Jennifer Casaletto, MD, FACEP
Board of Directors and Councillor, North Carolina College of Emergency Physicians

Political satirist Paul Paulsen once proclaimed, “Assuming either the Left Wing or the Right Wing gained control of the country, it would probably fly around in circles.”  While we might be very close to verifying the veracity of Paulsen’s prediction on a federal level, you’ll be happy to know that our 51%-49% Red-Blue divided ACEP Council came together to accept 32 and defeat 5 resolutions during its annual two-day meeting.  Three resolutions were referred to the ACEP Board of Directors for further consideration addressing: generic injectable drug shortages, development of ACEP policy regarding immigration, and revision of ACEP policy regarding the qualifications of expert witnesses.

For those members unfamiliar with the Council, it is a deliberative body of ACEP members representing the 53 chartered ACEP chapters (50 states, District of Columbia, Government Services, and Puerto Rico), the Sections of Membership (Young Physicians, EMS, etc.), Emergency Medicine Residents Association (EMRA), Council of Residency Directors (CORD), Association of Academic Chairs of Emergency Medicine (AACEM), and Society for Academic Emergency Medicine (SAEM). The Council debates and votes on resolutions submitted by no less than two members or component bodies. Ultimately, the actions of the Council are considered and ratified by the ACEP Board of Directors (BOD). In addition, the Council elects the members of the Board of directors and the ACEP President-Elect.

At this September’s meeting in San Diego, Dr. Vidor Friedman, of Florida was installed as ACEP President after the resignation of Dr. John Rodgers.  The Council elected Dr. William Jacquis, of the Florida Chapter, as its President-Elect.  Drs. Chris Kang and Mark Rosenberg, of Washington and New Jersey, respectively, were re-elected to their BOD positions.  Drs. Anthony Cirillo and J.T. Finnell, of Rhode Island and Indiana, respectively, were voted as new members to the BOD.

Each year, the Council adopts multiple resolutions calling for bylaws, standing rules, and policy changes to better serve College membership, and this year was no different.  The Leadership Diversity Task Force in collaboration with the Council Steering Committee put forth resolutions that clarified the Leadership Development Advisory Committee and amended the Council Standing Rules as they pertain to the Nominating Committee to increase diversity amongst elected ACEP leadership positions.  Resolutions directing ACEP to study the growth of the Council, identify specialty-specific factors leading to emergency physician depression and suicide, partner with other medical organizations to push for change in current state medical board practices that create barriers to mental healthcare for physicians, advocate with the ACGME to preserve requirements for protected core faculty teaching and academic time, and support development of a standardized hospital credentialing application for board-certified emergency medicine physicians were also passed.

The Council also considered multiple resolutions regarding the College’s position on health policy issues. There was a tremendous amount of discussion regarding state safe discharge mandates, which ultimately led to adoption of an organizational opposition to any additional local, state, and federal mandates on discharge requirements citing discharge as a clinical decision made by the emergency physician. There was widely held support for multiple resolutions adopted that pertain to the opioid crisis including advocating for increased naloxone training by laypersons and in schools, insurance coverage of opioid sparing therapies, federal or state funding for ED initiation of a medication assisted treatment program and resources for community follow-up, and methadone inclusion in state prescription drug monitoring systems. On the Medicaid front, resolutions adopted directed ACEP to advocate for the repeal of the Medicaid IMD exclusion and oppose ED copayments for Medicaid beneficiaries. Equally popular in their adoption were resolutions calling for an ACEP to request CMS policy reflect ACEP guideline on unscheduled procedural sedation, advocate for state and federal law requiring insurance companies to pay the professional fee directly to the clinician, and push for widespread state legislation honoring and recognizing out of state POLST forms.  Finally, with less discussion that anticipated, the Council voted for ACEP to oppose the practice of separating migrating children from their caregivers as well as to recognize violence as a health issue and pursue policies and funding for public-health-based approaches to reduce violence.

Finally, the Council also debated the merits of many resolutions regarding the College’s stance on emergency medicine practice and emergency department operational issues.  After years of cannabis discussions regarding both medical and recreational cannabis use, the Council voted to support rescheduling of cannabis to facilitate well-controlled studies of medical use. There was unanimous consent to develop guidelines or toolkits to provide support to emergency medicine physicians regarding: implementation of clinician and system level opportunities for antimicrobial avoidance, best practices for care of boarded psychiatric patients, educational resources for EDPs caring for patients with autism spectrum disorders, emergency medicine physician role and responsibility in completion of death certificates, and initiation of medication for opioid use disorder. At the direction of the Council, the College will revise its “Firearm Safety and Injury Prevention” policy statement to reflect current research and legislation as well as its “Law Enforcement Information Gathering in the ED” policy to reflect recent court decisions.  Finally, the Council voted to extend ACEP’s support for federal and state based Extreme Risk Protection Order (ERPO) legislation designed to temporarily remove firearms from those in mental health crisis and efforts to work with the AMA and AHA to coordinate regulatory and legislative efforts to address the implications of audio/video recording in the emergency department.

Please feel free to email with any questions regarding the Council and/or specific resolutions, jennifer.casaletto@atriumhealth.org. Until next year, may your plane fly straight!

Summary of 2018 Council Resolutions