AMA Adopts New Policies at 2018 Interim Meeting

NATIONAL HARBOR, Maryland, Nov. 13 -- The American Medical Association issued the following news release:

The American Medical Association (AMA), the premier national physician organization in the country, voted to adopt new policies on emerging health care topics during the voting session of its Interim Meeting.

The AMA's House of Delegates is the policy-making body at the center of American medicine, bringing together an inclusive group of physicians, medical students and residents representing every state and medical field. Delegates work in a democratic process to create a national physician consensus on emerging issues in public health, science, ethics, business and government to continually provide safer, higher quality and more efficient care for patients and communities.

The policies adopted by the House of Delegates today include:

Affirming the Medical Spectrum of Gender

The AMA will oppose efforts to deny an individual's right to determine their stated sex marker or gender identity. The new policy comes just weeks after a memo circulated within the Trump Administration proposed narrowly defining sex as "a person's status as male or female based on immutable biological traits identifiable by or before birth," according to a New York Times report.

"Sex and gender are more complex than previously assumed," said AMA Board Member William E. Kobler, M.D. "It is essential to acknowledge that an individual's gender identity may not align with the sex assigned to them at birth. A narrow limit on the definition of sex would have public health consequences for the transgender population and individuals born with differences in sexual differentiation, also known as intersex traits."

The AMA will work to preserve access to quality health care by educating state and federal policymakers to ensure they have a fundamental understanding of the scientific nature of a person's sex.

Protecting the Integrity of Public Health Data Collection

In recognition of a need to better understand the health of sexual and gender minorities, the AMA will advocate for collection of demographic data in federal and state surveys that is inclusive of sexual and gender identity.

The collection of sexual orientation and gender identity data is essential to allow physicians, public health experts, researchers and others to address health disparities and ensure care needs are met," said AMA Board Member William A. McDade, M.D., Ph.D. "The AMA will advocate against the removal of demographic data inclusive of sexual and gender identity from public health surveys and registries without plans for updating measures of these data."

The new AMA policy covers, but is not limited to, data collection by the Current Population Survey, United States Census, National Survey of Older Americans Act Participants, and the claims databases of public and private health insurers.

Opposing the Detention of Migrant Children

The AMA will continue to oppose and object to policies separating migrant children from their families, as well as any effort to end or weaken a 1997 legal settlement that limits the length of time and conditions under which the U.S. government can detain immigrant children.

"The AMA supports the humane treatment of all undocumented children, and advocates for regular, unannounced auditing of the medical conditions and services provided at all detention facilities," said Dr. Kobler. "These audits should be conducted by independent experts in the care of vulnerable children."

According to reports, some immigrant children detained by the U.S. government were given psychotropic drugs without parental permission or court order. New AMA policy does not support this violation of medical protocol.

"While immigrant children have experienced multiple emotional traumas on their travels to the U.S., the AMA only supports the practice of administering psychotropic drugs when there has been an evaluation by appropriate medical personnel, and with parental consent or court order in the case of imminent danger to the child or others," said Dr. Kobler.

Increased Access to Identification Cards for the Homeless Population

Recognizing that a lack of identification serves as a major barrier for homeless individuals seeking medical care, in particular preventing them from enrolling in Medicaid, delegates approved a resolution supporting legislative and policy changes that streamline, simplify, and reduce/eliminate the cost of obtaining identification cards for the homeless population. Unlocking Medicaid access would have tremendous benefit for the homeless population, 36 percent of which suffers from a severe mental illness or chronic substance abuse. Additionally, 43 states allow pharmacists to require photographic identification prior to dispensing drugs, and, according to the National Law Center on Homelessness and Poverty, 54 percent of homeless individuals were denied housing or shelter because of lack of ID.

"It is outrageous that the small fees associated with getting a birth certificate or state ID are preventing homeless Americans from receiving access to care and services they desperately need," said E. Scott Ferguson, M.D., a member of the AMA Board of Trustees. "The AMA has long prioritized access to care as key to improving the health of the nation, and, by today's action, we make very clear that more should be done to ensure that a lack of photo ID does not keep our fellow Americans from seeing a doctor."

Increasing Patient Access to Sexual Assault Medical Forensic Examinations and Post-Exposure Prophylaxis (PEP) for HIV in Emergency Departments

There were 323,450 reports of rape or sexual assault in the United States in 2016, according to the U.S. Department of Justice. Hospital emergency departments typically serve as the primary point of care for survivors of sexual assault, accounting for approximately 65,000 to 90,000 emergency department visits per year. Given the high volume of medical forensic examinations that need to be performed in emergency departments, the AMA adopted new policy today advocating for more emergency departments to have access to sexual assault nurse examiners and other trained, qualified clinicians in performing these examinations on post-pubertal patients.

"It is critical for sexual assault survivors to undergo a medical forensic examination within 72 hours of being assaulted to properly document their physical injuries and obtain evidence necessary for prosecution. It is also essential that these patients are offered HIV testing and Post-Exposure Prophylaxis within 72 hours. However, it can be difficult for emergency physicians to simultaneously oversee these very necessary and specific multiple-hour examinations while also caring for emergent patients," said E. Scott Ferguson, M.D., a member of the AMA Board of Trustees. "Having greater access to sexual assault nurse examiners, along with other trained and qualified clinicians, to perform medical forensic examinations will help increase timely access to care for patients."

Additionally, the AMA's new policy calls for HIV testing and Post-Exposure Prophylaxis (PEP) to be offered to all survivors of sexual assault who present within 72 hours of a substantial exposure risk. The new policy also aims to increase public education on PEP, which is an antiretroviral medication that has been shown effective in preventing infection after HIV exposure only if taken within 72 hours.