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Members of the American Medical Association (AMA) House of Delegates (HOD) Saturday attacked dozens of worsening obstacles they blamed for making safe patient care increasingly difficult -- and in some cases impossible -- to provide.

During its legislation-focused committee discussion Saturday in Orlando, Florida -- part of its annual November interim meeting -- delegates lamented intolerable overcrowding in emergency departments (EDs). One physician likened it to conditions in hospitals in developing nations, while another called it "our war zone" contributing to clinical burnout.

Delegates also called for the AMA to direct public attention to horrifying but preventable eye and other injuries in children caused by toy water beads and their blasters.

Water Beads

"Despite how they're being marketed and perceived by the public, these water bead gel blasters can have devastating consequences to vision," said Erin Shriver, MD, speaking as a delegate from the American Society of Ophthalmic Plastic and Reconstructive Surgery.

Shriver, who is at the University of Iowa in Iowa City, said one ophthalmology resident diagnosed hyphema, or blood inside the eye, caused by the toys during "four of his 20 calls." Other injuries include recurrent inflammation in the eye, iritis and herpetic keratitis, or herpes infection of the cornea, she said.

Douglas Myers, MD, chair of Otolaryngology Section Council, said the beads also can be ingested because they "look very much like candy. They can be stuck in ear canals and noses and have the capacity to expand up to 1,500 times their diameter. You don't have to have a blaster to do injury," he said.

The resolution urged the AMA to use its muscle to influence federal reclassification of the beads as hazardous, especially for children, and to encourage water bead sellers to supply customers with eye protection and educational materials on water bead dangers.

They noted due to water beads between 2007 and 2022, 46% from ingestion, 37% ear canal insertion, 12% nasal insertion, and 9% eye injury.

'No Privacy, No Dignity'

Boarding patients in EDs has been a problem in backed-up hospitals for decades. But now it's become a "shocking and appalling" public health emergency, said Nita Shumaker, MD, speaking on behalf of the AMA Organized Medical Staff Section. "It resembles a third-world country or mass casualty when I was in the military. We would not accept our pets to be treated in this fashion."

If adopted by the HOD, the resolution would prompt the AMA to work for ED staffing ratios and appropriate care requirements for patients who must stay in the ED until a bed for them becomes available.

Shumaker emphasized that the treatment of boarded ED patients "is appalling...there's no privacy and no dignity while our [ED] doctors and staff are doing heroic work [and] is leading to burnout and puts our patients at risk."

IMGs

A lengthy discussion centered on helping state licensing agencies find safe pathways for international medical school graduates (IMGs) to practice in the U.S., thus stemming this nation's physician shortage problem.

It's a delicate issue since the AMA has long opposed allowing those doctors to practice in the U.S. unless they completed at least 1 year of graduate medical education in a program accredited by the Accreditation Council for Graduate Medical Education (ACGME).

Meanwhile, at least eight states -- some designated as medically underserved -- are considering, or have passed, exceptions that vary extensively. The AMA currently has no recommendations regarding implementation of such pathways, the resolution said.

And in March, the Federation of State Medical Boards, , and the ACGME formed an to provide some guidance.

The AMA resolution would have the association produce a report on these alternate pathways and various state laws, to be considered during the AMA annual HOD meeting in June 2025 "to help inform advocacy efforts by state medical societies."

"Our medical community is largely unaware about these pathways and therefore unable to form an informed opinion on this matter, leading to a silence of positions," said Roopa Naik, MD, the author and chair-elect of the AMA IMG Governing Council who spoke on its behalf.

Many of the delegates expressed concerns that there needs to be "better alignment among state legislative language to ensure that such legislation supports the delivery of high quality medical care in the United States," according to Tripti Kataria, MD, MPH, vice chair of the AMA Council on Legislation (COL).

Immediate Access to Records

Passionate discussion also centered around physician opposition to the nation's information blocking rule, which allows patients to have access to certain test results and medical records before their physician has a chance to review them.

Contrary opinions also arose over discussion of a resolution that would authorize the AMA to advocate for a "36-hour embargo" on a provision in the federal , which requires patients to have immediate access to medical information, such as test results, as soon as they are available -- even prior to the physician reviewing them. The embargo would give physicians time to review the information and be prepared to inform the patient on interpretation and treatment plan so they don't jump to inappropriate conclusions or panic.

Kataria, speaking on behalf of COL, offered amendments that would specify the AMA would favor situations in which patients would have the option to authorize such an embargo or not authorize it if they want it immediately.

Electronic health record systems also do not always contain the ability for patients to select whether they only want such information after their physician has reviewed it, so Kataria's amendment would have the AMA advocate for criteria for information technology developers to include this option for patients.

Regulations prioritize "an individual's right to access their medical records," and research indicates "96% of patients prefer receiving results immediately online, even when test results are abnormal," she said.

But several speakers vehemently opposed her suggestions. Catherine Gutfreund, MD, an alternate delegate from California who spoke for herself, said that when her patients get the information online, the result has been disruptive and scary.

"I don't know how many emails I've gotten [about] a urinalysis, 'Oh my gosh, I have squamous cells in my urine,' and then they're looking at Dr. Google," she said. "I've had patients see their cancer diagnosis before I could get to it, and that's a tragedy."

Former AMA president Barbara McAneny, MD, delegate from the American Society of Clinical Oncology (ASCO), also was opposed to Kataria's amendments and said many of her patients are now experiencing what she called "scanxiety."

"The radiologist has seen those cysts in the liver for many years but [writes in the note that they] cannot rule out metastatic disease...and the patient cries all night because they think their life is over," she said.

"What we're asking is to look at the unintended consequences of this very well-intended rule to get patients their information, and allow physicians to be there and hold their hand when they're giving bad news, or to reassure patients that having an abnormal RDW [red cell distribution width blood test] does not mean the end of your life."

Other Issues

The more than 30 resolutions and reports considered included resolutions for the AMA to advocate for:

• Federal regulations governing how human body parts from cadavers may be used. Current laws cover only body parts used for transplants. In recent years, reports have emerged about body brokers' profitable sale of other human tissue to entities that "misused, abused or defiled" their acquisitions from some 1,638 people, such as when more than 20 bodies were used in U.S. Army without next-of-kin consent. Sponsored by the Michigan delegation.
• Tighter "scope creep" restrictions to prevent optometrists from performing laser surgery on the eye. Nine states now allow optometry laser surgery, even though optometrists' training for laser use "consists of a 16-hour didactic course with no training on live patients," according to the resolution.

Ravi Goel, MD, representing the American Academy of Ophthalmology, said current AMA language allows for optometrists to perform eye surgery using lasers as long as they are supervised by a physician, which he said does not protect patient safety.

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