Letter from Dr Zuckerman

IMPORTANT UPDATE: As this letter was being prepared, heath care reform activity in Washington accelerated on many different fronts. Rather than pre-empt this update, the AAOS has decided to initiate a separate series of e-mail updates related specifically to developments in health care reform. The first will appear tomorrow, and then at least weekly for as long as needed.

As it becomes necessary to mobilize the membership to contact their senators and congressional representatives, more frequent e-mails will be sent. We — the Presidential Line and Peter J. Mandell, MD, chair of the Council on Advocacy — believe this is a critical time for our membership to be informed and involved.

My Fellow members of the AAOS,

Four years ago, the AAOS Fellowship developed and adopted a Professional Compliance Program. Initially grounded in members’ concerns about expert witness testimony, the program has grown to establish minimum standards of conduct in areas as diverse as advertising by orthopaedic surgeons, professional and patient relationships, academic and research responsibilities, and orthopaedist-industry conflicts of interest.

Although several articles have been written about the program and its operations, I thought it appropriate to update you on its effectiveness and success.

A short history
You may recall that a professional compliance program was first proposed by the Board of Councilors in 2002. This was followed by the establishment of an AAOS project team and by two surveys of the Fellowship to assess support. The bylaws and the first three Standards of Professionalism (SOPs) were adopted on April 18, 2005, and the first case under the program was filed in August of that year. Since then, 70 grievances have been submitted, mostly in the area of expert witness testimony.

To ensure proper due process and allow both sides to be heard, several safeguards are built into the AAOS Professional Compliance Program. All members of both the Committee on Professionalism (COP) and the Judiciary Committee are given extensive training in the logistics and legalities of the program. Additionally, the grievance hearing process itself and AAOS Grievance Procedures have been designed to ensure maximum due process and at least two opportunities to be heard.

The first step of the grievance process is an administrative review conducted by the AAOS general counsel, to determine whether the materials submitted meet the program’s requirements, as outlined in the Grievance Procedures. If the case proceeds, the Committee on Professionalism (COP) reviews the material and determines whether a hearing is warranted.

The next step is the hearing, conducted by a Hearing Panel of the COP, and both parties have 30 minutes each to present their cases. In executive session after the hearing, the COP Hearing Panel will develop a report and may decide to take no action, to issue of a letter of concern, or to recommend that the AAOS Board censure, suspend for a specified period, or expel the AAOS Fellow or Member found to have violated the SOPs .

Either party may appeal the decision of the COP Hearing Panel to the Judiciary Committee (although the Grievant—the party bringing the grievance—may do so only at his/her own expense). During the appeal hearing, both parties may argue that the recommendation of the COP Hearing Panel violated due process or was contrary to the clear weight of the evidence.

Your Board of Directors makes the final decision, after hearing the reports and recommendations of the COP Hearing Panel, and as applicable, the Judiciary Committee and the two parties. Having reviewed a number of cases already and sat through several days of testimony, I can tell you that we take this responsibility very seriously. A written secret ballot is taken and a two thirds vote of the Board is necessary for the AAOS to take professional compliance action.

By the numbers…
So, what does all this mean? Here are the numbers:

70 grievances have been submitted.
8 grievances have been withdrawn or are in abeyance.
6 cases failed the administrative review process.
In 13 grievances, the COP determined in its prima facie assessment process that no hearing was warranted. One fellow demanded a hearing, which was granted at his/her own expense.
9 cases are currently undergoing the administrative review or prima facie assessment process.
The COP issued 13 letters of concern and closed or took no action in 10 cases.
The Judiciary Committee has conducted 10 appeal hearings.
The Board of Directors has taken action in 16 cases—4 censures and 12 suspensions. The suspensions ranged in length from 3 months to 2 years.

In short, the program works. It is being challenged, but we have been extraordinarily careful in developing the program and its safeguards.

Why it matters
At a time when the medical profession is under intense scrutiny and criticism, AAOS Fellows can be proud of the steps the Academy has taken to ensure that our members uphold the highest standards of professional ethics. The AAOS Standards of Professionalism (SOPs) spell out, in detail, exactly what is expected of orthopaedic surgeons in the following key areas:

If you have any questions about the AAOS Professional Compliance Program, I urge you to review the information on the AAOS Web site, or to e-mail our program coordinator, Rosalind Giulietti.

This is an outstanding program and I applaud our members who initiated and developed the program, our members on the Committee on Professionalism and the Judiciary Committee who have devoted countless hours to fulfilling their responsibilities, and our staff who have been instrumental in maintaining all facets of the program.