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2014 HOD Actions
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2014 Summary of Actions

AAPA House of Delegates

Boston, MA

May 24-26, 2014

Note:

Resolutions marked with * are recommendations to the AAPA Board of Directors.

Resolutions marked with ** require AAPA Board of Directors ratification.

 

Resolution

Title

Line Number

Action Taken

2014-A-01

Elect all BOD Members by the HOD

1

Rejected

2014-A-02

Elect President-elect & Secretary-Treasurer by the HOD

253

Rejected

2014-A-03

Elect Directors-at-Large by the HOD

498

Rejected

2014-A-04**

Meetings of the HOD

609

Adopted

2014-A-05**

Student Apportionment

652

Adopted

2014-A-06

Apportionment Changes with Maximum Limits

680

Rejected

2014-A-07**

BOD Elections – Conflict of Interest

710

Adopted as Amended

2014-A-08*

Access to Member Information for CO Membership Drives

865

Adopted on Consent Agenda

2014-A-09

Director of PA Services in the VA Central Office

875

Adopted on Consent Agenda

2014-A-10

Volunteer Membership Task Force

891

Rejected

2014-A-11

Public Relations

898

Rejected

2014-A-12**

Elections Process

904

Adopted

2014-A-13

Alternate Delegates

913

Referred

2014-A-14

Alternate Delegates 2

929

Referred

2014-A-15

Credentialing

942

Referred

2014-A-16

Credentials Committee

966

Adopted

2014-B-01

PAs as “Collaborative” Versus “Supervised” Medical Professionals

1011

Rejected

2014-B-02

Role and Definition of a PA

1022

Adopted as Amended

2014-B-03

Continuing Professional Development

1036

Adopted on Consent Agenda

2014-B-04

Educational Opportunities

1054

Adopted

2014-B-05

Media Violence

1066

Adopted on Consent Agenda

2014-B-06

Time-Limited NCCPA Certification

1079

Adopted as Amended

2014-B-07

Grandfathering of PAs

1090

Rejected

2014-C-01

Firearm Safety and Reduction of Firearm Related Violence

1095

Adopted as Amended

2014-C-02

Enforcement of Existing Gun Laws

1118

Rejected

2014-C-03

Mandatory Background Checks

1124

Rejected

2014-C-04

Illegal Transfer of Firearms

1129

Rejected

2014-C-05

Penalties for Unsecured Firearms Used Illegally or That Cause Injury

1135

Rejected

2014-C-06

Limiting Civilian Ownership of Rapid Firing Weapons

1140

Rejected

2014-C-07

Observation Units as a Solution to Overburdened Emergency Departments

1146

Rejected

2014-C-08

Obesity

1155

Adopted on Consent Agenda

2014-C-09

Education of Patients on Childhood Obesity

1210

Adopted on Consent Agenda

2014-C-10

Position Paper: Guidelines for the Physician Assistant Serving As an Expert Witness

1220

Adopted on Consent Agenda

2014-C-11

Position Paper: Direct to Consumer Advertising

1501

Adopted on Consent Agenda

2014-C-12

Position Paper: Improving Children’s Access to Health Care

1759

Rejected Expiration & Referred

Expired Policies

HP-3300.1.3

HP-3400.1.1

HX-4600.1.7

Reaffirmed Policies

HP-3200.3.1

HP-3500.1.3

HX-4300.1.1

HP-3200.6.3

HP-3500.3.2

HX-4400.1.2

HP-3300.1.9.0

HP-3500.4.1

HX-4400.1.3

HP-3300.1.10.0

HP-3700.1.3

HX-4400.1.10

HP-3300.1.13.1

HP-3700.1.4

HX-4500.8

HP-3300.1.13.2

HP-3700.3.2

HX-4600.2.1

HP-3300.1.13.3

HP-3800.1.2

HX-4600.2.2

HP-3300.1.14

HP-3800.2.1

HX-4600.6.2

HP-3400.2.3

HX-4200.1.4

HP-3500.1.1

HX-4200.2.1

New Business

Line Number

2014-NB-01

1815

Resolution of Commendation

Line Number

Purpose

2014-COMM-01

1823

Commendation for

R. Jeffrey Hulley

House Elections

Line Number

Results

1845

 

Bolded text within a resolution indicates the amendments submitted and accepted during the reports of the reference committees on May 26, 2014.

 

Presiding Officers

 

L. Gail Curtis, MPAS, PA-C             Speaker

David Jackson, DHSc, PA-C              First Vice Speaker

William Reynolds, PA-C                    Second Vice Speaker


2014-A-01 – Rejected

 

Amend Bylaws Articles III, VI, VII, and XIII as follows:

 

ARTICLE III  Membership.

 

Section 3:        Fellow Members. A fellow member shall be a physician assistant who is a graduate of a physician assistant program accredited by the Accreditation Review Commission on Education for the Physician Assistant (ARC-PA), or by one of its predecessor agencies (Committee on Allied Health Education and Accreditation [CAHEA], Commission on Accreditation of Allied Health Education Programs [CAAHEP]) or who has passed the Physician Assistant National Certifying Examination (PANCE) administered by the National Commission on Certification of Physician Assistants (NCCPA) or an examination administered by another agency approved by the Academy. Fellow members must satisfy such continuing medical and/or medically related educational requirements as may be prescribed by the Academy.  Non-clinical fellow members will not be required to maintain continuing medical education (CME).  Fellow members shall vote for Academy Officers and Directors with the exception of the Vice President and Student Director, and shall be eligible to hold office.

 

Section 14:      Annual Meeting.  There shall be an annual meeting of those members who are entitled to vote for Directors, to be held during the Academy’s annual conference, or at such other time and place as may be determined by the Board of Directors.  Notice of the place, date, and time of the annual meeting shall be given to those members who are entitled to vote for Directors at least 30 days but not more than 60 days before the meeting date.  Notice may be delivered by electronic means.

 

ARTICLE VI  House of Delegates.

 

Section 1:        Duties and Responsibilities.  The Academy shall have a House of Delegates, which shall represent the interests of the membership.  The House of Delegates shall exercise the sole authority on behalf of the Academy to enact policies establishing the collective values, philosophies, and principles of the physician assistant profession.  WITH THE EXCEPTION OF THE STUDENT DIRECTOR, THE HOUSE OF DELEGATES WILL ELECT THE DIRECTORS AND OFFICERS OF THE ACADEMY.  The House of Delegates shall make recommendations to the Board for granting charters to Chapters and for granting official recognition to specialty organizations.   The House of Delegates shall make recommendations to the Board for the establishment of Academy commissions and work groups, and shall establish such committees of the House of Delegates as necessary to fulfill its duties.   The House of Delegates shall be entitled to vote on amendments to these Bylaws on behalf of the members in accordance with Article XIII of these Bylaws.  The House of Delegates shall be solely responsible for establishing such rules of procedure, which are not inconsistent with these Bylaws, the Articles of Incorporation, or existing law, as may be necessary for carrying out the activities of the House (i.e. House of Delegates Standing Rules).

 

Section 2:        Composition.  The voting membership of the House of Delegates shall consist of the immediate past and current House Officers, one delegate elected by each officially recognized specialty organization, one delegate from each caucus, delegates from Chapters, and delegates from the Student Academy of the American Academy of Physician Assistants.  All delegates, other than those of the Student Academy, shall be fellow members of the Academy.  Student delegates shall be student or fellow members of the Academy. The delegates from the Chapters, specialty organizations, and caucuses are elected by the fellow members of those organizations.  Chapter and Student Academy delegate seats shall be allocated as follows: 

 

a.     Chapter Delegates. Each Chapter shall be entitled to two (2) delegates.  Additional delegates will be apportioned among the Chapters according to the number of Academy fellow members within the jurisdiction of each as of January 31 of each year.  When the number of fellow members within a Chapter’s jurisdiction exceeds 220, it will be apportioned a third delegate.  An additional delegate will be apportioned for each 300 additional members within a Chapter’s jurisdiction thereafter.  The Academy’s Constituent Relations Work Group will develop and recommend to the Board the definition of the Chapters’ jurisdiction.  

b.     Student Academy Delegates.  The Student Academy shall be entitled to one delegate for each 600 Student Academy members as of January 31 of each year. 

 

Section 3:        House Officers.  The House of Delegates shall elect from among its members the following House Officers: a Speaker (who shall also serve as Vice President of the Academy), a First Vice Speaker, and a Second Vice Speaker (the First Vice Speaker and the Second Vice Speaker are not Officers of the Corporation). 

 

a.     Election and Term of Service.  Each House Officer shall be elected by a majority of votes cast.  No absentee or proxy vote shall be cast.  The Governance Commission shall determine the general procedures for House Officers elections.  The terms of office shall be as specified in Article XIII, Section 2.

b.     Delegate-at-large Designation.  Each House Officer elected shall become a delegate-at-large during the term(s) as a House Officer, plus one additional year as an immediate past House Officer.  The delegate-at-large shall be accorded all the rights and privileges of elected delegates. 

c.     Duties of House Officers.

i.The Speaker shall preside at all meetings of the House of Delegates.

ii.              The First Vice Speaker shall assume the duties of the Speaker in the event of the absence of the Speaker, or in the event of vacancy in the position of Speaker.

iii.            The Second Vice Speaker will assume the duties of the First Vice Speaker in the absence of the First Vice Speaker, or in the event of vacancy in the position of First Vice Speaker.

iv.            The Second Vice Speaker shall be responsible for verification of the credentials of the delegates, for compiling the records of all general meetings of the House of Delegates, and for submitting such records to the Secretary-Treasurer of the Academy for filing with the Academy’s books and records. 

d.     Resignation or Removal of House Officers. Any House Officer may resign at any time by giving written notice to the Speaker, the President of the Academy, or the Board of Directors.  Such resignation shall take effect at the time specified in such notice, or, if no time is specified, at the time such resignation is tendered.  Any House Officer may be removed from his or her position at any time, with or without cause, by the affirmative majority vote of the House of Delegates.  Removal may only occur at a meeting called for that purpose, and the meeting notice shall state that the purpose, or one of the purposes, of the meeting is removal of the House Officer. Vacancies in these positions shall be filled in accordance with Article VI, Section 3 and Article XIII, Section 10 of these Bylaws.

 

ARTICLE VII Board of Directors and Officers of the Corporation.

 

Section 8:        Resignation or Removal of Directors and Officers of the Corporation.  Any Director or Academy Officer may resign at any time by giving written notice to the President or the Board of Directors.  Such resignation shall take effect at the time specified in such notice, or, if no time is specified, at the time such resignation is tendered.  Any Director-at-large, Student Director, or Academy Officer (excluding the Vice President) may be removed from office at any time, with or without cause, by the affirmative majority vote of those members entitled to elect THEM THE CURRENTLY CREDENTIALED HOUSE OF DELEGATES EXCEPT THAT STUDENT DELEGATES MAY ONLY VOTE FOR THE REMOVAL OF THE HOUSE OFFICERS.  THE STUDENT DIRECTOR MAY BE REMOVED FROM OFFICE BY A MAJORITY VOTE OF THE ASSEMBLY OF REPRESENTATIVES. Removal may only occur at a meeting called for that purpose, and the meeting notice shall state that the purpose, or one of the purposes, of the meeting is removal of the Director or Officer. Vacancies in these positions shall be filled in accordance with Article XII, Section 11 of these Bylaws.  Removal of the Vice President/Speaker shall be done in accordance with Article VI, Section 3 of these Bylaws pertaining to House Officers.

 

ARTICLE XIII    Elections.

 

Section 1:        Positions to be Filled by Election.  Elected positions include Directors-at-large; one Student Director; the Academy Officer positions of President-elect and Secretary-Treasurer; and the House Officer positions of Speaker, First Vice Speaker, and Second Vice Speaker; and such number of members of the Nominating Work Group as may be set forth in Article XI of these Bylaws.  The House Officer positions shall be filled by the House of Delegates in the manner prescribed by Article VI, Section 3. The Student Director shall be elected in the manner prescribed by Article V, Section 3.  THE REMAINING DIRECTORS AND OFFICERS OF THE ACADEMY SHALL BE ELECTED BY THE HOUSE OF DELEGATES, EXCEPT THAT THE DELEGATES FROM THE STUDENT ACADEMY SHALL NOT VOTE FOR THESE POSITIONS. The Nominating Work Group positions shall be filled by the House of Delegates in the manner prescribed by Article XI.  All other elected positions shall be filled in the manner prescribed by this Article XIII.

 

Section 2:        Term of Office.  The term of office for the Academy Officer positions of President, President-elect, and Immediate Past President shall be one year.  The term of office for the Student Director shall be one year.  The term of office for Directors-at-large and for the Academy Officer position of Secretary-Treasurer shall be two years.  The term of service for House Officer positions shall be one year.

 

Section 3:        Eligibility and Qualifications of Candidates for Elected Positions Other Than Student Director or Nominating Work Group Member.

 

a.     A candidate must be a fellow member of the AAPA.

b.     A candidate must be a member of an AAPA Chapter.

c.     A candidate must have been an AAPA fellow member for the last three years.

d.     A candidate must have accumulated at least three distinct years of experience in the past five years in at least two of the following major areas of professional involvement. This experience requirement will be waived for currently sitting AAPA board members who choose to run for a subsequent term of office.

                                                   i.       An AAPA or constituent organization officer, board member, committee, council, commission, work group,  task force chair

                                                ii.       A delegate or alternate to the AAPA House of Delegates

                                                iii.            A board member, trustee, or committee chair of the PA Foundation, Society for the Preservation of Physician Assistant History, American Academy of Physician Assistants Political Action Committee, Physician Assistant Education Association or National Commission on Certification of Physician Assistants.

                                                iv.            AAPA board appointees.

 

Section 4:        Self-declaration of Candidacy.  Self-declaration, in accordance with policy, shall be permitted in the election of Academy Officers, Directors-at-large, and House Officers.

 

Section 5:        Time of Elections.  The time of House Officers’ elections is prescribed in Article VI, Section 3.  The Governance Commission shall determine the timing of elections of all other positions, in accordance with the requirements of these Bylaws.

 

Section 6:        Eligibility of Voters.  FOR THE HOUSE OFFICERS AND THE NOMINATING WORK GROUP POSITIONS, THE ELIGLBLE VOTERS ARE THE CREDENTIALED DELEGATES AT THE TIME OF THE ELECTION. FOR THE POSITIONS OF PRESIDENT-ELECT, SECRETARY-TREASURER, AND DIRECTORS-AT-LARGE, THE ELIGIBLE VOTERS ARE THE CREDENTIALED DELEGATES AT THE TIME OF THE ELECTION EXCEPT THAT THE DELEGATES FROM THE STUDENT ACADEMY SHALL NOT VOTE FOR THESE POSITIONS.  THE STUDENT DIRECTOR OF THE ACADEMY IS SELECTED BY THE STUDENT ACADEMY OF THE AAPA.

 

For all positions other than the Student Director, House Officer, and Nominating Work Group positions, eligible voters are fellow members listed on the Academy membership roster as of the date that is thirty (30) days before the election

 

Section 7:        Election Procedures.  The Governance Commission shall determine the procedures for the election of Academy Officers and Directors-at-large, including the dates for distribution and return of ballots, subject to the requirements of the North Carolina Nonprofit Corporation Act.  Voting IF DONE AT A TIME OTHER THAN THE HOUSE OF DELEGATES MEETING shall be by mail or electronic ballots.  The Academy staff shall manage the ballot distribution. The procedures for electing the House Officers are prescribed in Article VI, Section 3; and the procedures for electing the Student Director are prescribed in Article V, Section 3; and the procedures for electing members of the Nominating Work Group shall be determined by the House of Delegates in accordance with Article XI, Section 2.

 

Section 8:        Vote Necessary to Elect.  A plurality of the votes cast shall elect the Directors-at-large and the Academy Officers (excluding the Vice President), so long as the TOTAL number of votes cast equals or exceeds a quorum MAJORITY OF THE CREDENTIALED DELEGATES, LESS THE STUDENT DELEGATES OF one (1) percent of the members entitled to vote in the election. THE HOUSE OF DELEGATES.  In the case of a tie vote, the Governance Commission shall determine the process for selecting the winner.  The vote necessary to elect the House of Delegates Officers (including the Speaker, who shall serve as the Vice President of the Academy) shall be prescribed in Article VI, Section 3.

 

Section 9:        Commencement of Terms.  The term of office for all elected positions, including Directors-at-large, the Student Director, Academy Officers, and House Officers, shall begin on June 10.  In the event that the election of the House Officers, OFFICERS AND DIRECTORS occurs later than June 10, the new OFFICERS, DIRECTORS, AND House Officers will take office at the close of the meeting during which they were elected.

 

Section 10:      Vacancies.  Academy Officers and Directors, and House Officers may resign or be removed as provided in these Bylaws.  The method of filling positions vacated by the holder prior to completion of term shall be as follows:

a.     OFFICE OF THE PRESIDENT.  The President-elect shall become the President to serve the unexpired term. The President-elect shall then serve his/her own successive term as President.

b.     OFFICE OF THE PRESIDENT-ELECT.  In the event of a vacancy in the office of President-elect, the Immediate Past President shall assume the duties, but not the office of the President-elect while continuing to perform the duties of Immediate Past President. The Nominating Work Group will prepare a slate of candidates.  The House of Delegates shall elect a new President-elect from the candidates proposed and any candidates that self-declare, who will take office immediately upon election and will serve the remainder of the un-expired term. 

c.     SPEAKER; First vice Speaker; Second vice-Speaker.  A vacancy in the positions of the Speaker, First Vice Speaker, or Second Vice Speaker shall be filled in the manner prescribed by the House of Delegates Standing Rules, and in accordance with Article VI, Section 3 of these Bylaws.

d.     Student Academy Board Member.  A vacancy in the Student Director position shall be filled in the manner prescribed by the Student Academy Bylaws.

e.     Other Board vacancies.  All other vacancies occurring in the Board of Directors shall be filled by a vote of the majority of the remaining members of the Board from a slate of candidates prepared by the Nominating Work Group.  All terms of office for such appointees to the Board of Directors shall expire June 10, or until their successor has been duly elected and assumed office.  The remaining term of the vacated seat, if any, will be filled at the next regularly scheduled election.

 

2014-A-02 – Rejected

           

Amend Bylaws Articles III, VI, VII, and XIII as follows:

 

ARTICLE III  Membership.

 

Section 3:        Fellow Members. A fellow member shall be a physician assistant who is a graduate of a physician assistant program accredited by the Accreditation Review Commission on Education for the Physician Assistant (ARC-PA), or by one of its predecessor agencies (Committee on Allied Health Education and Accreditation [CAHEA], Commission on Accreditation of Allied Health Education Programs [CAAHEP]) or who has passed the Physician Assistant National Certifying Examination (PANCE) administered by the National Commission on Certification of Physician Assistants (NCCPA) or an examination administered by another agency approved by the Academy. Fellow members must satisfy such continuing medical and/or medically related educational requirements as may be prescribed by the Academy.  Non-clinical fellow members will not be required to maintain continuing medical education (CME).  Fellow members shall vote for Academy Officers and Directors-AT-LARGE with the exception of the Vice President and Student Director, and shall be eligible to hold office.

 

Section 14:      Annual Meeting.  There shall be an annual meeting of those members who are entitled to vote for Directors, to be held during the Academy’s annual conference, or at such other time and place as may be determined by the Board of Directors.  Notice of the place, date, and time of the annual meeting shall be given to those members who are entitled to vote for Directors at least 30 days but not more than 60 days before the meeting date.  Notice may be delivered by electronic means.

 

ARTICLE VI  House of Delegates.

 

Section 1:        Duties and Responsibilities.  The Academy shall have a House of Delegates, which shall represent the interests of the membership.  The House of Delegates shall exercise the sole authority on behalf of the Academy to enact policies establishing the collective values, philosophies, and principles of the physician assistant profession.  THE HOUSE OF DELEGATES SHALL ELECT THE HOUSE OFFICERS, PRESIDENT-ELECT, AND THE SECRETARY-TREASURER.  The House of Delegates shall make recommendations to the Board for granting charters to Chapters and for granting official recognition to specialty organizations.   The House of Delegates shall make recommendations to the Board for the establishment of Academy commissions and work groups, and shall establish such committees of the House of Delegates as necessary to fulfill its duties.   The House of Delegates shall be entitled to vote on amendments to these Bylaws on behalf of the members in accordance with Article XIII of these Bylaws.  The House of Delegates shall be solely responsible for establishing such rules of procedure, which are not inconsistent with these Bylaws, the Articles of Incorporation, or existing law, as may be necessary for carrying out the activities of the House (i.e. House of Delegates Standing Rules).

 

Section 2:        Composition.  The voting membership of the House of Delegates shall consist of the immediate past and current House Officers, one delegate elected by each officially recognized specialty organization, one delegate from each caucus, delegates from Chapters, and delegates from the Student Academy of the American Academy of Physician Assistants.  All delegates, other than those of the Student Academy, shall be fellow members of the Academy.  Student delegates shall be student or fellow members of the Academy. The delegates from the Chapters, specialty organizations, and caucuses are elected by the fellow members of those organizations.  Chapter and Student Academy delegate seats shall be allocated as follows: 

 

a.     Chapter Delegates. Each Chapter shall be entitled to two (2) delegates.  Additional delegates will be apportioned among the Chapters according to the number of Academy fellow members within the jurisdiction of each as of January 31 of each year.  When the number of fellow members within a Chapter’s jurisdiction exceeds 220, it will be apportioned a third delegate.  An additional delegate will be apportioned for each 300 additional members within a Chapter’s jurisdiction thereafter.  The Academy’s Constituent Relations Work Group will develop and recommend to the Board the definition of the Chapters’ jurisdiction.  

b.     Student Academy Delegates.  The Student Academy shall be entitled to one delegate for each 600 Student Academy members as of January 31 of each year.  

 

Section 3:        House Officers.  The House of Delegates shall elect from among its members the following House Officers: a Speaker (who shall also serve as Vice President of the Academy), a First Vice Speaker, and a Second Vice Speaker (the First Vice Speaker and the Second Vice Speaker are not Officers of the Corporation). 

 

a.          Election and Term of Service.  Each House Officer shall be elected by a majority of votes cast.  No absentee or proxy vote shall be cast.  The Governance Commission shall determine the general procedures for House Officers elections.  The terms of office shall be as specified in Article XIII, Section 2.

b.         Delegate-at-large Designation.  Each House Officer elected shall become a delegate-at-large during the term(s) as a House Officer, plus one additional year as an immediate past House Officer.  The delegate-at-large shall be accorded all the rights and privileges of elected delegates. 

c.          Duties of House Officers.

i.             The Speaker shall preside at all meetings of the House of

Delegates.

ii.              The First Vice Speaker shall assume the duties of the

Speaker in the event of the absence of the Speaker, or in the event of vacancy in the position of Speaker.

iii.            The Second Vice Speaker will assume the duties of the First Vice Speaker in the absence of the First Vice Speaker, or in the event of vacancy in the position of First Vice Speaker.

iv.            The Second Vice Speaker shall be responsible for verification of the credentials of the delegates, for compiling the records of all general meetings of the House of Delegates, and for submitting such records to the Secretary-Treasurer of the Academy for filing with the Academy’s books and records. 

d.         Resignation or Removal of House Officers. Any House Officer may resign at any time by giving written notice to the Speaker, the President of the Academy, or the Board of Directors.  Such resignation shall take effect at the time specified in such notice, or, if no time is specified, at the time such resignation is tendered.  Any House Officer may be removed from his or her position at any time, with or without cause, by the affirmative majority vote of the House of Delegates.  Removal may only occur at a meeting called for that purpose, and the meeting notice shall state that the purpose, or one of the purposes, of the meeting is removal of the House Officer. Vacancies in these positions shall be filled in accordance with Article VI, Section 3 and Article XIII, Section 10 of these Bylaws.

 

ARTICLE VII Board of Directors and Officers of the Corporation.

 

Section 8:        Resignation or Removal of Directors and Officers of the Corporation.  Any Director or Academy Officer may resign at any time by giving written notice to the President or the Board of Directors.  Such resignation shall take effect at the time specified in such notice, or, if no time is specified, at the time such resignation is tendered.  Any Director-at-Large, Student Director, or Academy Officer (excluding the Vice President) may be removed from office at any time, with or without cause, by the affirmative majority vote of those members entitled to elect them.  Removal may only occur at a meeting called for that purpose, and the meeting notice shall state that the purpose, or one of the purposes, of the meeting is removal of the Director at Large or Officer.  THE SECRETARY-TREASURER, PRESIDENT-ELECT, PRESIDENT, OR IMMEDIATE-PAST-PRESIDENT MAY BE REMOVED FROM OFFICE AT ANY TIME, WITH OR WITHOUT CAUSE, BY THE AFFIRMATIVE MAJORITY VOTE OF THOSE MEMBERS OF THE HOUSE OF DELEGATES ENTITLED TO ELECT THEM.  Vacancies in these positions shall be filled in accordance with Article XII, Section 11 of these Bylaws.  Removal of the Vice President/Speaker shall be done in accordance with Article VI, Section 3 of these Bylaws pertaining to House Officers.

 

ARTICLE XIII    Elections.

 

Section 1:        Positions to be Filled by Election.  Elected positions include Directors-at-large; one Student Director; the Academy Officer positions of President-elect and Secretary-Treasurer; and the House Officer positions of Speaker, First Vice Speaker, and Second Vice Speaker; and such number of members of the Nominating Work Group as may be set forth in Article XI of these Bylaws.  The House Officer positions shall be filled by the House of Delegates in the manner prescribed by Article VI, Section 3.  The Student Director shall be elected in the manner prescribed by Article V, Section 3.  The Nominating Work Group positions shall be filled by the House of Delegates in the manner prescribed by Article XI.  All other elected positions shall be filled in the manner prescribed by this Article XIII.

 

Section 2:        Term of Office.  The term of office for the Academy Officer positions of President, President-elect, and Immediate Past President shall be one year.  The term of office for the Student Director shall be one year.  The term of office for Directors-at-large and for the Academy Officer position of Secretary-Treasurer shall be two years.  The term of service for House Officer positions shall be one year.

 

Section 3:        Eligibility and Qualifications of Candidates for Elected Positions Other Than Student Director or Nominating Work Group Member.

 

a.     A candidate must be a fellow member of the AAPA.

b.     A candidate must be a member of an AAPA Chapter.

c.     A candidate must have been an AAPA fellow member for the last three years.

d.     A candidate must have accumulated at least three distinct years of experience in the past five years in at least two of the following major areas of professional involvement. This experience requirement will be waived for currently sitting AAPA board members who choose to run for a subsequent term of office.

                                                 i.        An AAPA or constituent organization officer, board member,

     committee, council, commission, work group,  task force chair

                                                ii.      A delegate or alternate to the AAPA House of Delegates

                                                iii.           A board member, trustee, or committee chair of the PA Foundation, Society for the Preservation of Physician Assistant History, American Academy of Physician Assistants Political Action Committee, Physician Assistant Education Association or National Commission on Certification of Physician Assistants.

                                                iv.           AAPA board appointees.

 

Section 4:        Self-declaration of Candidacy.  Self-declaration, in accordance with policy, shall be permitted in the election of Academy Officers, Directors-at-large, and House Officers.

 

Section 5:        Time of Elections.  The time of House Officers’ elections is prescribed in Article VI, Section 3.  The Governance Commission shall determine the timing of elections of all other positions, in accordance with the requirements of these Bylaws.

 

Section 6:        Eligibility of Voters.  For all positions other than the Student Director, House Officer, and Nominating Work Group positions, FOR THE POSITION OF DIRECTOR-AT-LARGE eligible voters are fellow members listed on the Academy membership roster as of the date that is thirty (30) days before the THAT election. THE POSITIONS OF PRESIDENT-ELECT AND SECRETARY-TREASURER WILL BE ELECTED BY THE CREDENTIALED MEMBERS OF THE HOUSE OF DELEGATES AT THE TIME OF THE ELECTION, EXCEPT THAT THE STUDENT DELEGATES MAY NOT VOTE FOR THESE POSITIONS.

 

Section 7:        Election Procedures.  The Governance Commission shall determine the procedures for the election of Academy Officers and Directors-at-large, including the dates for distribution and return of ballots, subject to the requirements of the North Carolina Nonprofit Corporation Act.  Voting FOR PRESIDENT-ELECT AND SECRETARY-TREASURER, IF DONE AT A TIME OTHER THAN THE HOUSE OF DELEGATES MEETING, shall be by mail or electronic ballots.  EXCEPT FOR VOTING DONE AT A MEETING OF THE HOUSE OF DELEGATES, the Academy staff shall manage the ballot distribution. The procedures for electing the House Officers are prescribed in Article VI, Section 3; and the procedures for electing the Student Director are prescribed in Article V, Section 3; and the procedures for electing members of the Nominating Work Group shall be determined by the House of Delegates in accordance with Article XI, Section 2.

 

Section 8:        Vote Necessary to Elect.  A plurality of the votes cast shall elect the Directors-at-large and the Academy Officers (excluding the Vice President, so long as the number of votes cast equals or exceeds a quorum of one (1) percent of the members entitled to vote in the election.  In the case of a tie vote, the Governance Commission shall determine the process for selecting the winner.  The vote necessary to elect the House of Delegates Officers (including the Speaker, who shall serve as the Vice President of the Academy) shall be prescribed in Article VI, Section 3.

 

Section 9:        Commencement of Terms.  The term of office for all elected positions, including Directors-at-large, the Student Director, Academy Officers, and House Officers, shall begin on June 10.  In the event that the election of the House Officers, PRESIDENT-ELECT AND SECRETARY-TREASURER, occurs later than June 10, the new PRESIDENT-ELECT, SECRETARY-TREASURER, AND House Officers will take office at the close of the meeting during which they were elected.

 

Section 10:      Vacancies.  Academy Officers and Directors, and House Officers may resign or be removed as provided in these Bylaws.  The method of filling positions vacated by the holder prior to completion of term shall be as follows:

a.     OFFICE OF THE PRESIDENT.  The President-elect shall become the President to serve the unexpired term. The President-elect shall then serve his/her own successive term as President.

b.     OFFICE OF THE PRESIDENT-ELECT.  In the event of a vacancy in the office of President-elect, the Immediate Past President shall assume the duties, but not the office of the President-elect while continuing to perform the duties of Immediate Past President. The Nominating Work Group will prepare a slate of candidates.  The ELIGIBLE MEMBERS OF THE House of Delegates shall elect a new President-elect from the candidates proposed and any candidates that self-declare. who THE INDIVIDUAL ELECTED will take office immediately upon election and will serve the remainder of the un-expired term. 

c.     SPEAKER; First vice Speaker; Second vice-Speaker.  A vacancy in the positions of the Speaker, First Vice Speaker, or Second Vice Speaker shall be filled in the manner prescribed by the House of Delegates Standing Rules, and in accordance with Article VI, Section 3 of these Bylaws.

d.     Student Academy Board Member.  A vacancy in the Student Director position shall be filled in the manner prescribed by the Student Academy Bylaws.

e.     Other Board vacancies.  All other vacancies occurring in the Board of Directors shall be filled by a vote of the majority of the remaining members of the Board from a slate of candidates prepared by the Nominating Work Group.  All terms of office for such appointees to the Board of Directors shall expire June 10, or until their successor has been duly elected and assumed office.  The remaining term of the vacated seat, if any, will be filled at the next regularly scheduled election.

 

2014-A-03 – Rejected

 

Amend Bylaws Articles III, VI, and XIII as follows:

 

ARTICLE III        Membership

 

Section 3:        Fellow Members. A fellow member shall be a physician assistant who is a graduate of a physician assistant program accredited by the Accreditation Review Commission on Education for the Physician Assistant (ARC-PA), or by one of its predecessor agencies (Committee on Allied Health Education and Accreditation [CAHEA], Commission on Accreditation of Allied Health Education Programs [CAAHEP]) or who has passed the Physician Assistant National Certifying Examination (PANCE) administered by the National Commission on Certification of Physician Assistants (NCCPA) or an examination administered by another agency approved by the Academy. Fellow members must satisfy such continuing medical and/or medically related educational requirements as may be prescribed by the Academy.  Non-clinical fellow members will not be required to maintain continuing medical education (CME).  Fellow members shall vote for PRESIDENT-ELECT AND SECRETARY-TREASURER Academy Officers and Directors, with the exception of the Vice President and Student Director, IN ACCORDANCE WITH ARTICLE VI, SECTION 3, and shall be eligible to hold office.

 

ARTICLE VI  House of Delegates.

 

Section 1:        Duties and Responsibilities.  The Academy shall have a House of Delegates, which shall represent the interests of the membership.  The House of Delegates shall exercise the sole authority on behalf of the Academy to enact policies establishing the collective values, philosophies, and principles of the physician assistant profession.  The House of Delegates shall make recommendations to the Board for granting charters to Chapters and for granting official recognition to caucuses and specialty physician assistant organizations.   The House of Delegates shall make recommendations to the Board for the establishment of Academy commissions and work groups, and shall establish such committees of the House of Delegates as necessary to fulfill its duties.   The House of Delegates shall be entitled to vote on amendments to these Bylaws on behalf of the members in accordance with Article XIII of these Bylaws.  THE HOUSE OF DELEGATES SHALL ELECT THE DIRECTORS-AT-LARGE OF THE ACADEMY. The House of Delegates shall be solely responsible for establishing such rules of procedure, which are not inconsistent with these Bylaws, the Articles of Incorporation, or existing law, as may be necessary for carrying out the activities of the House (i.e. House of Delegates Standing Rules).

 

ARTICLE VII Board of Directors and Officers of the Corporation.

 

Section 8:        Resignation or Removal of Directors and Officers of the Corporation.  Any Director or Academy Officer may resign at any time by giving written notice to the President or the Board of Directors.  Such resignation shall take effect at the time specified in such notice, or, if no time is specified, at the time such resignation is tendered.  ANY DIRECTOR-AT-LARGE MAY BE REMOVED FROM OFFICE AT ANY TIME, WITH OR WITHOUT CAUSE, BY THE AFFIRMATIVE MAJORITY VOTE OF THOSE MEMBERS ENTITLED TO ELECT THEM BY THE AFFIRMATIVE MAJORITY VOTE OF THOSE MEMBERS OF THE HOUSE OF DELEGATES ENTITLED TO ELECT THEM.  Any Director-at-large, THE Student Director, or ANY Academy Officer (excluding the Vice President) may be removed from office at any time, with or without cause, by the affirmative majority vote of those members entitled to elect them.  Removal may only occur at a meeting called for that purpose, and the meeting notice shall state that the purpose, or one of the purposes, of the meeting is removal of the Director or Officer. Vacancies in these positions shall be filled in accordance with Article XII, Section 11 of these Bylaws.  Removal of the Vice President/Speaker shall be done in accordance with Article VI, Section 3 of these Bylaws pertaining to House Officers.

 

ARTICLE XIII    Elections.

Section 1:        Positions to be Filled by Election.  Elected positions include Directors-at-large; one Student Director; the Academy Officer positions of President-elect and Secretary-Treasurer; and the House Officer positions of Speaker, First Vice Speaker, and Second Vice Speaker; and such number of members of the Nominating Work Group as may be set forth in Article XI of these Bylaws.  The House Officer positions shall be filled by the House of Delegates in the manner prescribed by Article VI, Section 3. THE DIRECTORS-AT-LARGE SHALL BE ELECTED BY THE HOUSE OF DELEGATES IN ACCORDANCE WITH THIS ARTICLE. The Student Director shall be elected in the manner prescribed by Article V, Section 3.  The Nominating Work Group positions shall be filled by the House of Delegates in the manner prescribed by Article XI.  All other elected positions shall be filled in the manner prescribed by this Article XIII.

 

Section 5:        Time of Elections.  The time of House Officers’ elections is prescribed in Article VI, Section 3.  THE ELECTION OF THE DIRECTORS-AT-LARGE WILL OCCUR AT THE TIME OF THE HOUSE OFFICER ELECTIONS. The Governance Commission shall determine the timing of elections of all other positions, in accordance with the requirements of these Bylaws.

 

Section 6:        Eligibility of Voters. ELIGIBLE VOTERS FOR ACADEMY OFFICERS ARE FELLOW MEMBERS. For all positions other than the Student Director, DIRECTOR-AT-LARGE, House Officer, and Nominating Work Group positions, eligible voters are fellow members listed on the Academy membership roster as of the date that is thirty (30) days before the THAT election.

 

ELIGIBLE VOTERS FOR DIRECTORS-AT-LARGE SHALL BE THE CREDENTIALED FELLOW DELEGATES AT THE TIME OF THE ELECTION EXCEPT THAT DELEGATES FOR THE STUDENT ACADEMY SHALL NOT BE ELIGIBLE TO VOTE FOR DIRECTORS-AT-LARGE.

 

Section 7:        Election Procedures.  The Governance Commission shall determine the procedures for the election of Academy Officers and Directors-at-large, including the dates for distribution and return of ballots, subject to the requirements of the North Carolina Nonprofit Corporation Act.  Voting shall be by mail or electronic ballots.  The Academy staff shall manage the ballot distribution. THE GOVERNANCE COMMISSION SHALL DETERMINE THE PROCEDURES FOR THE ELECTION OF DIRECTORS AT LARGE. The procedures for electing the House Officers are prescribed in Article VI, Section 3; and the procedures for electing the Student Director are prescribed in Article V, Section 3; and the procedures for electing members of the Nominating Work Group shall be determined by the House of Delegates in accordance with Article XI, Section 2.

 

Section 9:        Commencement of Terms.  The term of office for all elected positions, including Directors-at-large, the Student Director, Academy Officers, and House Officers, shall begin on June 10.  In the event that the election of the House Officers AND/OR DIRECTORS-AT-LARGE occurs later than June 10, the new House Officers AND/OR DIRECTORS-AT-LARGE will take office at the close of the meeting during which they were elected.

 

2014-A-04 – Adopted

 

Amend Bylaws Article VI, Section 4 as follows:

 

Section 4 Meetings of the House of Delegates

 

a.     Annual and Special Meetings.  The House of Delegates shall hold an annual meeting.  Special meetings of the House of Delegates shall be called by the Speaker upon written request of 25 percent or more of the currently credentialed delegates.  Special meetings of the House shall also be called by a two-thirds (2/3) affirmative vote of the Board of Directors or by a majority affirmative vote of the House Officers.  The object of such special meetings shall be stated in the meeting notice, and no other business other than that specified in the notice shall be transacted at the meeting

b.     Notice.  Notice of the place, date, and time of the annual meetings of the House of Delegates shall be given to each member of the House of Delegates at least 30 days but not more than 60 days before the meeting date.  If proposed Bylaws amendments are to be presented to the House of Delegates for approval at the annual House meeting, the notice of the meeting shall include a description of the proposed amendments to be approved, and must be accompanied by a copy or summary of the proposed amendments.  Notice of the place, date, and time of a special meeting of the House of Delegates shall be given to each member of the House of Delegates at least five (5) days before the meeting date.  Notice of a special meeting shall include a description of the matter or matters for which the meeting is called.  Notice of the annual meeting or a special meeting may be delivered by electronic means.

c.     Quorum.  A majority of the total number of the currently credentialed delegates shall constitute a quorum at any meeting of the House of Delegates.  Unless otherwise stated in the Bylaws, an affirmative vote by a majority of the delegates present and voting shall constitute action of the House.

d.     Mail and Electronic Voting.  Mail and electronic voting of the House of Delegates will be permitted for any House business. Mail and electronic votes will be called for by the Speaker of the House when directed by: (i) a simple majority of the House Officers; (ii) a two-thirds affirmative vote of the Board of Directors; or (iii) a call from 25 percent of delegates currently credentialed.  Additionally, mail and electronic votes will be called for by the Speaker when there is a vacancy in an elected office of the House during the time period between regularly scheduled House elections. The House of Delegates Officers and Academy staff shall determine the procedures for voting on issues requiring a mail or electronic ballot, subject to the requirements of the North Carolina Nonprofit Corporation Act. 

 

2014-A-05 – Adopted

 

Amend Bylaws Article VI, Section 2 as follows:

 

Article VI    House of Delegates

Section 2: Composition. The voting membership of the House of Delegates shall consist of the immediate past and current House Officers, one delegate elected by each officially recognized specialty organization, one delegate from each caucus, delegates from Chapters, and delegates from the Student Academy of the American Academy of Physician Assistants. All delegates, other than those of the Student Academy, shall be fellow members of the Academy. Student delegates shall be student or fellow members of the Academy. The delegates from the Chapters, specialty organizations, and caucuses are elected by the fellow members of those organizations. Chapter and Student Academy delegate seats shall be allocated as follows:

a.     Chapter Delegates. Each Chapter shall be entitled to two (2) delegates. Additional delegates will be apportioned among the Chapters according to the number of Academy fellow members within the jurisdiction of each as of January 31 of each year. When the number of fellow members within a Chapter’s jurisdiction exceeds 220, it will be apportioned a third delegate. An additional delegate will be apportioned for each 300 additional members within a Chapter’s jurisdiction thereafter. The Academy’s Constituent Relations Work Group will develop and recommend to the Board the definition of the Chapters’ jurisdiction.

b.     Student Academy Delegates. The Student Academy shall be entitled to one delegate for each 600 850 Student Academy members as of January 31 of each year.

           

2014-A-06 – Rejected

 

Amend Bylaws Article VI, Section 2 as follows:  

 

ARTICLE VI    House of Delegates

 

Section 2: Composition.  The voting membership of the House of Delegates shall consist of the immediate past and current House Officers, one delegate elected by each officially recognized specialty organization, one delegate from each caucus, delegates from Chapters, and delegates from the Student Academy of the American Academy of Physician Assistants.  All delegates, other than those of the Student Academy, shall be fellow members of the Academy.  Student delegates shall be student or fellow members of the Academy. The delegates from the Chapters, specialty organizations, and caucuses are elected by the fellow members of those organizations.  Chapter and Student Academy delegate seats shall be allocated as follows:   

 

a. Chapter Delegates. Each Chapter shall be entitled to two (2) delegates.  Additional delegates will be apportioned among the Chapters according to the number of Academy fellow members within the jurisdiction of each as of January 31 of each year.  When the number of fellow members within a Chapter’s jurisdiction exceeds 220, it will be apportioned a third delegate.  An additional delegate will be apportioned for each 300 additional members within a Chapter’s jurisdiction thereafter, TO A MAXIMUM OF 12 DELEGATES.  The Academy’s Constituent Relations Work Group will develop and recommend to the Board the definition of the Chapters’ jurisdiction. 

 

b. Student Academy Delegates.  The Student Academy shall be entitled to one delegate for each 600 700 Student Academy members as of January 31 of each year, TO A MAXIMUM OF 12 DELEGATES.

 

2014-A-07 – Adopted as Amended

 

            Amend Bylaws Article VII to read as follows:

 

ARTICLE VII Board of Directors and Officers of the Corporation.

 

Section 1:        Board Duties and Responsibilities.  The Academy shall have a Board of Directors, which, in accordance with North Carolina law, shall be responsible for the management of the Corporation, including, but not limited to, management of the Corporation’s property, business, and financial affairs.  In addition to the duties and responsibilities conferred upon it by statute, by the Articles of Incorporation, or by these Bylaws, it is expressly declared that the Board of Directors shall have the following duties and responsibilities:

a.     To grant charters to Chapters, recognize specialty  organizations, establish criteria for caucuses, and establish Academy commissions or work groups as may be in the best interests of the Academy, taking into consideration any recommendations of the House of Delegates thereon;

b.     To appoint or remove the Executive Vice President pursuant to the affirmative vote of a two-thirds (2/3) majority of the Directors;

c.     To direct the activities of the Academy’s national office through the Executive Vice President;

d.     To provide for the management of the affairs of the Academy in such a manner as may be necessary or advisable;

e.     To establish committees necessary for the performance of its duties;

f.      To establish, regularly review, and update the Academy's management plan to attain the goals of the Academy;

g.     To call special meetings of the House of Delegates as provided under Article VI, Section 4;

h.     To report the activities of the Board of Directors for the preceding year to the House of Delegates and members at the Academy’s annual meeting;

i.      To establish the amount and timing of Academy membership dues and assessments.

j.      To review and determine, on no less than an annual basis, how to implement those policies enacted by the House of Delegates on behalf of the Academy that establish the collective values, philosophies, and principles of the physician assistant profession. If it determines that implementation of one or more such policies will require an inadvisable expenditure of Academy resources, or is otherwise not presently prudent or feasible, the board shall, at its earliest convenience, report to the House the reasons for its decision. 

 

          SECTION 2:   DUAL ROLES WITH AAPA CONSTITUENT ORGANIZATIONS. MEMBERS OF THE AAPA BOARD OF DIRECTORS MAY NOT HOLD ELECTED VOTING POSITIONS IN THE ACADEMY’S CONSTITUENT ORGANIZATIONS.  DIRECTORS MAY HOLD ELECTED OR APPOINTED NON-VOTING POSITIONS IN THE ACADEMY’S CONSTITUENT ORGANIZATIONS.

 

Section 23:   Board Composition.  There shall be the following members of the Board of Directors:  five (5) Academy Officers, five (5) Directors-at-large, one (1) Student Director, and the First Vice Speaker and Second Vice Speaker.  The First Vice Speaker and Second Vice Speaker are voting members of the Board of Directors by virtue of position.  The terms of office shall be as specified in Article XII, Section 2.

 

Section 34:      Officers of the Corporation.  The Officers of the Corporation shall be a President, a President-elect, a Vice President, a Secretary-Treasurer, and the Immediate Past President (“Academy Officers”).  The Academy Officers are voting members of the Board of Directors by virtue of position.

 

Section 45:      Duties of Officers of the Corporation. 

 

a.     The President shall be the chief spokesperson for the Academy.  The President shall report to the House of Delegates and the members at the annual meeting of the Academy with an account of the activities of the Board for the past year and its recommendations for the House of Delegates.

b.     The President-elect shall succeed to the office of President at the expiration of the President’s term or earlier should that office become vacant for any reason.

c.     The Vice President is the Speaker of the House of Delegates and shall represent the House of Delegates to the Board of Directors and shall perform such other duties as shall be assigned by the Board of Directors.

d.     The Secretary-Treasurer shall:

1.     be responsible for adequate and proper accounts of the properties and funds of the Academy; 

2.     give a full report to the membership at the annual meeting;

3.     deposit or call to be deposited all monies and other valuables in the name and to the credit of the Academy with such depositories as may be designated by the Board of Directors; 

4.     disburse the funds of the Academy as may be ordered by the Board of Directors; 

5.     render to the Board of Directors, whenever it may request it, an account of all the transactions as Secretary-Treasurer, and of the financial conditions of the Academy;

6.     maintain the records of the Academy including the records of the Board of Directors and of the House of Delegates;

7.     execute the general correspondence;

8.     attest the signature of the Academy Officers;

9.     affix the corporate seal on documents so requiring; and

10.  have such other powers and perform such other duties as may be prescribed by the President or the Board of Directors.

e.     The Immediate Past President shall perform such other duties as may be assigned by the President or the Board of Directors.

 

Section 56:      Meetings of the Board of Directors. 

 

a.     Regular and Special Meetings.  The Board of Directors shall hold such regular meetings at such time and at such places as designated by Board policy, but in no event shall there be fewer than two such meetings in any calendar year.  Regular meetings of the Board may be held without notice.  Special meetings shall be called by the Secretary-Treasurer at the request of the President or upon written request to the President of at least 20 percent of the members of the Board then in office.  The object of such special meetings shall be stated in the meeting notice, and no business other than that specified in the notice shall be transacted at the meeting.  Notice of a special meeting shall be provided not less than two (2) days before the meeting.

b.     Quorum. A majority of the membership of the Board then in office shall constitute a quorum for the purposes of transacting business. 

c.     Manner of Acting. The affirmative vote of a majority of the Directors present at a meeting at which a quorum is present shall be the act of the Board of Directors, except as otherwise provided by law, by the Articles of Incorporation, or by these Bylaws.  Each Director shall have one (1) vote on all matters submitted to a vote of the Board of Directors.  No Director voting by proxy shall be permitted.      

d.     Teleconferencing. To the extent permitted by law, any person participating in a meeting of the Board of Directors may participate by means of conference telephone or by any means of communication by which all persons participating in the meeting are able to hear one another, and otherwise fully participate in the meeting.  Such participation shall constitute presence in person at the meeting. 

e.     Action by Unanimous Written Consent.  Any action required to be taken at a meeting of the Board of Directors or any action which may be taken at a meeting of the Board of Directors may be taken without a meeting if a consent in writing, setting forth the action so taken, is signed by all of the Directors entitled to vote with respect to the subject matter thereof.  A Director's consent to action taken without a meeting may be in electronic form and delivered by electronic means.

 

Section 67:      Chair of the Board.  The Board of Directors may elect a Chair of the Board from among its members.  The Chair of the Board shall have such duties and responsibilities and may be elected according to such procedures as may be determined by the Board from time to time.

 

Section 78:      Executive Committee.  The Executive Committee of the Board of Directors shall consist of the President, Vice President, President-elect, Immediate Past President, Chair of the Board, and Secretary-Treasurer.  The Executive Committee shall be empowered to act for the Board of Directors on emergency matters only.  Actions of the Executive Committee shall be reported to the Board of Directors no later than the Board’s following meeting.  All such Committee actions must be reviewed and ratified by the Board of Directors and shall be included in the official Board minutes.

 

Section 89:      Resignation or Removal of Directors and Officers of the Corporation.  Any Director or Academy Officer may resign at any time by giving written notice to the President or the Board of Directors.  Such resignation shall take effect at the time specified in such notice, or, if no time is specified, at the time such resignation is tendered.  Any Director-at-large, Student Director, or Academy Officer (excluding the Vice President) may be removed from office at any time, with or without cause, by the affirmative majority vote of those members entitled to elect them.  Removal may only occur at a meeting called for that purpose, and the meeting notice shall state that the purpose, or one of the purposes, of the meeting is removal of the Director or Officer. Vacancies in these positions shall be filled in accordance with Article XII, Section 11 of these Bylaws.  Removal of the Vice President/Speaker shall be done in accordance with Article VI, Section 3 of these Bylaws pertaining to House Officers.

 

2014-A-08 – Adopted on Consent Agenda

 

The HOD recommends to the AAPA Board of Directors the amendment of policy BA-2500.1.5 as follows:

 

Notwithstanding any restrictions in information distribution policy, the Academy may distribute e-mail addresses, practice and home addresses and phone numbers from the masterfile to assist AAPA constituent organizations with their legislative and regulatory activities. AS WELL AS THEIR MEMBERSHIP RECRUITMENT ACTIVITIES.

 

2014-A-09 – Adopted on Consent Agenda

 

Amend policy HP-3300.2.5 as follows:

 

AAPA places a high priority on the increased involvement of physician assistants in national, state and local health care policy discussions involving patient care, legislative regulatory and reimbursement issues.  To ensure meaningful involvement of physician assistants in the Veterans Health Administration (VA) and promote equal and fair opportunities for physician assistants, the AAPA supports the continuation of the role of a full time the creation of a full time Director of Physician Assistant Services in the VA Central Office in perpetuity, who shall be responsible to and report to the Assistant Deputy Under Secretary of Health for Patient Care Services on all matters dealing with PA issues.  Furthermore, the AAPA supports the allocation of adequate resources and staff necessary for full effectiveness.

 

2014-A-10 – Rejected

 

The House of Delegates recommends the AAPA Board of Directors establish a volunteer membership task force with the objectives of increasing AAPA membership, member retention and encouraging PA programs to promote student membership in their PA professional organizations.

 

2014-A-11 – Rejected

 

The House of Delegates recommends the AAPA Board of Directors develop a public relations program that focuses on what PAs do to serve those in need, such as "PAs serve America and the world."

 

2014-A-12 – Adopted

 

Amend Bylaws Article XIII, Section 6 as follows:

 

Section 6:        Eligibility of Voters.  For all positions other than the Student Director, House Officer, and Nominating Work Group positions, eligible voters are fellow members listed on the Academy membership roster as of the date that is thirty (30) FIFTEEN (15) days before the election.

 

2014-A-13 – Referred

 

Amend Standing Rule 1400.2.7 as follows:

 

Each chapter, each officially recognized specialty organization, each caucus and the Student Academy may select alternate delegates who may be credentialed and seated by the sergeant at arms in the event that a delegate is not present. Elected alternate delegates from each chapter, each officially recognized specialty organization, each caucus and the Student Academy may be credentialed and seated by the sergeant at arms in the event that a delegate is not present. Seated alternate delegates are accorded all the privileges of a seated delegate. ONLY CREDENTIALED DELEGATES MAY VOTE IN AN ELECTRONIC VOTE. IT IS THE CHAPTER’S RESPONSIBILITY TO NOTIFY THE CREDENTIALS COMMITTEE OF CHANGE OF ALTERNATE TO DELEGATE STATUS.

 

2014-A-14 – Referred

 

            Amend Standing Rule 1400.2.8 as follows:

All eligible chapters, caucuses, and specialty organizations shall submit an official notification of ELECTED delegates/ALTERNATE DELEGATES selected to the appropriate staff member at the national office by July 1 of the year the delegate/alternate delegate takes office.  Notification process may be in writing or by electronic method. The process for the identification of delegates shall be established by the House Officers, and published in procedure in the House manual. Chapters, caucuses, and specialty organizations that fail to meet this deadline may not be seated in the House of Delegates unless granted exception by the House Officers not later than two weeks prior to the opening of the House.

 

2014-A-15 – Referred

 

            Amend Standing Rule 1400.2.9 as follows:

 

No delegate shall be seated who is not a fellow member or student member in good standing of the Academy. A DELEGATE OR ALTERNATE DELEGATE MAY BE CREDENTIALED IF:

1.     THE DELEGATE OR ALTERNATE DELEGATE IS ELECTED BY HIS OR HER CONSTITUENT ORGANIZATION OR THE STUDENT ACADEMY PER AAPA POLICY.

2.     THE DELEGATE OR ALTERNATE DELEGATE IS A FELLOW MEMBER IN GOOD STANDING IN THE ACADEMY.  A STUDENT DELEGATE MUST BE A STUDENT MEMBER IN GOOD STANDING IN THE ACADEMY.

3.     ALL OFFICERS OF THE CONSTITUENT ORGANIZATION ARE FELLOW MEMBERS IN GOOD STANDING IN THE ACADEMY OR THE CONSTITUENT ORGANIZATION WAS GRANTED AN EXEMPTION BY THE CONSTITUENT RELATIONS WORK GROUP PER AAPA POLICY.

4.     CONSTITUENT ORGANIZATIONS HAVE SUBMITTED THE NAMES OF THEIR OFFICERS, DELEGATES AND ALTERNATE DELEGATES TO THE APPROPRIATE STAFF PERSON IN THE MANNER PRESCRIBED BY THE HOUSE OFFICERS.

 

2014-A-16 – Adopted

 

            Amend Standing Rule 1400.9.2 as follows:

 

Under the direction of the second vice speaker, the Credentials Committee works with the sergeant at arms of the House of Delegates at the annual conference registration desk to credential delegates and alternates at the House of Delegates meeting.  Any conference attendee may serve on the committee.  Duties include: 

1) receiving the certificate signed by the President, the secretary or the chief delegate of the chapter, caucus, specialty organization or Student Academy when there is a change in the delegate from the original form submitted; 2) verifying delegate’s name against lists prepared prior to the meeting from forms submitted by the delegations formally designating their delegates and alternates; and 3) giving a ribbon and all appropriate materials to the delegates and alternates. 

 

THE CREDENTIALS COMMITTEE WILL BE RESPONSIBLE FOR CREDENTIALING ALL DELEGATES AND ALTERNATE DELEGATES UNDER THE DIRECTION OF THE FIRST VICE SPEAKER. 

 

THE CREDENTIALS COMMITTEE SHALL BE COMPOSED OF THE SERGEANT AT ARMS WHO SHALL ACT AS THE CHAIR, THE STAFF ADVISOR TO THE HOUSE OF DELEGATES, AND AT LEAST 3 OTHER FELLOW OR STUDENT MEMBERS APPOINTED BY THE HOUSE OFFICERS. 

 

THE DUTIES OF THE CREDENTIALS COMMITTEE SHALL INCLUDE:

1.     CONFIRMING THAT EACH DELEGATION AND DELEGATE IS IN COMPLIANCE WITH CURRENT ACADEMY POLICY IN REGARDS TO CREDENTIALING.

2.     NOTIFYING DELEGATIONS OR DELEGATES THAT ARE OUT OF COMPLIANCE AND PROVIDING NEEDED INFORMATION SO THAT THE DELEGATION/DELEGATE CAN BECOME CREDENTIALED

3.     STAFFING THE CREDENTIALING DESK AT THE ANNUAL MEETING. THE COMMITTEE WILL BE RESPONSIBLE TO COLLECT ANY CERTIFICATES SIGNED BY THE PRESIDENT, SECRETARY, SECRETARY/TREASURER OR CHIEF DELEGATE OF A CONSTITUENT ORGANIZATION WHEN THERE IS A CHANGE IN THE STATUS OF ANY DELEGATE FROM THAT PREVIOUSLY SUBMITTED.  IN ADDITION, THE COMMITTEE WILL VERIFY THE NAMES OF CREDENTIAL DELEGATES AND DISTRIBUTE A DELEGATE OR ALTERNATE RIBBON AND ANY OTHER MATERIALS NEEDED FOR THE MEETING.

4.     COLLECTING A CONFLICT OF INTEREST FORM FROM EACH DELEGATE AND ALTERNATE DELEGATE.  THE COMMITTEE WILL REVIEW THE CONFLICT OF INTEREST FORMS AND NOTIFY THE FIRST VICE SPEAKER OF ANY POTENTIAL CONFLICTS OF INTEREST.

 

2014-B-01 – Rejected

 

(Referred 2013-B-12)

 

PAs are collaborative medical professionals. PAs are integral partners and colleagues of the physicians with whom they practice medicine. A broad, comprehensive medical education prepares PAs for autonomous clinical decision making and a high level of responsibility for patient care. Although “supervision” is a term commonly used in statute and regulation, it does not reflect the true nature of PA-physician teams providing high-quality, coordinated healthcare. 

 

2014-B-02 – Adopted as Amended

 

Amend policy HP-3100.3.1 as follows:

 

PAs are health professionals licensed or, in the case of those employed by the federal government, credentialed to practice medicine in association COLLABORATION with   designated collaborating physicians. PAs are qualified by graduation from an accredited PA educational program and/or certification by the National Commission on Certification of Physician Assistants.

 

Within the physician-PA relationship, PAs provide patient-centered medical care services as a member of a health care team. PAs practice with defined levels of autonomy and exercise independent medical decision making within their scope of practice.

 

2014-B-03 – Adopted on Consent Agenda

 

Amend policy HP-3200.2.1 as follows:

 

AAPA recognizes the concept of continuing professional development (CPD) as a means to maintain competence and ensure the delivery of high quality care. CPD is a process that includes ongoing identification of learning needs, development of a learning plan, acquisition of new knowledge and skills, application to practice, PERSONAL REFLECTION and reassessment.

 

Continuing medical education consists of clinical and professional educational activities that serve to maintain, develop, or increase the knowledge, skills, and professional performance and relationships that a physician assistant uses to provide services for patients, the public, and the profession. Continuing medical education is a formal component of CPD. All continuing medical education reported should comply with this definition, regardless of whether it is reported as Category I (pre-approved) or Category II (elective). 

 

2014-B-04 – Adopted

 

Amend policy HP-3200.3.2 as follows:

 

AAPA believes that it is vital for graduate PAs to be involved in the education of student PAs.  This involvement may include, but is not limited to 1) recruitment of new students 2) participation in the selection of new students 3) classroom instruction and 4) clinical preceptorship. ADDITIONALLY, AAPA SUPPORTS APPROVED PA PROGRAMS IN AWARDING CATEGORY 1 CME CREDIT TO GRADUATE PAS WHO PRECEPT PA STUDENTS. The AAPA will, through its publications, programs and services, encourage its members to actively participate in these educational opportunities.

 

2014-B-05 – Adopted on Consent Agenda

           

Amend policy HX-4400.1.12 as follows:

 

The AAPA believes that physician assistants should be aware of the potential effects of media violence to include cyberbullying on their patients and within their community.  PAs should consider involvement in professional organizations and community activities that seek to reduce the amount of violence, cyberbullying, and other problematic content in media materials. PAs should encourage increased parental involvement in their children’s computer activities, media exposure, USE OF SOCIAL MEDIA and game-playing decisions. PAs should make information on media literacy available to patients and families.

           

2014-B-06 – Adopted as Amended

 

Amend policy HP-3500.2.3 as follows:

 

The AAPA believes that the NCCPA certificate should be time-limited and that maintenance of a current valid certificate requires that physician assistants pass the Physician Assistant National Recertifying Exam (PANRE) within four attempts if initiated in the fifth year WITHIN THE FINAL TWO YEARS of the recertification cycle. for those IN the six-year cycle and the ninth year for those in the 10-year cycle.

 

2014-B-07 – Rejected

The AAPA supports the grandfathering of physician assistants who initially passed

the PANCE, on or before December 31,1990, as NCCPA certified.

 

2014-C-01 – Adopted as Amended

 

            (Referred 2013-B-01)

 

Amend policy HX-4400.2.2 as follows:       

 

The AAPA supports policies and educational programs that will effectively reduce homicide, suicide and other violence that occurs through the use of firearms.  The AAPA also supports measures that effectively reduce the criminal ownership and use of firearms.  As the AAPA represents the diverse membership of physician assistants, the AAPA supports the requirement of:

1.     Reporting by physician assistants to law enforcement agencies persons in their care exhibiting behavior dangerous to themselves or others making them unfit to purchase or own firearms.

2.     Supporting state legislation that allows PAs to counsel patients regarding firearm ownership and safety.

3.     Participation in AND/OR ADVOCACY OF educational programs on the safe storage and use of firearms.

4.     PARTICIPATION IN AND/OR ADVOCACY OF training programs for the safe use and employment of firearms.

5.     The Enforcement of current laws for the purposes of public safety regarding firearms.

 

2014-C-02 – Rejected

 

            AAPA believes that all existing gun laws be strictly enforced.

 

 

 

2014-C-03 – Rejected

 

           AAPA believes that with the exception of transfers between first degree relatives, background checks be mandatory for all ownership transfers of firearms.

 

2014-C-04 – Rejected

 

           AAPA believes that criminal and civil penalties should be imposed on all individuals who are found to knowingly transfer possession of a firearm to an individual who was prohibited from possessing it.

 

2014-C-05 – Rejected

 

           AAPA believes that gun owners should be subject to criminal and civil penalties if their improperly secured firearms are the cause of an injury or used in a crime.

 

2014-C-06 – Rejected

 

AAPA believes that civilians should be banned from owning automatic and semiautomatic firearm/magazine combinations capable of firing, without reloading, more than ten times a minute.

 

2014-C-07 – Rejected

 

Amend policy HX-4700.2.5 as follows:

 

AAPA recommends hospitals allocate staff so that the staffing ratios are balanced throughout the hospital AND RECOMMENDS THE DEVELOPMENT OF OBSERVATION UNITS to avoid overburdening the emergency department staff while maintaining patient safety.

 

2014-C-08 – Adopted on Consent Agenda

Amend by substitution policies HP-3300.1.11.1, HP-3300.1.11.2, HP-3300.1.11.3 and HP-3300.1.11.4 as follows:

aapa encourages pas to become educated about the prevention and management of being overweight and obese for both adult and pediatric populations, and to take an active leadership role in educating their patients and the public about the health risks of being overweight and obese. Pas are encouraged to address the issues of healthy weight and regular physical activity as critical components of health promotion/health maintenance for adults and children in their care. Additionally, pas are encouraged to be proficient in identifying and treating obesity-related disease states and comorbidities. Pas themselves are encouraged to maintain a healthy weight in order to set the best example for their patients.

The aapa encourages the pa profession to combat the epidemic of childhood obesity within their clinical practices and to collaborate with public health organizations and federal agencies to meet the goals of improved nutritional education in schools, expanded physical education and exercise programs, and healthier eating habits in the home.

HP-3300.1.11.1
Physician assistants are encouraged to address the issues of healthy weight and regular physical activity as critical components of health promotion.
[Adopted 2004, amended 2009]

HP-3300.1.11.2
The American Academy of Physician Assistants (AAPA) encourages PAs to take a leadership role in prevention and early recognition of pediatric obesity as well as identifying and treating obesity related co-morbidities.  PAs are urged to participate in collaborative efforts with public health organizations and federal agencies to prevent pediatric obesity in our communities by encouraging healthy eating and nutritional practices with regular physical activity.
[Adopted 2004, amended 2009]

HP-3300.1.11.3
The AAPA encourages the PA profession to combat the epidemic of childhood obesity by improved nutritional education in schools, expanded physical education and exercise programs.  The Academy supports physician assistants in their efforts to provide leadership in schools promoting healthy lifestyles for our nation’s children.
[Adopted 2004, reaffirmed 2009]

HP-3300.1.11.4
The Academy encourages educating physician assistants about the prevention and management of being overweight and obese.  Additionally, the AAPA encourages national efforts to educate the public about the health risks of being overweight and obese.  AAPA encourages all physician assistants and patients to maintain a desired weight and prevent inappropriate weight gain.
[Adopted 2004, reaffirmed 2009]

 

2014-C-09 – Adopted on Consent Agenda

 

AAPA encourages PAs to reduce rates of childhood obesity by development of an educational pamphlet on healthy meal planning focused on patients and families with a limited food budget. The goal of this pamphlet is to provide PAs with a downloadable tool that would help reduce childhood obesity and to promote the PA profession by incorporating the AAPA logo on this material with a short paragraph describing the PA role in healthcare.

 

 

2014-C-10 – Adopted on Consent Agenda (changes highlighted)

 

Amend policy HP-3700.1.5, Guidelines for the Physician Assistant Serving As an Expert Witness as follows:

 

      Guidelines for the Physician Assistant Serving as an Expert Witness

(Adopted 1977, amended 1987, 1991, and 2001, reaffirmed 2004 and 2009)

Executive Summary of Policy Contained in this Paper

Summaries will lack rationale and background information and may lose nuance of policy. You are highly encouraged to read the entire paper.

·      A PA serving as an expert witness should have current experience and knowledge in the area(s) about which he or she is to testify.

·      A PA expert must objectively evaluate facts and provide an opinion. If no opinion can be derived from available facts, this should be stated to the attorney.

·      The PA’s review of medical facts should be thorough, fair, and impartial and should not exclude any relevant information in order to create a view favoring either the plaintiff or the defendant. The expert should champion what he or she believes to be the truth.

·      A PA giving testimony does not attack performance that which falls within accepted standards of practice or support obviously deficient practice.

·      A PA offering an opinion should know what constitutes customary practice. Testimony about innovation in medical practice should be identified as such.

·      The PA should testify truthfully and consistently, recognizing his or her testimony may be subject to peer review.

·      The PA should not accept a contingency fee – compensation based on the outcome of a case in which testimony is given – or derive personal, financial, or professional favor in addition to compensation.

 

Introduction

 

A physician assistant may serve as a witness in a legal proceeding in one of several capacities.1 These guidelines discuss serving as expert witness and giving opinions in professional liability (medical malpractice) cases. Accompanying notes and references outline other roles a PA may have as a witness or consultant, preparation for testifying, legal terms, strategies and tactics that may be encountered.

 

It is the intent of the Academy to inform physician assistants about the duties PAs have, as health care professionals, to society, the legal system, and the profession. These guidelines and comments are not legal advice. Physician assistants involved in legal matters are urged to obtain legal advice from a qualified attorney.

 

A physician assistant may be called upon or directed to give an expert medical opinion in the judicial system because knowledge about medicine and PA practice is generally considered beyond the average judge or juror’s experience. A patient who alleges injury (plaintiff) and the judge or jury will need opinions about standards of medical care, if and how a standard of care was met, and, if not, how falling below a standard caused injury to the patient. The practitioner (defendant) may also need expert opinions and may serve as an expert witness in his or her own behalf.

 

The responsibility of providing a professional opinion as an expert witness should be undertaken after careful self-evaluation and thorough preparation with an attorney. The PA should have an understanding of medical, legal and ethical principles involved.2

Guideline 1: A physician assistant serving as an expert witness should have current experience and knowledge in the area(s) about which he or she is to testify.3

A PA’s knowledge and experience alone may not sufficiently satisfy an attorney or qualify the PA to testify in court as an expert witness. Maturity, integrity, composure and other personal characteristics should be evaluated with an attorney prior to offering testimony. Prior testimony, income from testifying, potential conflicts of interest with, or bias toward, other parties involved in the case may render a PA unsuitable as a witness. If, after meeting with an attorney, the PA is unclear on issues about which he or she will testify, feels uncomfortable offering an opinion, or has no opinion, voluntary testimony should not be given.

Guideline 2: A PA expert must objectively evaluate facts and provide an opinion. If no opinion can be derived from available facts, this should be stated to the attorney. The PA’s review of medical facts should be thorough, fair, and impartial and should not exclude any relevant information in order to create a view favoring either the plaintiff or the defendant. The expert should champion what he or she believes to be the truth.

PAs serving as expert witnesses have an ethical responsibility to the profession. The Guidelines for Ethical Conduct for the Physician Assistant Profession admonishes a PA from participating in an activity that will discredit or dishonor the profession. Providing an expert opinion in a judicial process is never a trivial matter. There are risks to the witness, profession, other parties, and society. Yet, AAPA Policy further asks PAs to expose without fear or favor, any illegal or unethical conduct in the medical profession. Participating in a judicial proceeding as an expert witness, like peer review, is a necessary obligation of the profession and its members. Expert opinion may support or criticize a colleague.

 

This duty, to serve for the good of society and the courts, is a guiding principle. This responsibility may override the concept that PAs should act, in these situations, as advocates for a patient or serve only a patient’s interest. Expert opinion may help or hinder a patient’s cause.

Guideline 3: It is incumbent upon a PA giving testimony in legal proceedings that his or her testimony does not attack performance that falls within accepted standards of practice or, conversely, support obviously deficient practice. Since experts establish the standards of practice in a given case, care should be exercised to ensure that such standards do not narrowly reflect the experts’ views to the exclusion of other acceptable choices.

An expert witness should recognize that there is uncertainty inherent in medical practice. It is a dynamic and changing discipline based on concepts of probability rather than on absolute certainty. Principles drawn from the experience of a number of patients and providers are applied to individual patients with hope for success. Further, with technologically advanced medical care, both benefits and risks are likely to be increased. Risks of complication in the practice of technical specialties can be frequent and/or severe. In providing expert testimony, a PA should have in mind a clear distinction between the occurrence of unavoidable and/or severe complications which do not represent malpractice (good medical care, but a bad outcome), and the occurrence due to negligence4 (poor medical care that contributes to or causes a bad outcome).

 

Testimony is usually given concerning customary or standard practice. Innovation in medical practice is sometimes considered in a legal proceeding. An innovation may or may not fall outside of the standard of care. Many advances in medical practice rely on innovation.

Guideline 4: A physician assistant offering an opinion should know what constitutes customary practice. Testimony about innovation in medical practice should be identified as such.

A physician assistant may offer an expert opinion several times in one legal proceeding or in several separate proceedings. Expert testimony offered by the PA in previous cases and proceedings is often reviewed and compared by attorneys and other experts. All testimony should be truthful and consistent.

(15)  Guideline 5: The PA should testify truthfully and consistently, recognizing his or her testimony may be subject to peer review.

Custom and rules governing compensation for legal witnesses vary. The PA should be fairly compensated for time spent preparing, appearing and testifying as an expert witness.

(17)  Guideline 6: The PA should not accept a contingency fee — compensation based on the outcome of a case in which testimony is given — or derive personal, financial, or professional favor in addition to compensation.

Summary of Academy

Guidelines for the Physician Assistant Serving as an Expert Witness

 

The PA should have current experience and ongoing knowledge in the areas of clinical practice about which he or she is testifying.

 

The PA should objectively evaluate the facts and provide an opinion. The PA’s review of medical facts should be thorough, fair and impartial and should not exclude any relevant information in order to create a view favoring either the plaintiff or the defendant. The expert should champion what he or she believes to be the truth, not the cause of one party in a dispute.

 

The PA’s testimony should reflect an evaluation of performance considering generally accepted standards, neither condemning performance that clearly falls within generally accepted practice standards nor condoning performance that clearly falls below these standards. The PA should examine the relationship of an alleged substandard practice to the outcome and acknowledge, when necessary or uncertain, that a deviation from a practice standard is not always causally related to a bad outcome. The PA should make a clear distinction between medical malpractice and the occurrence of unavoidable complications, which do not arise from negligence.

The PA should identify testimony about customary practice and testimony about innovation.

The PA should offer testimony recognizing it may be subject to peer review. Testimony given should be truthful and consistent.

The PA expert witness should be fairly compensated for time spent preparing, appearing and testifying. The PA should not accept a contingency fee based on the outcome of a case in which testimony is given, or derive personal, financial or professional favor in addition to compensation.

Recommended Reading

 

American Academy of Physician Assistants. “Guidelines for Ethical Conduct for the Physician Assistant Profession,” may 20002013.

 

Babitsky S. The Ten Biggest Mistakes Experts Make During Deposition. Available on ExpertPages.com.

wysiwyg://162/ http://expertpages.com/news/ten_biggest_mistakes.htm   

 

Babitsky S, Mangraviti JJ. How To Excel During Cross Examination: Techniques for Experts that Work. SEAK Inc. Falmouth, MA, 1997.

MANGRAVITI JJ, BABITSKY S. HOW TO EXCEL AT YOUR EXPERT WITNESS DEPOSITIONS. SEAK 2013

 

Bronstein DA. Law for the Expert Witness. CRC Press. Boca Raton, FL, March 1999 DECEMBER 2011.

 

Kolczynski PJ. How To Be a Successful Expert Witness. Copyright 1997 by the author. Available on ExpertPages.com.

wysiwyg://150/http://expertpages.com/news/how_to_be_a_successful_expert_wi.htm

 

Leonetti KM. In The Professional Liability Handbook: A Basic Guide for Physician Assistants. American Academy of Physician Assistants, Alexandria, VA, 1990.

 

Lubet S. Expert Testimony: A Guide for Expert Witnesses and the Lawyers Who Examine Them. National Institute for Trial Advocacy, Notre Dame, IN, 1998.

 

Malone DM, Zwier PJ. Expert Rules: 100 (and more) Points You Need to Know about Expert Witnesses. National Institute for Trial Advocacy, Notre Dame, IN, 2001 LEXIS/NEXIS, 2012.

 

Malone DM, Zwier PJ. Effective Expert Testimony. National Institute for Trial Advocacy, Notre Dame, IN, July 2000 2006.

 

Merenbach DG, Stephen A. How To Be an Expert Witness: Credibility in Oral Testimony. Fithian Press, Santa Barbara, CA, April 1993.

 

Poynter D. Expert Witness Handbook: Tips and Techniques for the Litigation Consultant. Para Publishing, New York, June 1997 JANUARY 2012.

 

Tsushima WT, Nakano KK. Effective Medical Testifying: A Handbook for Physicians. Butterworth-Heinemann Medical, Woburn, MA, March 1998.

_____________________________________________

 

Endnotes

 

1           Testimony may be given at the request of either party in a lawsuit. Testimony may be given by affidavit, at a deposition, transcribed and then used in court by either party, or testimony may be given directly in court. There are several types of medical testimony.

           

            When a PA has a prior relationship, such as treating or providing a consultation for the patient, there is a duty to assist that patient in legal matters pertaining to the medical care. RS Toth, Legal Medicine: Legal Dynamics of Medical Encounters, American College of Legal Medicine; Mosby (St Louis) 1988. An example of this is treating a patient who was involved in an automobile accident or job-related injury and later testifying about the observed injuries or extent of disability. In this circumstance, the PA may testify voluntarily or, less frequently, may be compelled by subpoena to give factual testimony. The testimony may be given in person or in writing.

           

            In contrast, a non-treating PA may provide expert opinion testimony in a malpractice case about a standard of care -- possessing and using that degree of skill and learning which is customarily expected of practitioners acting under the same or similar circumstances. During litigation, a general standard of care is applied to the facts of a case by the introduction of expert witness testimony. See Toth.

           

            Time spent preparing for and giving testimony, possible future court appearances and compensation for these services should be agreed upon with the attorney before undertaking these activities.

           

            During testimony, a factual (percipient) witness may be asked to give an opinion and in doing so offers expert testimony without being called as an expert witness. Similarly, a PA performing chart review as an expert consultant in a legal matter may be called upon to give an expert opinion. To understand your situation and to prepare adequately for testifying you should ask the attorney who wants your services or testimony to specify the request in writing. This may be a letter, contract, or, less often, a formal notice (a subpoena) to compel your testimony. A subpoena, citation or other court order may be issued, if only to help the attorney follow legal procedures should you not be available or qualified to testify.

           

            Whether compelled or testifying voluntarily and regardless of your intent to provide only factual testimony or consultation, you still may be asked to give an expert opinion. An attorney should advise you on the best course of action.

           

            There sometimes are exceptions for having to give expert, opinion testimony. There may be insufficient information on which to base an opinion. Also, a practitioner who treats a patient may refrain from giving an expert opinion on the standard of care in a malpractice case if the injury is alleged to have occurred before the practitioner's care and someone else is alleged to have caused the injury.

           

            Legal jurisdictions have rules about expert opinion, qualifications of experts, applicable fees and types of testimony. Local custom in the medical and legal communities may dictate fees that are appropriate.

 

2  Testimony given by a PA expert may cover one or several areas such as clinical practice and procedures, professional standards, conduct and ethics, scope of practice or statutes and regulations relating to practice. In civil and criminal proceedings, PA experts may also offer testimony such as cause of injury or disability, extent of temporary or permanent disability, and medical findings in assault or abuse cases.

 

3  The Federal Rules of Evidence define an expert witness as anyone "...qualified as an expert by knowledge, skill, experience, training, or education." (Rule 702) Although most cases in which a PA might testify will be conducted in state courts, which are governed by the particular state's rules of evidence, Federal Rules of Evidence will be cited here to offer generic illustration. There are expert witnesses representing every type of human activity (accountants, engineers, homemakers, mechanics, nurses, physicians, etc.).

 

4 The legal definition of negligence has four elements: (1) that the PA owed a legal duty to the patient. A PA owes each patient the duty to possess and use on the patient's behalf that degree of knowledge, skill, and care usually exercised by reasonable practitioners under similar circumstances. This duty creates a standard of care for various medical acts. (2) That the PA breached the duty, failed to comply with the standard of care. (3) That the patient sustained actual damages, such as physical impairment, emotional injuries and/or financial consequences. (4) That the PA's breach of duty proximally caused the patient's injuries. All four elements must be satisfied for a finding of negligence. Expert witness testimony is often needed to support any or all of these elements. Expert opinion testimony often defines the standard of care in malpractice cases. KM Leonetti, in The Professional Liability Handbook: A Basic Guide for Physician Assistants, AAPA (Alexandria), 1990. RS Toth, Legal Medicine: Legal Dynamics of Medical Encounters, American College of Legal Medicine; Mosby (St Louis), 1988. MD McCafferty and SM Meyer, Medical Malpractice Bases of Liability, McGraw Hill (Colorado Springs),1985.

 

2014-C-11 – Adopted on Consent Agenda (changes highlighted)

 

Amend policy HP-3300.2.8 Direct to Consumer Advertising as follows:

 

Direct to Consumer Advertising

(Adopted 2004 and amended 2009)

Executive Summary of Policy Contained in this Paper

Summaries will lack rationale and background information and may lose nuance of policy. You are highly encouraged to read the entire paper.

·      The AAPA believes that direct to consumer advertising (DTCA) presented in a responsible and ethical manner may be of some value to patients. Such information should be scientifically substantiated, accurately presented, and free of bias and false or misleading claims.

 

·      AAPA urges that any DTCA by pharmaceutical companies be based on disease state only, without mention of a specific drug by name or category of drug, and that patients should always be urged to see their health care professional before taking prescription medications.

 

Introduction

Direct to consumer advertising (DTCA) is the promotion directly to potential patients of prescription drugs through newspaper, magazine, television and internet marketing. Drug companies also produce a range of other materials that are available in medical offices or designed to be given to patients by medical professionals or via patient groups. DTCA advertising is just one strand in the marketing and public relations efforts of drug companies to promote brand-name prescription drugs.

Other elements in the marketing and PR mix aimed at prescribers include advertising in medical journals, the placement and promotion of favorable studies in medical journals, the visits of sales representatives to prescribers, the provision of free samples of drugs for prescribers to give to their patients, gifts and subsidized educational events and conferences.

The only two developed countries where DTCA is currently legal are the U.S. and New Zealand. While banned elsewhere, the drug industry has repeatedly mounted is mounting major lobbying campaigns to have DTCA allowed in Europe and Canada. While there is oversight of pharmaceutical marketing in the developed world, there are few provisions for monitoring DTCA in low and middle income countries, where it remains illegal. Furthermore, the use of social media platforms and advertising through the internet circumvents national boundaries and has resulted in largely unchecked global DTCA by both legitimate and illegitimate pharmaceutical companies.

Total spending on pharmaceutical promotion grew from an estimated $11.4 billion in 1996 to $29.9 billion in 2005. Although during that time spending on DTCA increased by approximately 330%, it made up only 14% of total promotional expenditures in 2005. DTCA campaigns generally begin within a year after the approval of a product by the FDA. In the context of regulatory changes requiring legal review before issuing letters, the number of letters sent by the FDA to pharmaceutical manufacturers citing those companies for violations of drug-advertising regulations fell from 142 in 1997 to only 21 in 2006, in part due to a lack of FDA-resources. [Donohue et al. NEJM 357(7):673 Aug 16, 2007]

The federal Food and Drug Administration (FDA) regulates the promotion and advertising of prescription drugs in the United stateS, including DTCA and materials directed to medical professionals, to ensure that they are not false or misleading and otherwise comply with applicable laws and regulations. [See 21 U.S.C. § 352(n), 21 C.F.R. § 202.1 (2013)].  FDA regulations require that drug companies submit final advertising materials to the FDA at the time they are first disseminated to the public. In addition, drug companies may voluntarily submit draft versions of DTC advertising materials to FDA prior to their release in order to obtain advisory comments from the agency. FDA’s authority does not extend to “help-seeking” advertisements – those that do not identify prescription drugs by name, but rather discuss a disease or condition and advise the audience to “see your doctor” for possible treatments.

In 1997 the FDA relaxed regulations on broadcast media advertising of prescription drugs by stating that adequate provision of risks and benefits could be communicated by simply referencing a toll free number or website. Annual spending on DTCA promptly tripled to $1.3 billion dollars and reached $4.3 billion by 2010. The fastest growing aspect of drug marketing, DTCA has outpaced marketing directly to providers, and drug research and development. The majority of spending is now on television advertising with viewers exposed to nine commercials per day for prescription drugs. As spending increased, so did the number of regulatory letters sent by the FDA to pharmaceutical companies concerning false or misleading DTCA.

The Pros and Cons of DTCA

The pharmaceutical industry argues that DTCA advertising helps educate consumers of potential conditions and encourages them to see their health care professional for diagnosis and treatment. While acknowledging that DTCA increases the amount spent on prescription drugs, they argue that in the long run early treatment and diagnosis reduces spending on other medical services, such as hospitalization.

Critics of DTCA argue that the industry's advertising is primarily emotional in style and understates the adverse side-effects and as such is misleading. The imagery of the ads is appealing while the potentially serious side effects are buried in the fine print. They also argue that the claimed health benefits are overstated. Surveys reveal that people who have seen DTCA ads will often request and be prescribed the drug. DTCA campaigns will usually aim to have pre-primed prescribers via a closely linked parallel promotional campaign. Critics argue that this results in over-diagnosis of conditions and inappropriate use of prescription drugs, even where non-drug treatments are as effective or more effective. As a result, they say, DTCA unnecessarily drives up the overall cost of healthcare without necessarily improving the health of those treated.

Problems with DTCA of pharmaceuticals may have significant unintended consequences. These include but are not limited to patients that seek medications from pharmacies on the Internet and outside the United States without a prescription or without prescriber monitoring or even awareness of medications. Patients may not be aware of the entire spectrum of other more appropriate and less expensive therapeutic options than the advertised drug. Side effects are often not communicated in a comprehensive manner in advertising or marketing communications. Furthermore, every drug has risks and benefits, and patients are often unaware of drug-drug, drug-herb, drug-supplement, or drug-food interactions. Health care professional monitoring ensures that pharmaceuticals are appropriate for a patient’s particular health condition and that the benefit outweighs any risk.

A November 2006 report by the U.S. Government Accountability Office report noted that "studies we reviewed found that increases in DTC advertising have contributed to overall increases in spending on both the advertised drug itself and on other drugs that treat the same conditions. For example, one study of 64 drugs found a median increase in sales of $2.20 for every $1 spent on DTC advertising. Consumer surveys suggest that DTC advertising increases utilization of drugs by prompting some consumers to request the advertised drugs from their physicians, who studies find are generally responsive to these requests. The surveys we reviewed found that between 2 and 7 percent of consumers who saw DTC advertising requested and ultimately received a prescription for the advertised drug." [http://www.gao.gov/htext/d0754.html accessed August 9, 2008 March 8, 2014]

The GAO also found that pharmaceutical company spending on DTC advertising on television and in magazines of prescription drugs increased twice as fast from 1997 through 2005 as spending on promotion to prescribers or on research and development. In spite of this substantial and not insignificant increase pharmaceutical companies spent less each year on DTCA ($4.2 billion in 2005) than on promotion to prescribers ($7.2 billion in 2005) or research and development ($31.4 billion in 2005). [http://www.gao.gov/htext/d0754.html accessed August 9, 2008.]

The federal Food and Drug Administration (FDA) regulates the promotion and advertising of prescription drugs, including DTCA and materials directed to medical professionals, to ensure that they are not false or misleading and otherwise comply with applicable laws and regulations. [See 21 U.S.C. § 352(n), 21 C.F.R. § 202.1(e)(2006)]. This oversight function is carried out by the Division of Drug Marketing, Advertising, and Communications (DDMAC) within FDA’s Center for Drug Evaluation and Research. FDA regulations require that drug companies submit final advertising materials to FDA at the time they are first disseminated to the public. In addition, drug companies may voluntarily submit draft versions of DTC advertising materials to FDA prior to their release in order to obtain advisory comments from the agency. FDA’s authority does not extend to “help-seeking” advertisements – those that do not identify prescription drugs by name, but rather discuss a disease or condition and advise the audience to “see your doctor” for possible treatments. Other centers within FDA are responsible for overseeing promotion and advertising of biologics—such as vaccines and blood products—and electronic products emitting radiation. The Federal Trade Commission has primary oversight responsibility for the regulation of advertising for over-the-counter drugs.

 

The GAO also found that FDA regulatory letters have been limited in their effectiveness at halting the dissemination of false and misleading DTC advertising materials. They found that, from 2004 through 2005, FDA issued regulatory letters an average of about eight months after the violative DTC materials they cited were first disseminated by pharmaceutical companies. By the time these letters were issued, the pharmaceutical companies had already discontinued more than half of the cited materials. For the materials that were still being disseminated, pharmaceutical companies removed the cited materials in response to FDA’s letter. To their credit, these same companies also identified and removed other materials with claims similar to the materials cited in the regulatory letters. Although pharmaceutical companies complied with FDA’s requests to create materials that correct the misimpressions left by the cited materials, these corrections were not disseminated until 5 months or more after FDA issued the regulatory letter. Despite halting the dissemination of both cited and other violative materials at the time the letter was issued, FDA’s issuance of these letters did not always prevent drug companies from later disseminating similar violative materials for the same drugs. [http://www.gao.gov/new.items/d0754.pdf Accessed August 9, 2008]

 

In response to criticisms by GAO, the FDA candidly admits that it recognizes “that, with current staffing, DDMAC’s DTC Review Group cannot review in detail the more than 10,000 DTC materials that are submitted to the agency each year.” [http://www.gao.gov/new.items/d0754.pdf Accessed August 9, 2008]

 

Spending on DTCA has continued to increase recently both in absolute terms and as a percentage of pharmaceutical sales in spite of outside pressure on manufacturers to curtail such advertising. [Committee on the Assessment of the US Drug Safety System, Baciu A, Stratton K, Burke SP, eds. The future of drug safety: promoting and protecting the health of the public. Washington, DC: National Academies Press, 2006.] Promotion to prescribers continues to be the dominant marketing strategy used by the pharmaceutical industry, but there are some drugs in a majority of the top-selling classes that are promoted by DTCA. Driven by increases in DTCA, total promotion as a percentage of sales has increased substantially during the past 5 years, leading some observers to worry that consumers must bear these increased costs in the form of higher prices. Economic theory and evidence suggest that changes in marketing costs are unlikely to have a direct effect on pharmaceutical prices, which largely reflect perceptions of product value held by consumers, physicians, and payers. [Berndt ER. Pharmaceuticals in U.S. health care: determinants of quantity and price. J Econ Perspect 2002;16:45-66.] Of course, it is possible that advertising reduces the price responsiveness of demand and thus leads manufacturers to increase prices, but the empirical evidence on this point is mixed. [Rizzo JA. Advertising and competition in the ethical pharmaceutical industry: the case of antihypertensive drugs. J Law Econ 1999;42:89-116. and Gonul FF, Carter F, Petrova E, Srinivasan K. Promotion of prescription drugs and its impact on physicians' choice behavior. J Marketing 2001;65:79-90.]

 

Conclusion

The American Academy of Physician Assistants (AAPA) believes direct to consumer advertising (DTCA) that is presented in a responsible and ethical manner may be of some value to patients. Such information should be scientifically substantiated, accurately presented, and free of bias and false or misleading claims. DTCA and marketing of pharmaceuticals, devices, or surgical procedures may create significant patient safety concerns if it leads patients to seek health care solutions without consulting with a health care professional, increases costs of care, or inappropriately directs patients or providers away from best-practice solutions or evidence-based medicine. As such, AAPA urges that any DTCA by pharmaceutical companies be based on disease state only, without mention of a specific drug by name or category of drug, and that patients should always be urged to see their health care professional before taking prescription medications.


References

Ventola CL. Direct-to-Consumer Pharmaceutical Advertising: Therapeutic or Toxic? P&T. 2011; 36(10):669-684.

 

Greene JA, Herzberg D. Hidden in Plain Sight: Marketing Prescription Drugs to Consumers in the Twentieth Century. Am J Public Health. 2010;100:793–803.

 

Biegler P, Vargas P. Ban the Sunset? Nonpropositional Content and Regulation of Pharmaceutical Advertising. Am J Bioethics, 2013;13(5): 3–13.

 

Mintzes B. Advertising of Prescription-Only Medicines to the Public:Does Evidence of Benefit Counterbalance Harm? Annu Rev Public Health 2012. 33::259–277.

 

Greene JA, KesselheimAS. Pharmaceutical Marketing and the New Social Media. N Engl J Med. 2010; 363;2087-2089.

 

Liang BA, Mackey T. Direct-to-Consumer Advertising With Interactive Internet Media: Global Regulation and Public Health Issues. JAMA, 2011; 305 (8):824-825.

 

Arnold DG, Oakley JL. The Politics and Strategy of Industry Self-Regulation:The Pharmaceutical Industry’s Principles for Ethical Direct-to-Consumer Advertising as a Deceptive Blocking Strategy. Journal of Health Politics, Policy and Law, 2013; 38:505-544.

 

Donohue JM, Cevasco M, Rosenthal MB. A Decade of Direct-to-Consumer Advertising of Prescription Drugs. N  Engl J Med. 2007; 357(7): 673 – 681.

 

Table 1: Prescription Drug Promotion and Research and Development, 1997 through 2005

[http://www.gao.gov/new.items/d0754.pdf Accessed August 9, 2008]

Dollars in billions

1997

1998

1999

2000

2001

2002

2003

2004

2005

Average annual percentage increase

Total percentage increase, 1997-2005

Promotion

Text Box: DELETE TABLESpending on DTC advertising a

$1.1

$1.3

$1.8

$2.5

$2.7

$2.6

$3.3

$4.0

$4.2

19.6

296.4

Spending on promotion to physicians b

3.9

4.6

4.8

5.6

5.9

6.6

7.4

7.8

7.2

9.0

86.0

Retail value of samples c

6.0

6.6

7.2

8.5

10.5

11.9

13.5

15.9

n.a.

14.9 d

162.4d

Research and Development

Spending on research and development e

15.5

17.1

18.5

21.4

23.5

25.7

27.1

29.6

31.4f

9.3

103.3

 

Sources: GAO analysis of IMS Health and PhRMA data.

Legend: n.a. = not available.

a Includes estimated spending on DTC advertising on television, in magazines and newspapers, on radio, and outdoors (such as on billboards). The estimates do not include other spending, such as spending to develop and maintain drug companies’ Web sites or spending on sponsorship of sporting events.

b Includes estimated spending on office- and hospital-based promotion to physicians and journal advertising. These estimates do not include other spending, such as drug company spending on meetings and events, or spending on promotion that targets medical professionals other than physicians, such as nurse practitioners and physicians assistants.

c We used the retail value of drug samples as a measure of the volume of drug samples provided to physicians, but the retail value of samples does not directly reflect the amount spent by drug companies to manufacture and provide these samples.

d Represents data from 1997 through 2004.

e Includes spending on research and development reported by PhRMA member companies, as reported in PhRMA’s annual industry review. Although not all drug companies are members of PhRMA, its member companies account for almost all spending on prescription drug promotion.

f This figure represents an estimate by PhRMA of spending for this year.

[http://www.gao.gov/new.items/d0754.pdf Accessed August 9, 2008]

Text Box: DELETE TABLETable 2Table 2. U.S. Sales Revenues and Promotional Spending for Leading Therapeutic Classes of Drugs, According to Dollar Sales in 2005. [Donohue et al. NEJM 357(7):673 Aug 16, 2007]

 

2014-C-12 – Rejected Expiration & Referred

           
Expire policy HX-4600.1.7 Improving Children’s Access to Health Care.

 

Improving Children’s Access to Health Care

(Adopted 2004 and reaffirmed 2009)

 

            The increasing diversity of the American family within the last 50 years has challenged society to create a new definition of the family unit. Included in that diversity are families parented by unmarried couples. This changing demography of America has resulted in the visible emergence of non-traditional families and parenting structures. Despite these changes, the central core of the family has remained constant. Families are individuals who join together to meet each other’s basic needs and provide nurturing, security, and love. Families also exist to meet responsibilities, obligations and commitments to each other and the society in which they exist.

 

            With increasing frequency, children are raised in families in which there is only one biological or adoptive legal parent. The second individual in a parental role is called the "co-parent" and/or "second parent." Under current laws, the security of a two parent family may be in jeopardy if the legally recognized parent should die, be declared incompetent, or if the couple separates.

 

            Our changing society requires us to examine and tend to the health care needs of emerging families. Like other professional medical associations, the AAPA has endorsed the goals of the Healthy People 2010 project, which is “firmly dedicated to the principle that “regardless of age, gender, race or ethnicity, income, education, geographic location, disability, and sexual orientation-every person in every community across the nation deserves equal access to comprehensive, culturally competent, community-based health care systems…” (Healthy People 2010, 2000) by denying some families equal adoption rights, we deny children in these families equal access to “comprehensive and culturally competent” health care, consequently contradicting the principles of healthy people 2010.

 

            Providing all qualified adults with co-parent/second parent adoption rights promotes the health of children by giving them the legal and social benefits of two parents along with subsequent access to health care. co-parent and/or second parent adoption would provide legal grounds for either parent to make decisions on behalf of the child, such as providing medical consent and ensuring the child’s eligibility to access the health care benefits of both parents.

 

Conclusion

 

            The AAPA supports co-parent or second parent adoption in order to protect the child’s right to maintain continuing legal relationships with both parents, thereby creating security and access to health care for the child.

 

            The AAPA believes that the following benefits result from co-parent or second parent adoption:

 

1. The child’s legal right of relationship with both parents is protected.

 

2. The second parent’s custody rights and responsibilities are also guaranteed if the legal parent were to die or become incapacitated.

3. The requirement for child support from both parents is established in the event of the parents’ separation.

 

4. The child’s eligibility for health benefits from both parents is ensured.

 

5.   The legal grounds are provided for either parent to provide consent for medical care and to make education, health care and other important decisions on behalf of the child, and the basis for financial security for children is created in the event of the death of either parent by ensuring eligibility to all appropriate entitlements, such as social security survivors’ benefits.

 

New Business

 

2014-NB-01 – Motion Passed Unanimously

 

I move that the AAPA House of Delegates ratify the selection of all Alternate Delegates to the 2014 HOD that have been identified to the House of Delegates Credentials committee at this time.

 

Resolution of Commendation

2014-COMM-01   

 

Resolution of Commendation

R. Jeffrey Hulley, MS, PA-C, DFAAPA

May 2014

 

Whereas PAs are recognized as innovators in health care and

 

Whereas PAs practicing in Home Care Medicine are filling in gaps in health care and

 

Whereas R. Jeffrey Hulley, MS, PA-C, AAPA Distinguished Fellow was recently named the American Academy of Home Care Medicine, House Call Clinician of the Year, the first PA ever awarded this honor

 

Be it resolved that the AAPA recognizes R. Jeffrey Hulley, MS, PA-C, DFAAPA for his contributions to US health Care and for being awarded the honor of being the American Academy of Home care Medicine, House Call Clinician of the Year.

 

Submitted by the Florida Academy of PAs

 

House Elections 2014                               Results

 

Vice President/Speaker                           L. Gail Curtis

First Vice Speaker                                   David Jackson    

Second Vice Speaker                               William Reynolds                       

 

Nominating Work Group                        Theresa Gavula

                                                                    Pamela Lucas

                                                                       

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