental health provider, unless the student already has an appointment to do so or has asked not to be contacted with regards to mental health appointments;
-provide an easy and confidential process for students to initiate treatment with school mental health professionals at no cost to the student, or at an affordable cost with mental health professionals in the community;
-and do so without undue bureaucratic burden.
MSSNY will immediately bring this resolution to the AMA HOD at Annual-19. (HOD 2019-161)
85.948 Reducing Health Disparities through Education
The Medical Society of the State of New York (MSSNY) will work with the New York State Department of Health (NYSDOH), and the New York State Department of Education (NYSDOE), to raise awareness about the health benefits of education and to establish a meaningful health curriculum (including nutrition) for grades kindergarten through 12 which will be required for High School graduation. MSSNY will forward this resolution to the American Medical Association toward the same goals and strategies nationally to reduce health disparities. (HOD 2019-159)
85.949 Autopsies as an Educational Tool
The Medical Society of the State of New York supports postmortem examinations, including autopsies, and that such examinations make use of all available modern technologies. MSSNY will advocate to the Associated Medical Schools of New York (AMSNY) that post mortem examinations, including autopsies be incorporated into the curriculum of medical schools. (HOD 2019-152)
85.950 Mental Health Services for Medical Students
MSSNY will encourage Medical Schools in New York State to provide confidential in-house mental health services at no cost to students, without billing health insurance, and to set up programs to educate both students and staff about burnout, depression, and suicide. MSSNY will also encourage Medical Schools in New York State to offer affordable, confidential off-site counseling.
MSSNY will bring this resolution to the AMA so that the AMA can recommend that the AAMC strengthen their recommendations to all the medical schools to mandate these services for our medical students. (HOD 2019-104)
85.951 Promoting 4-Year, Vertical Ultrasound Curricula in Undergraduate Medical Education
The Medical Society of the State of New York, the American Medical Association, and the American Osteopathic Association will communicate with US medical schools that the inclusion of clinician-performed, point of care ultrasound instruction and training; including didactic and practical experiences covering the application to a broad range of organ systems and procedures for a wide variety of future specialists should be studied. The resolution should be sent to the AMA for consideration. (HOD 2017-156; amended and adopted by Council, March 2018).
85.952 Providing Income tax Credit to Healthcare Professionals for Clinical Preceptorships
The Medical Society supports the creation of a state-wide clinical preceptorship tax credit for community and hospital based health care practitioners and that any necessary documentation for the tax credit be contained in a simple form to encourage participation in the program. The resolution was additionally sent to AMA. (HOD 2017-112; amended and adopted by Council, March 2018)
85.953 Expanding GME Concurrently With UME
MSSNY will support the expansion of residency slots with a view to the current and future needs of the United States population, and bring a resolution to this effect to the 2016 Annual Meeting of the American Medical Association. (HOD 2016-208)
85.954 Educating Physicians and Students on the Identification and Care of Human Trafficking Victims
MSSNY will publicize the availability of existing screening tools to assist in the identification of victims of human trafficking, and make them available through linkage on the Society’s website. MSSNY will also work with all appropriate specialty societies to increase human trafficking awareness among medical students and physicians. (HOD 2015-205)
85.955 MSSNY to Endorse the “Choosing Wisely” Program
The Medical Society of the State of New York endorses the American Board of Internal Medicine’s Choosing Wisely program and the New York delegation to the American Medical Association will encourage the AMA to consider endorsing the ABIM’s Choosing Wisely program. (HOD 2014-205)
85.956: Life-Sustaining Treatment in the Developmentally Disabled with Severe Dementia
MSSNY requests that the New York State Department of Health (DOH) study the problems physicians and surrogates face when seeking the required permission from the Office for People With Developmental Disabilities (OPWDD) and the Mental Hygiene Legal Service (MHLS) to withdraw or withhold cardiopulmonary resuscitation and life-sustaining treatment in people with developmental disabilities who develop severe dementia. The DOH should educate the agencies (OPWDD, MHLS, and Commission on Quality of Care and Advocacy for Persons with Disabilities (CQC)) that make healthcare decisions for this population on the implications of severe dementia in people with developmental disabilities, as well as the futility and burden of care created for these patients by cardiopulmonary resuscitation and life-sustaining treatments such as long term artificial hydration and nutrition. MSSNY should work with the AMA and DOH to establish guidelines that define terminal dementia and give guidance for its diagnosis in the developmentally disabled. (HOD 2013-259)
85.957: Protecting Biomedical Research
MSSNY supports legislation to further protect all participants in bio-medical research from violence, harassment, and cyberstalking from protesters (HOD 2013-70)
85.958 First Do No Harm-Initiative to Improve Mistreatment Transparency of Medical Students, Residents And Fellows
The Medical Society of the State of New York is very concerned about mistreatment of medical students, residents, and fellows; defined by the Association of American Medical Colleges in its Graduate Questionnaire of 2001 as behavior that “shows disrespect for the dignity of others and unreasonably interferes with the learning process. It can take the form of physical punishment, sexual harassment, psychological cruelty, and discrimination based on race, religion, ethnicity, sex, age or sexual orientation.”
The Medical Society of the State of New York will request that the AMA Council on Medical Education produce a report in which the ACGME, LCME, and Commission on Osteopathic College Accreditation (COCA) accredited institutions and residency and fellowship training programs be invited to participate in a “First Do No Harm Initiative” by voluntarily disclosing to the Council recent internal records containing, but not limited to, anonymous individual institutional annual rate of formally and informally reported mistreatment, which may be reported by department and by course/rotation, including mechanisms for reporting and efforts at transparency; and that the AMA Council on Medical Education report back to the Interim 2013 AMA House of Delegates. (HOD 2012-164, amended & adopted by Council 11/29/12)
85.959 Increasing Funding for Graduate Medical Education:
- encourage both public and private payers to contribute to Graduate Medical Education (GME) funding, through, for example, expansion of government grant opportunities similar to the Primary Care Residency Expansion Program;
- encourage adjusting GME funding to account for the need of an expanded workforce;
- advocate for transparency in the funding of residency programs and for how those programs in turn use allotted funding;
4) urge the American Medical Association to work toward the removal of caps on the number of Medicare funded residency programs and physicians therein. (HOD 2011-166)
85.960 Securing Quality Clinical Education Sites for US-Accredited Schools:
MSSNY will support preference being given to students from LCME/COCA accredited medical schools over international and dual campus students for clinical clerkship rotations in hospital or affiliated clinics. (HOD 2011-165)
85.961 AMA Encouragement of State Medical Societies to Form Committees to Eliminate Health Care Disparities:
MSSNY’s Delegation to the American Medical Association will introduce a resolution at its next meeting requesting that the AMA (1) urge that the state medical societies that are not yet members of the AMA Commission to Eliminate Health Care Disparities join and participate in this important public health initiative and (2) strongly encourage all state medical societies to form a Standing Committee to Eliminate Health Care Disparities and that those committees share ideas and work together as a coalition. (HOD 2011-163)
85.962 Specialty Exams:
MSSNY will request of the American Medical Association that:
(1) it recommend to the American Board of Specialties that a physician in private practice be required to take only one proctored board exam within that physician’s specialty every ten years, and that within the maintenance of certification at the same exam other optional sections should be devoted to the added qualifications; and
(2) it request that its component specialty societies restrain from dividing every aspect of their specialist physician practice into numerous added qualification exams and that, whenever possible, alternate methods be sought to ensure adequate qualifications and make the process less onerous for physicians in private practice. (HOD 2011-115; Reaffirmed in lieu of HOD 2017-205)
85.963 Promotion of Financial Aid Opportunities for New York Medical Students:
MSSNY will: (a) advocate for the expansion of the Doctors Across New York Physician Loan Repayment Program by increasing the number of available positions, and directing any unused funds in the Loan Repayment Program toward the Practice Support Program; (b) support the development of State funded loan forgiveness and repayment programs for physicians; and (3) advocate for the development of scholarships and/or grants for medical students who plan to work in the state. (HOD 2011-108; Reaffirmed HOD 2019 in lieu of res 103 and 201)
85.964 Non-Alcohol Fatty Liver Disease:
MSSNY will educate the public and physicians about Non-Alcoholic Fatty Liver Disease (NAFLD), its link to Metabolic Syndrome, the possible dire consequences which may lead to cirrhosis and hepatocellular carcinoma, and that this disease is preventable by lifestyle changes, including proper diet, diabetes prevention and control and weight loss. (HOD 2010-156; Amended and reaffirmed HOD 2020)
85.965 Use of Prefilled Insulin Syringes: SUNSET HOD 2020)
85.966 Use of Waiting Room Educational DVDs: SUNSET HOD 2020
85.967 The Importance of the Theory of Evolution in Science Education:
MSSNY endorses the teaching of the theory of evolution as an integral part of science curriculum throughout the continuum of the educational experience. (HOD 2009-165; Reaffirmed with amendment HOD 2019)
85.968 Reform the Methodology for Calculating Direct Graduate Medical Education Payments:
MSSNY will urge that (1) the current methodology for calculating direct Graduate Medical Education (GME) payments be updated to reflect the actual costs that a hospital incurs for training residents, rather than a hospital-specific per resident amount determined by the Centers for Medicare & Medicaid Service (CMS) for all teaching hospitals; (2) caps on Medicare’s support for GME residency positions be eliminated which would enable teaching hospitals to cover their costs and subsequently train more physicians. (HOD 2009-153; Reaffirmed with amendment HOD 2019)
85.969 Increasing Matriculation of Medical Students:
(HOD 2008-102; SUNSET HOD 2018)
85.970 Physician Education to Address Malpractice Insurance Crisis:
All physicians in the State of New York will be urged to participate in a series of malpractice educational seminars in their respective communities. The urgency for such an educational program, to highlight the malpractice crisis and the prospective loss of available medical care, will be communicated to the general public via the media with citizens being directed to demand action by their State legislators for medical liability tort reform. (HOD 2008-99; Reaffirmed HOD 2018)
85.971 Health Promotion Visits: (Sunset HOD 2017)
85.972 Broad-based Education Campaign for New Yorkers on the Medical Liability Crisis: (Sunset HOD 2017)
85.973 Medical School and Graduate Medical Education:
That MSSNY work with the Associated Medical Schools of New York, to develop a program that would encompass: 1) Recruitment of interested community-based physicians to serve as preceptors/mentors for undergraduate medical students assigned to ambulatory clinical learning experiences; 2) Training for the role of preceptor/mentor for such volunteers, with appropriate CME credits for the training; 3) Appointment to the clinical faculty rolls of a medical school for such volunteers, who satisfy agreed-upon standards of performance as preceptors/mentors; 4) Assignment of medical students to the practice offices of such volunteer physicians for purposes of ambulatory clinical learning experiences, with appropriate access to the patients of the practice for educational purposes; and 5) Evaluation at intervals of the experiences of the students and the community-based physicians to determine the effectiveness of the program. (Council 6/22/06; Reaffirmed HOD 2016)
85.974 Need to Expose and Counter Nurse Doctoral Programs (NDP) Misrepresentation:
Institutions offering advanced education in the healing arts and professions shall fully and accurately inform applicants and students of the educational programs and degrees offered by an institution and the limitations, if any, on the scope of practice under applicable state law for which the program prepares the student; that MSSNY work jointly with the State Education Department to identify and prosecute those individuals who misrepresent themselves as physicians to their patients and mislead program applicants as to their future scope of practice; and that MSSNY encourage hospital staff organizations, to counter misrepresentation by Nurse Doctoral Programs and their students and graduates, particularly in clinical settings. (HOD 2006-91; Reaffirmed HOD 2016)
85.975 Federation Credentials Verification Service (FCVS):
That the Medical Society of the State of New York supports beginning the process, by the Federation Credentials Verification Service (FCVS), of compiling documents needed for medical licensure of International Medical Graduates, after 2 ½ years of medical residency, upon receiving certification by the Residency Program Director that the IMG will be competent to be licensed, pending satisfactory completion of the final 6 months of training; and that one month before the end of the Residency Program, FCVS send all necessary documentation for licensure of an International Medical Graduate to the New York State Education Department in order that the license be ready immediately upon the completion of the 3 year Residency Program. (Council 1/26/06; Reaffirmed HOD 2016)
85.976 Task Force to Eliminate Ethnic and Racial Health Care Disparities Recommendations:
SUNSET HOD 2015
85.977 Oppose Tuition Increase for Medical Students:
MSSNY develop policy and take action to oppose any proposed legislation that would require students and graduates of the State University of New York (SUNY) medical schools to agree to practice in a particular locale as a condition of matriculating or paying New York State resident tuition. (HOD 2005-68; Reaffirmed HOD 2015)
85.978 Preventing Excessive and Retroactive Tuition Increases:
That MSSNY and the Medical Student Section officially oppose implementation of retroactive tuition increases, that MSSNY encourage all medical schools in New York State to implement a “truth-in-tuition” policy, that would freeze the tuition charged for the four years, at the same amount a student was charged at the time of enrollment into medical school (with adjustments made for increases in the Consumer Price Index) to allow students to do financial and career choice planning, and that the MSSNY encourage all medical schools in New York State to implement a “timely disclosure” policy that discloses the tuition for the schools, prior to May 15, so that students can have this information before choosing which medical school to attend. (Council 11/4/04; Reaffirmed HOD 2005-68; Reaffirmed HOD 2015)
85.979 Academic Medical Centers Resident/Fellow Recruitment: SUNSET HOD 2014
85.980 Nutrition, Physical Activity and Weight Management Curriculum in Medical Schools:
MSSNY encourages all New York State medical schools to develop a nutrition, physical activity and weight management curriculum at both the basic science level and the clinical level; (2) that MSSNY also encourage New York State medical schools to integrate nutrition and physical activity education into their residency programs and encourage the development of bariatric medicine fellowship programs. (HOD 2004-161; Modified and reaffirmed HOD 2014)
85.981 State Mandated Training Programs: SUNSET HOD 2013
85.982 Resident Work Hours: SUNSET HOD 2013
85.983 Registration of MSSNY CME Credits:
MSSNY will enter continuing medical education (CME) information into the MSSNY database for its members who have taken a MSSNY CME course thereby allowing the physician to have his/her CME information available. (HOD 2002-167; Modified and Reaffirmed HOD 2013)
85.984 Impact of Changes to Section 405 of Title 10 of the New York Code of Rules and Regulations:
Sunset HOD 2011
85.985 Full Reimbursement for Training Costs of PGY V and VI of Child Psychiatry Training:
It is MSSNY’s policy that there should be full reimbursement for training costs of PGY V and VI years of child psychiatric training. (HOD 2001-74; Reaffirmed HOD 2011)
85.986 Funding for Graduate Medical Education: Rescinded HOD 2011-166; Replaced by 85.959
85.987 Adjusting Medical School Curricula: SUNSET HOD 2014
85.988 Placement of Resident Physicians From Disbanded Residency raining Programs:
MSSNY reaffirms its support for AMA Policy H-310.943 on closing residency programs to strongly encourage residency programs to offer placement of their resident physicians in comparable positions before disbanding a training program. (Council 3/19/98; Reaffirmed HOD 2014)
85.989 Advocacy Policy to Increase Number of Minority Physicians:
MSSNY recognizes the threat to minority physician training incident to downsizing of training programs in the state; and will work with other organizations, including physician organizations and government toward maintaining and increasing relative numbers of minority physicians. (HOD 1998-160; Modified and reaffirmed HOD 2014)
85.990 The HCFA Demonstration Project’s Potential for Abuse: SUNSET HOD 2014
85.991 Preservation of Opportunities for US Graduates and IMGs Already Legally Present in This Country:
In the event of reductions in the resident workforce in the State of New York, the Medical Society of the State of New York will advocate for a mechanism of resident selection which promotes the maintenance of resident physician training opportunities for all qualified graduates of United States Liaison Committee on Medical Education and American Osteopathic Association accredited institutions.
MSSNY adopts and will publicize the position that if hospitals reduce the number of residency positions they offer, MSSNY will continue to advocate for equal consideration in the candidate selection process of IMGs who are already legally present in this country.
MSSNY will ask the AMA to urge the Educational Commission for Foreign Medical Graduates (ECFMG) to reduce the number of examinations it offers abroad, in the light of decreased availability of residency position; and make it clear to graduates of international medical schools that the opportunity for residency training and practice in the United States are becoming extremely limited.
This information should be included in the initial application materials given to the candidates prior to the examination. (HOD 1997-228; Reaffirmed Council 3/19/98; Reaffirmed HOD 2014 with recommendation for development of more relevant policy)
85.992 Residents’ Ability to Write Restraint Orders: SUNSET HOD 2014
85.993 Opposition to Medical Resident Education Fee:
MSSNY will continue to strongly oppose any legislation that includes an annual fee for medical residents. The Division of Governmental Affairs of MSSNY will continue to strongly oppose any New York State budget that includes an annual fee for medical residents; and will report to the MSSNY-RPS any further action attempted by the State of New York regarding this issue as soon as possible. (HOD 1997-86; Reaffirmed HOD 2014)
85.994 Hepatitis Vaccinations for all Medical Students:
MSSNY supports efforts to require all medical students to be vaccinated for Hepatitis A and B unless they have already been vaccinated; and will also require everyone entering a US residency training program to be vaccinated for Hepatitis A and B if they have not yet received vaccination. (Council 3/27/97; Modified and reaffirmed HOD 2014)
85.995 Infection Control Course, Mandated:
MSSNY will seek legislation to eliminate the statutory requirement that physicians complete course work or training in infection control practices every four years. (HOD 1995-67; Reaffirmed HOD 2014)
85.996 Funding for Medical Schools and Teaching Hospitals:
SUNSET HOD 2014
85.997 Animals in Biomedical Research:
MSSNY supports the humane use of animals in biomedical research and advocates support of regulatory policies to protect animals from unnecessary uses in biomedical research. (HOD 91-49; Modified and reaffirmed HOD 2014)
85.998 Graduate Medical Education: SUNSET HOD 2014
85.999 Manpower Assistance for Medical Students:
MSSNY supports the concept of continuing some form of federal manpower financial assistance and support, including general institutional grants, special project grants for medical schools and the continuation of the National Health Service Corps and other support mechanisms such as long term, low interest loans for medical students. (Council 6/26/80; Reaffirmed HOD 2013; Reaffirmed HOD 2019 in lieu of res 103 and 201)
87.991 Support Three-Tiered System of Stroke Centers in New York State
The Medical Society of the State of New York supports development of a comprehensive stroke system within New York State as well as the development of either statewide or regional stroke protocols for New York State’s emergency medical service (EMS) agencies. (Adopted Council, June 2, 2016)
87.992: ST Elevation Myocardial Infarction
MSSNY supports efforts by the New York State Emergency Medical Advisory Committee and the Department of Health Bureau of EMS to encourage the adoption of protocols by the regional emergency advisory councils to transfer suspected STEMI patients, when feasible, directly to a PCI capable facility. (HOD 2013-162)
87.993 Concussion and Traumatic Brain Injuries in Youth:
MSSNY to advocate for the immediate removal from play/practice of any youth suspected of having a concussion or Traumatic Brain Injury (TBI) and also that any youth suspected of sustaining a concussion or traumatic brain injury need written approval by a physician before they can return to play or practice. In addition, MSSNY will promote adoption of this policy within school settings and organized youth sports programs and support educational efforts to improve understanding of concussion and traumatic brain injuries in youth among coaches, trainers, athletes, school officials, parents and legal guardians. (HOD 2011-153; Reaffirmed HOD 2014-151)
87.994 CPR Training as a High School Requirement:
MSSNY to advocate for legislation requiring that high school students attend a training course in cardiopulmonary resuscitation (CPR) and the use of the automated external defibrillator (AED), using the course guidelines recommended by the American Heart Association and endorsed by the American Academy of Pediatrics. (HOD 2011-152)
87.995 Government Funding of Care Given by US Healthcare Providers to Haitian Evacuees: SUNSET HOD 2020)
87.996 Emergency Care Data Collection:
MSSNY to collaborate with the Department of Health and the American College of Emergency Physicians-New York Chapter to determine what data should be collected in Emergency Departments to address the problems of Emergency Department overcrowding, gridlock and diversion and be used for the strategic planning of the health care needs of communities. (HOD 2008-110; Reaffirmed HOD 2018)
87.997 New York State Parking Placard for Physicians on Medical Call:
MSSNY and county medical societies to work with New York State and local agencies in designing and implementing a dashboard parking placard, similar to those used by police and Boards of Education, to function in lieu of MD plates for member physicians for parking in restricted areas in the course of rendering medical care. (HOD 2007-158; Reaffirmed HOD 2017)
87.998 Automated External Defibrillators: SUNSET HOD 2015
87.999 Cardiopulmonary Resuscitation Training:
MSSNY support the training of private citizens in cardiopulmonary resuscitation and defibrillation to enable them to assist others within their community. (HOD 2005-152; Modified and Reaffirmed HOD 2015)
90.986 Air Quality and the Protection of Citizen Health
The Medical Society of the State of New York will urge the American Medical Association to review the Environmental Protection Agency’s guidelines for monitoring air quality which is emitted from smokestacks and that the AMA develop a report of this review, taking into consideration the risks to citizens living downwind of smokestacks and that it include recommendations that would protect public health. (HOD 2020-153)
90.987 Plastic Drinking Straws
The Medical Society of the State of New York will support legislation banning plastic straws with exceptions made for people with disabilities that need them. (HOD 2019-151)
90.988 Ban the Use of Paraquat
MSSNY supports state legislation to permanently ban the use of Paraquat in all forms in New York State and will transmit a copy of this resolution to the AMA for its consideration at its annual House of Delegates. (HOD 2017-153)
90.989 Banning the Use of Gasoline Powered Leaf Blowers
The Medical Society of the State of New York will call upon the New York State Department of Environmental Conservation and the manufacturers of gas leaf blowers to develop guidelines that would dramatically reduce the toxic emissions and noise level of gas leaf blowers. MSSNY will also encourage New York State and other governmental entities to promote the use of non-polluting alternatives to gas leaf blowers.
A copy of this resolution will be transmitted to the American Medical Association for consideration at its House of Delegates. (HOD 2016-152)
MSSNY shall encourage those health care institutions that provide employee housing to make such housing smoke free to the extent allowed by applicable local laws. (HOD 2015-202)
90.991 Public Health Implications of Natural Gas Extraction using Hydraulic Fracturing
The Medical Society of the State of New York will support the planning and implementation of a Health Impact Assessment to be conducted by a New York State School of Public Health; advocate for the establishment of an industry-funded, independently-arbitrated state trust fund for people that may be harmed as a result of hydraulic fracturing; and oppose any non-disclosure provisions related to the practice of hydraulic fracturing that interfere with any aspect of the patient-doctor relationship and/or the ready collection of epidemiological data for future health impact studies. (HOD 2013-171)
90.992 High Volume Hydraulic Fracturing in the Marcellus Shale Area:
MSSNY supports a moratorium of natural gas extraction using high volume hydraulic fracturing in New York State until valid scientific information is available to evaluate the process for its potential effects on human health and the environment. (Council 12/9/10; Reaffirmed HOD 2013-171)
90.993 Latex Gloves:
MSSNY supports legislation to ban the commercial use of latex gloves in New York State. (HOD 2010-152; Reaffirmed HOD 2020)
90.994 Global Climate Change and Public Health Implications:
MSSNY agrees with the Centers for Disease Control and Prevention (CDC) and the World Health Organization (WHO) position that global climate change is occurring and that there exists the potential for abrupt climate change resulting in significant public health consequences.
Also, MSSNY will continue to explore low-cost opportunities to address this matter, such as: (a) sessions at educational conferences and the development of a policy position statement as well as other modes of communicating this issue to the MSSNY membership; (b) inviting qualified members to serve where appropriate on workgroups, coalitions and committees to advance climate change research, interventions, policies and legislation that are consistent with MSSNY’s mission and objectives; and (c) supporting policies and legislation that address measures to prevent or mitigate public health effects of climate change. (HOD 2008-151; Reaffirmed HOD 2018)
90.995 Safe Disposal of Toxic Materials in Consumer Products:
MSSNY will seek laws regarding the disposal of consumer products containing toxic substances sold in New York State to effectively deal with the future public health and financial impacts. (HOD 2008-166; amended and reaffirmed HOD 2018)
90.996 PCB Contamination of the Hudson River:
MSSNY supports the current U.S. Environmental Protection Agency (EPA) recommendations for remediation of polychlorinated biphenyl (PCB) contamination of the Hudson River.(Council 3/19/01; Reaffirmed and Modified HOD 2011)
90.997 Polystyrene and Polyvinyl Chloride Products for Packaging:
MSSNY opposes the use of polystyrene and polyvinyl chloride products for all retail food packaging in New York State. (HOD 1989-40; Reaffirmed HOD 2013)
90.998 Toxic/Hazardous Substances: SUNSET HOD 2013
90.999 Radioactive Waste, Disposal of Low Level:
MSSNY supports low-level radioactive waste disposal providing it contains the following principles: (1) A disposal site must be promptly identified; (2) Low level wastes should be segregated from high level wastes; (3) Long term monitoring of such disposal must be included (4) The costs of such disposal must be borne by those disposing of the wastes; (5) The environment and the health, safety and welfare of those inhabiting nearby areas must be protected. (HOD 1985; Modified and Reaffirmed HOD 2013)
95.967 Truth in Advertising with Regard to Board Certification
The Medical Society of the State of New York will support legislative and regulatory efforts to require that a medical doctor or doctor of osteopathic medicine may not hold oneself out to the public in any manner as being “certified” by a public or private board including, but not limited to a multidisciplinary board, or “board certified,” unless all of the following criteria are satisfied:
- The advertisement states the full name of the certifying board.
- The certification is accurate, current and in good standing.
- The certifying board either:
i. Is a member board of the American Board of Medical Specialties (ABMS), or the American Osteopathic Association (AOA); or
ii.Is an organization that requires successful completion of a postgraduate training program approved by the Accreditation Council for Graduate Medical Education (ACGME) or the AOA that provides complete training in the specialty or subspecialty certified, followed by prerequisite certification by
the ABMS or AOA board for that training field and further successful completion of examination in the specialty or subspecialty certified.
iii.The organization must have written proof of a determination by the Internal Revenue Service that the certifying board is tax exempt under the Internal Revenue Code pursuant to Section 501(c)
- The terms “board eligible”, “board qualified”, or any similar words or phrase calculated to convey the same meaning may not be used in physician advertising.
- A physician who is not board certified by, or a member, fellow, or diplomate of an organization that meets the above requirements in section (3) may not advertise a field of interest, except that the physician may advertise that his or her practice is “limited to” a certain area of practice. (HOD 2017-55)
95.968 AMA Policy on American Health Care Act
MSSNY will call on the AMA to engage in negotiations with the current leadership of the United States in crafting healthcare policy that is in keeping with MSSNY and AMA values. This resolution shall be sent to the AMA Annual 2017 meeting. (HOD 2017-214)
95.969 Healthcare is a Fundamental Human Good
The Medical Society of the State of New York (MSSNY) will help advance the health and well-being of patients, including their access to medical care; MSSNY will reaffirm its commitment to removing barriers to healthcare; and MSSNY will publicly state that healthcare is a fundamental human good. (HOD 2017-208)
95.970 Increasing Organ Donation
The Medical Society of the State of New York will support educational efforts by the New York State Department of Health to promote organ donation.
MSSNY will support laws and corporate policies allowing employees to use paid sick time to become living organ donors. (HOD 2015-168)
95.971 A More Ethical Legislature and Advancing Medicine’s Agenda
The Medical Society of the State of New York (MSSNY) will advocate for legislation and regulation to promote improved ethics and transparency in the state legislature including but not limited to:
- Measures that would sensibly limit all campaign contributions.
- Measures that would restrict the campaign contributions made by law firms of which a legislator is a member, to that legislator only,
- Measures to promote greater transparency and accountability with regard to the lawmakers’ professional activities outside the legislature.
MSSNY will pursue collaboration with health care stakeholders as well as key affinity groups to promote legislative accountability by means of
- Limiting campaign financing,
- Improved transparency and accountability, and
- Limiting the outside impact of the relationship between lawmakers and the legal profession, in order to promote unity and more effective advocacy particularly as it relates to medical liability reform. (HOD 2012-112)
95.972 Organ Donation:
MSSNY will: (1) support efforts to increase education to New York State residents about organ donation; (2) promote physicians’ awareness of the need to discuss organ donation with their patients; and (3) continue its support of the New York State Department of Health’s Organ Donation Registry as a means of increasing organ donation in the state. (HOD 2010-157 referred and adopted Council 1/20/11)
95.973 Physician Involvement in Interrogation and in Torture:
The following definitions are for purposes of this statement:
Torture is defined as the intentional infliction of physical or mental harm for the purpose of gathering information, or to secure control or cooperation of a detainee, or for disciplinary or retaliatory purposes.
Interrogation is defined as questioning related to law enforcement or to military and national security intelligence gathering, designed to prevent harm or danger to individuals, the public or national security. Interrogations are distinct from questioning used by physicians to assess the physical or mental condition of an individual.
Coercive is defined as threatening to cause harm through physical injury or mental suffering.
Detainee is defined as a criminal suspect, prisoner of war, enemy combatant, or any other individual who is being held involuntarily.
Physicians who engage in any activity that relies on their medical knowledge and skills, regardless of jurisdiction or location, must continue to uphold principles of medical ethics. Physicians must not engage, directly or indirectly, in torture or in interrogations. Questions about the propriety of physician participation in interrogations and in the development of interrogation strategies may be addressed by balancing obligations to individuals with obligations to protect the public interest, e.g. from terrorist attack. Precedent for this may be found in public health ethics in which physicians’ expertise inform guidelines, policies, and procedure that lead to the imposition of relatively minor hardships on individuals for public welfare. However, when a physician is directly and clinically involved with an individual, the physician’s obligations to the individual take precedent over public interests.
Physician involvement with interrogations during law enforcement or intelligence gathering should be guided by the following:
(1) Physicians must not directly or indirectly participate in torture or in the development of techniques of torture.
(2) Physicians may perform physical and mental assessments of detainees to determine the need for and to provide medical care. When so doing, physicians must disclose to the detainee the extent to which others has access to information included in medical record. Treatment must never be conditional on a patient’s participation in an interrogation.
(3) Physicians must neither conduct nor directly participate in an interrogation, because a role as physician-interrogator undermines the physician’s role as healer and thereby erodes trust in the individual physician-interrogator and in the medical profession.
(4) Physicians must not monitor an interrogation with the intention of intervening in the interrogation, because this constitutes direct participation in interrogation.
(5) Physicians may participate in developing effective interrogation strategies for general training purposes. These strategies must be humane, respect the rights of individuals, and must not be coercive, for example, threaten or cause physical injury or mental suffering.
(6) When a physician has sound reason to believe that an interrogation constitutes torture, he or she must report this concern to the appropriate authorities. If the authorities are aware of the inappropriate interrogation but have not intervened to either stop the interrogation or prevent further inappropriate interrogations, physicians are ethically obligated to report such interrogations to independent authorities that have the power to investigate and/or adjudicate such allegations. (Council 11/19/09; Reaffirmed HOD 2015-167)
95.974 Discourage Gifts from Pharmaceutical and Device Companies:
MSSNY will affirm its support for American Medical Association Council on Ethical and Judicial Affairs (CEJA) Opinion No. 8.061 and disseminate this opinion to the membership so that it guides them in their contacts with industry. (HOD 2009-203; Reaffirmed HOD 2019)
95.975 Politics Should Not Over Rule FDA Scientific Findings: Sunset HOD 2016)
95.976 No Place for Vicarious Liability:
MSSNY seeks legislation, regulation or other appropriate means to assure that settlements or judgments vicarious in nature, as determined by the liability carrier, NOT be posted, listed or utilized by the Department of Health for any physician public Website profile. (HOD 2006-62; Reaffirmed HOD 2016)
95.977 Health Care Proxies:
MSSNY urges all physicians to complete their own Health Care Proxies and encourage their families and their patients to do the same.(Council 3/14/05; Reaffirmed HOD 2015)
95.978 Moratorium on Capital Punishment: Sunset HOD 2011
95.979 Testimony in Professional Liability Cases:
MSSNY takes the position that a physician who provides expert medical testimony in bad faith and/or who provides expert medical testimony that has no recognized scientific validity, is guilty of professional misconduct, and should be reported to the appropriate Office of Professional Medical Conduct.
MSSNY shall encourage all national specialty organizations to enact rules and disciplinary methods, utilizing the American Association of Neurological Surgeons as a model, to promote fair and honest expert testimony. (HOD 2000-82; Reaffirmed HOD 2014)
95.980 Use of Percentage-of-Fee Based Compensation Arrangements:
The Medical Society reaffirms its support for the underlying principle that a physician’s dedication to providing competent medical service for his or her patient is paramount. Moreover, we also support the opinion that the physician’s control over clinical decision-making must remain unencumbered and independent from non-clinical influence. The Medical Society recognizes that the continuation of the corporate practice of medicine doctrine’s prohibition against an unlicensed person or entity’s influence in the practice of medicine is necessary to uphold these principles and to protect against potential abuses and fraudulent activity. Physicians must remain knowledgeable of and in control of the business aspects of their practice and should not relinquish such authority to non-physician business entities. In our opinion, the following “business” decisions and activities involving control over the physician’s individual practice of medicine should be made by a physician and not by a non-physician or entity:
- ownership and control of a patient’s medical records, including determining the contents thereof;
- selection (hiring/firing as it relates to clinical competency or proficiency) of professional, physician extender and allied health staff;
- set the parameters under which the physician will enter into contractual relationships with third party payors
- decisions regarding coding and billing procedures for patient care services; and
- approval of the selection of medical equipment.
Moreover, the following health care decisions should be made by a physician only and would constitute the unlicensed practice of medicine if performed by an unlicensed person:
- determining what diagnostic tests are appropriate for a particular condition;
- determining the need for referrals to or consultation with another physician/specialist;
responsibility for the ultimate over-all care of the patient including treatment options available to the patient; and
- determining how much attention to devote to address a patient’s needs.
As a result of the foregoing, the Medical Society supports the continuation of the corporate practice of medicine doctrine.
Additional information on this position is on file at MSSNY Headquarters, Office of the Executive Vice-President, ext. 397, E-mail: firstname.lastname@example.org. This information addresses the following topics:
1) Use of credit cards to pay medical bills (percentage commission to bank or credit card company).
2) Use of collection agencies for a percentage of the medical fee collected.
3) Use of a practice management company on a percentage-of-fee basis, under any circumstances, including practice enhancement or marketing of the practice.
4) Use of a practice management company on a percentage-of-fee basis for non-clinical services where no patient referral or practice enhancement is involved, compared with use of “fair market value” as the basis for determining charges and maintaining the same restrictions.
5) Use of a billing service on a percentage-of- fee basis, compared to charges based on “fair market value,” with periodic negotiation of the charges. What would be the effect of not permitting certain activities, such as referral of patients by the billing company to the practice?
6) Leasing/renting space, services or equipment to a physician (by another physician, for example) on a percentage-of-fee basis without restriction, compared to a situation where cost of the lease/rent is based on fair market value and there are restrictions, such as not allowing cross-referrals between the landlord and tenant physicians.
7) Sale of a practice for a percentage of future income by the widow(er) of a physician, or by him or herself, without restriction, compared to a sale where the seller severs all connections with the practice, including referrals.
8) Accepting or paying a fee for a patient referral to or from any source.
9) Receiving payment in return for ordering lab tests, prescription drugs, medical appliances etc. (Council 3/18/99; Reaffirmed HOD 2014)
It is the policy of MSSNY that there should be a moratorium by the medical and research communities on cloning a human being. Congress should permit human, animal or cellular cloning related research that is not directed at producing a human being. (Council 5/21/98; Modified and reaffirmed HOD 2014)
95.982 Gerald Einaugler, MD Full Pardon by Governor Pataki: SUNSET HOD 2014
95.983 Physician-Assisted Suicide SUNSET HOD 2014
95.984 Health Care Proxy Identifier: SUNSET HOD 2014
95.985 Physician Participation in Capital Punishment:
MSSNY has adopted the following policy statement relative to Physician Participation in Capital Punishment:
(1) An individual’s opinion on capital punishment is the personal moral decision of the individual. A physician, as a member of a profession dedicated to preserving life, when there is hope of doing so, should not be a participant in a state execution. “Physician participation in execution” is defined generally as actions which would fall into one or more of the following categories: (a) An action which could automatically cause an execution to be carried out on a condemned prisoner; (b) An action which would assist, supervise, or contribute to the ability of another individual to directly cause the death of the condemned; (c) An action which could automatically cause an execution to be carried out on a condemned prisoner.
(2) Physician participation in an execution includes but is no limited to the following actions: prescribing or administering tranquilizers and other psychotropic agents and medications which are part of the execution procedure; monitoring vital signs on site or remotely (including monitoring electrocardiograms); attending or observing an execution as a physician; and rendering of technical advice regarding execution.
(3) In the case where the method of execution is lethal injection the following actions by the physicians would also constitute physician participation in execution: selecting injection sites; starting intravenous lines as a port for a lethal injection device; prescribing, preparing, administering, or supervising injection drugs or their doses or types; inspecting, testing, or maintaining lethal injection devices; consulting with or supervising lethal injection personnel. (4) The following actions do not constitute physician participation in execution:
(a) Testifying as to competence to stand trial testifying as to relevant medical evidence during trial, or testifying as to medical aspects of aggravating or mitigating circumstances during the penalty phase of a capital case; (b) Certifying death provided that the condemned has been declared dead by another person; (c) Witnessing an execution in a totally non-professional capacity; (d) Witnessing an execution at the specific voluntary request of the condemned person, providing that the physician observes the execution in a non-physician capacity and takes no action which would constitute physician participation in an execution; and (e) Relieving the acute suffering of a condemned person while awaiting execution, including providing tranquilizers at the specific voluntary request of the condemned person to relieve pain or anxiety in anticipation of the execution. (HOD 1995-71; Modified and reaffirmed HOD 2014)
95.986 DNR Within New York State Correctional Facilities: SUNSET HOD 2014
95.987 Expert Medical Witness – Ethical Guidelines of MSSNY Members:
MSSNY declares as an “Ethical Consideration” that physicians should aspire to the following objectives in providing expert medical testimony: (1) In order to have the requisite skill, knowledge and expertise to offer expert medical testimony, medical experts should devote the greater part of their professional activities to practicing their specialties rather that testifying in litigation cases; (2) That when medical experts do offer testimony in litigation cases, their testimony should be objective, represent generally accepted facts reflecting the consensus of the scientific community, consist of verifiable scientific truths and be limited to testimony in his/her sphere of professional medical expertise.
MSSNY defines an “Ethical Consideration” as a principle intended to be aspirational in character and which represents objectives toward which every member of the profession should strive. An Ethical Consideration is intended to provide principles upon which a physician can rely for guidance in specific situations. Being aspirational in character, while every member of the profession should strive toward the attainment of the objective, the failure to attain the objectives of the Ethical Consideration does not subject the individual to disciplinary action. MSSNY will seek appropriate legislation that would require individuals to satisfy the requirements of paragraphs 1 and 2 above in order to be qualified to provide expert medical testimony. (Council 9/22/94; Reaffirmed HOD 2000-82; Reaffirmed HOD 2014)
95.989 Physician-Assisted Suicide and Euthanasia:
MSSNY affirms as its policy:
Patients, with terminal illness, uncommonly approach their physicians for assistance in dying including assisted suicide and euthanasia. Their motivations are most often concerns of loss of autonomy, concerns of loss of dignity, and physical symptoms which are refractory and distressing. Despite shifts in favor of physician-assisted suicide as evidenced by its legality in an increasing number of states, physician-assisted suicide and euthanasia have not been part of the normative practice of modern medicine.
Compelling arguments have not been made for medicine to change its footing and to incorporate the active shortening of life into the norms of medical practice. Although relief of suffering has always been a fundamental duty in medical practice, relief of suffering through shortening of life has not. Moreover, the social and societal implications of such a fundamental change cannot be fully contemplated.
MSSNY supports all appropriate efforts to promote patient autonomy, promote patient dignity, and to relieve suffering associated with severe and advanced diseases. Physicians should not perform euthanasia or participate in assisted suicide.
(Council 5/14/92; Reaffirmed HOD 1995-80; Modified and reaffirmed HOD 2014; Replaced by HOD 2015-162; Reaffirmed HOD 2020 End of Life Task Force report)
95.990 Futile Cardio-Pulmonary (CPR) Resuscitation Therapy: SUNSET HOD 2014
95.991 Gender Disparities in Medical Care and Research: SUNSET HOD 2014
95.992 Capital Punishment – Physician Participation: SUNSET HOD 2014
95.993 Advance Directives:
MSSNY endorses the right of an individual to make an informed decision in advance of incapacity in order to guide surrogates and providers with treatment decisions. (HOD 1988-40; Modified and Reaffirmed HOD 2013)
95.994 Pharmaceutical Companies – Compensation for Specified Prescribing Practices:
SUNSET HOD 2013
95.995 Terminal Care – Directives For: SUNSET HOD 2013
95.996 Life Sustaining Apparatus, Withholding and Terminating: SUNSET HOD 2013
95.997 DNR – Do Not Resuscitate – Guidelines for Physicians, Hospitals, and Nursing Homes:.
SUNSET HOD 2013
95.998 Neonates – Decision Making for Treatment of Disabled: SUNSET HOD 2013
95.999 Euthanasia: SUNSET HOD 2013
 Note by General Counsel – Article 29C of the Public Health Law, which became law on July 27, 1990, establishes a procedure for individuals to appoint health care agents to make health care decisions in the event the individual loses capacity to make such decisions.
 At this point, this remains MSSNY position and the policy in whole states: 95.989 Physician-Assisted Suicide and Euthanasia: Patients, with terminal illness, uncommonly approach their physicians for assistance in dying including assisted suicide and euthanasia. Their motivations are most often concerns of loss of autonomy, concerns of loss of dignity, and physical symptoms which are refractory and distressing. Despite shifts in favor of physician assisted suicide as evidenced by its legality in an increasing number of states, physician-assisted suicide and euthanasia have not been part of the normative practice of modern medicine. Compelling arguments have not been made for medicine to change its footing and to incorporate the active shortening of life into the norms of medical practice. Although relief of suffering has always been a 4 fundamental duty in medical practice, relief of suffering through shortening of life has not. Moreover, the social and societal implications of such a fundamental change cannot be fully contemplated. MSSNY supports all appropriate efforts to promote patient autonomy, promote patient dignity, and to relieve suffering associated with severe and advanced diseases. Physicians should not perform euthanasia or participate in assisted suicide. (Council 5/14/92; Reaffirmed HOD 1995-80; Modified and reaffirmed HOD 2014; Replaced by HOD 2015-162