Download All TOMA Resolutions - Texas Osteopathic Medical Association

The Texas Osteopathic Medical Association’s House of Delegates is the policy making body of the osteopathic profession in Texas.
Every year at its annual meeting, the House of Delegates considers policy statements submitted by individuals, departments,
committees and the TOMA Board of Trustees.
The full text of policy statements adopted by the TOMA House of Delegates is printed below in alphabetical order by the title. A
short title for each has been adopted for ease of reference. By action of the TOMA House of Delegates in 1988, each TOMA policy
will be reviewed at least every five years and reaffirmed, revised or deleted according to the TOMA House of Delegates' action.
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INFORMATION ON SUBMITTING/WITHDRAWING
RESOLUTIONS TO THE TOMA HOUSE OF DELEGATES
Who can submit resolutions?
A. Resolutions can be submitted by individual TOMA members who are in good standing, TOMA districts,
committees and the TOMA Board of Trustees.
B. Each resolution will have its origin indicated – individual, district, committee, etc.
C. Resolutions should be submitted to the TOMA Office at least 30 days prior to the House of Delegates.
Resolutions may be introduced at the House of Delegates with the permission of the Speaker and a majority vote of
the delegates.
Who can pull resolutions once they are submitted?
A. Resolutions can be pulled by the original author or if the author is not
readily available for communication, by the chairman of the district delegation to the TOMA House of Delegates from
which the author has designated as his/her home district.
B. TOMA department heads, chairman of TOMA committees and the President of TOMA have the authority to pull
resolutions that have been submitted by the entity they represent.
When can resolutions be pulled?
A. Resolutions can be pulled up to the time that the TOMA House of Delegates takes final action.
B. Once the Speaker of the TOMA House of Delegates is notified that the resolution is pulled, that resolution can not
be resubmitted during the same session of the TOMA House of Delegates.
Who determines which TOMA House of Delegates’ reference committee will hear and discuss individual
resolutions?
A. The Speaker of the TOMA House of Delegates has the sole responsibility of assigning each resolution
to the appropriate reference committee.
B. Authors of resolutions are encouraged to attend the appropriate reference committee to explain, promote and defend
their resolution.
TOMA RESOLUTIONS
ACCESS TO APPROVED POLICIES OF THE
AMERICAN OSTEOPATHIC ASSOCIATION
WHEREAS, the American Osteopathic Association (AOA) no longer publishes the AOA Annual Directory; and
WHEREAS, the AOA Directory contained the approved resolutions and policies of the American Osteopathic Association; and
WHEREAS, without access to approved resolutions, members of the American Osteopathic Association are unaware of the
association’s approved stand on government, social, political, ethical, and other issues; and
WHEREAS, members and state associations of the American Osteopathic Association need access to approved resolutions and
policies of the American Osteopathic Association; therefore
BE IT RESOLVED, that the TOMA House of Delegates supports development of a process that will afford all members of the
American Osteopathic Association opportunity for access to approved resolutions and policies; and
BE IT FURTHER RESOLVED, that the American Osteopathic Association list and update approved resolutions on their website
RESOLUTION 03-17 revised & affirmed 08
ADD/ADHD
WHEREAS, primary care physicians often initially diagnose and begin treatment of children and adolescents with ADD/ADHD;
and
WHEREAS, primary care physicians are often the only physicians care for these patients; now therefore
BE IT RESOLVED, that the TOMA House of Delegates recommends that insurance carriers provide coverage for
comprehensive services including counseling for primary care physicians treating patients with AD/ADHD.
RESOLUTION 05-11 reaffirmed 10
ADVANCED NURSE PRACTITIONER
WHEREAS, Texas osteopathic physicians respect the professional training and expertise of mid-level practitioners, and
WHEREAS, Advanced Nurse Practitioners (ANPs) are mid-level practitioners and valuable members of the health care delivery
system in Texas, and
WHEREAS, mid-level practitioners do not have independent medical practice rights in Texas but perform medical tasks under
the supervision of a licensed Texas physician, and
WHEREAS, ANPs are currently being reimbursed less than the rate physicians receive for performing similar medical services
under the Texas Medicaid and Medicare programs, therefore
BE IT RESOLVED, that the TOMA House of Delegates goes on record opposing reimbursement of mid-level practitioners at a
rate comparable to unrestricted licensed physicians when performing similar medical services in the State of Texas.
RESOLUTION 03-26 revised & affirmed 08
ADVOCATING FOR NEW AOA ACCREDITED GME PROGRAMS
WHEREAS, the State of Texas has a striking scarcity of AOA accredited Graduate Medical Education (GME) programs
(approximately 32 funded PGY-1 positions available); and
WHEREAS, class sizes are increasing rapidly at UNTHSC/TCOM (155 students in the 2006 entering class; 200 students by
2010) and other colleges of osteopathic medicine across the US; and
WHEREAS, an overwhelming majority of UNTHSC/TCOM graduates are leaving Texas to pursue training in other states, or
bypassing the osteopathic match altogether in order to secure an ACGME residency in Texas; and
WHEREAS, attending an AOA accredited GME program provides young physicians with continued training in osteopathic
principles and practices that will give them greater distinction and professional identity as they begin their careers as osteopathic
physicians; and
WHEREAS, allopathic medical schools in Texas are increasing class sizes, an action that will result in a larger applicant pool for
ACGME accredited residencies in Texas, making competition for admission to those programs even more difficult for
osteopathic medical graduates wishing to train in Texas; and
WHEREAS, it is in the best interest of the Texas Osteopathic Medical Association to attract more young osteopathic physicians
and physician-educators to the State of Texas; now therefore
BE IT RESOLVED, that the TOMA House of Delegates encourages its physician members to advocate for and take an active
role in the development of new AOA accredited and dually accredited graduate medical education programs in Texas; and
BE IT FURTHER RESOLVED, that the TOMA Executive Director, or an appointee, continue to work with the Texas OPTI to
encourage the formation of new AOA accredited GME programs and dual accreditation of existing ACGME programs.
RESOLUTION 06-15, reaffirmed 11
AMERICAN OSTEOPATHIC ASSOCIATION BOARD CERTIFICATION
WHEREAS, the fundamental strength of any association is dependent upon membership, and increased membership numbers are
essential to achieve maximum association potential, and
WHEREAS, divisional osteopathic society membership retention and growth in the future may be substantially affected by
current American Osteopathic Association’s rules and policies, and
WHEREAS, the American Osteopathic Association (AOA) should assist divisional societies to facilitate optimum membership
and eliminate any impediment to state and national membership for osteopathic physicians, and
WHEREAS, the number of osteopathic colleges continues to increase, and the demand for osteopathic intern and residency
training positions has traditionally exceeded approved and funded AOA accredited training positions thereby forcing more and
more osteopathic medical school graduates to seek American College of Graduate Medical Education (ACGME) accredited
residency positions, and
WHEREAS, experience and research clearly demonstrate that osteopathic physicians who are active members in osteopathic
organizations during their student and residency training years are more likely to continue their membership, and
WHEREAS, osteopathic medical graduates can currently choose between two tracks for residency training- the traditional AOA
accredited tract and the ACGME accredited track, and
WHEREAS, many osteopathic physicians who have completed ACGME accredited residency programs are “truly osteopathic”
and desire to return to the osteopathic family and work to further the goals and uniqueness of the profession, and
WHEREAS, the results of a random effect meta-analysis published in June, 1997 edition of The Journal of the American
Osteopathic Association (Volume 97, Number 6; pages 359-362) indicated that osteopathic medical graduates in AOA accredited
residency programs and osteopathic medical graduates in ACGME accredited residency programs performed equally well on the
NBOME Part III or Level 3 examinations, therefore
BE IT RESOLVED, that the TOMA House of Delegates calls upon the American Osteopathic Association, through the Bureau of
Osteopathic Specialists, to instruct the Boards of Certification to amend their current prescribed board certification minimum
requirement and allow osteopathic physicians, who have completed ACGME accredited residency programs and have otherwise
satisfactorily complied with the requirements for examination, to take the AOA certification examination(s) in their
corresponding specialty.
RESOLUTION 03-20 reaffirmed 08
ANY WILLING PROVIDER
WHEREAS, many insurance companies and managed care entities have restricted the availability of lab and x-ray services to
“approved providers” only; and
WHEREAS, this can limit the accessibility to lab and x-ray services by placing obstacles for the patient and additional co-pays;
and
WHEREAS, timely lab and x-ray data can enhance patient comfort and outcomes; therefore
BE IT RESOLVED, that the Texas Osteopathic Medical Association House of Delegates supports the American Osteopathic
Association to work with the insurance industry so that physicians would be given the option of providing services at the same
price that the insurance carrier has contracted with its other providers
RESOLUTION 03-18 revised and affirmed 08
AOA/ACCME CME RECOGNITION
WHEREAS, a large number of graduating osteopathic physicians in the United States are doing ACGME (allopathic) residencies,
and
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WHEREAS, these osteopathic physicians need to obtain ACCME (allopathic) Continuing Medical Education (CME) credits to
satisfy their American Board of Medical Specialties (ABMS) board certification, and
WHEREAS, the majority of AOA (osteopathic) accredited CME programs only give osteopathic credit and not ACCME
(allopathic) accredited credit, and
WHEREAS, osteopathic physicians who are board certified by the ABMS have to attend CME programs that satisfy their
certification requirements, therefore
BE IT RESOLVED, that the Texas Osteopathic Medical Association House of Delegates goes on record supporting the awarding
of both AOA accredited and ACCME joint sponsored CME credits at all TOMA CME programs.
RESOLUTION 01-42 revised & affirmed 06, reaffirmed 11
AMERICAN OSTEOPATHIC ASSOCIATION’S RE-ENTRY PROGRAM FOR
ACGME TRAINED D.O.’S
WHEREAS, the American Osteopathic Association (AOA) has agreed to a re-entry program for those osteopathic physicians
who took ACGME residency programs and did not have prior approval by the American Osteopathic Association; and
WHEREAS, the current process of bringing back ACGME trained osteopathic physicians into the Osteopathic Family has moved
extremely slowly; and
WHEREAS, any administrative hurdles to the re-entry program must be removed so that the process is “physician friendly”;
therefore
BE IT RESOLVED, that the Texas Osteopathic Medical Association’s House of Delegates calls upon the American Osteopathic
Association to streamline and expedite the process of returning ACGME trained osteopathic physicians to the Osteopathic Family
RESOLUTION 03-02 revised & affirmed 08
ASSOCIATION COMMUNICATION WITH MEMBERS
WHEREAS, the transmittal of information to its members is a key service of the Texas Osteopathic Medical Association; and
WHEREAS, that information provides members and supporters with critical information on advocacy, medical education,
conferences, practice management, legal issues, and other areas of interest; and
WHEREAS, the use of technology to communicate with members is the future of communication; and
WHEREAS, technology provides an ever-growing array of types of both one-way and two-way communication; and
WHEREAS, technology, such as Internet access, email, text messaging, and other methods, provides for efficient, effective and
timely communication; now therefore be it
RESOLVED, that the Texas Osteopathic Medical Association will fully adopt the use of communication utilizing technology in
its primary method of communication with its members and supporters; and be it further
RESOLVED, that the Texas Osteopathic Medical Association strongly encourages its members to adopt technological
capabilities of communication, such as Internet, email, text messaging, and other methods as soon as possible; and be it further
RESOLVED, that the Texas Osteopathic Medical Association will utilize email as its primary and first choice method of
communication with its members no later than December 31, 2009.
RESOLUTION 09-06
AUTOPSIES
WHEREAS, medical anatomy is learned in many aspects during medical school and residency training, and one of the best ways
to learn anatomy is by direct observation of both normal and abnormal anatomical features; and
WHEREAS, most medical schools, private training hospital systems, and public medical institutions have dramatically decreased
the use of autopsies as a training tool; and
WHEREAS, physicians have decreased requesting families for educational autopsies; the most common reason for autopsies now
is for litigation purposes rather than for education; and
WHEREAS, when autopsies are performed most are limited in nature and only of specific body areas; and
WHEREAS, most autopsies that are performed in a training facility are not open to students and residents; now therefore
BE IT RESOLVED, that the Texas Osteopathic Medical Association (TOMA) supports the concept of medical schools, private
hospital systems, and public medical facilities encouraging families to allow autopsies for training purposes, and
BE IT FURTHER RESOLVED, that TOMA encourages medical schools, private hospital systems, and public medical facilities
to allow the viewing of autopsies by medical students and residents for teaching purposes; and
BE IT FURTHER RESOLVED, that this resolution be sent to the American Osteopathic Association for consideration.
RESOLUTION 10-02
AVAILABILITY OF FLU VACCINE FOR PHYSICIANS
WHEREAS, there have been shortages of flu vaccine for the past several years; and
WHEREAS, all persons 65 years of age and older are strongly encouraged to get a flu vaccine each year; and
WHEREAS, physician offices need flu vaccine for their patients 65 years of age and older in order to prevent illness; and
WHEREAS, there have been instances of retail outlets such as WalMart and pharmacy chains receiving flu vaccine before it is
available to physician offices; now therefore
BE IT RESOLVED, that the TOMA House of Delegates petition the Food and Drug Administration to make flu vaccines
available to physician offices before they are made available to retail outlets; and
BE IT FURTHER RESOLVED, that this resolution be forwarded to the American Osteopathic Association House of Delegates.
RESOLUTION 06-04; reaffirmed 11
3
BAN ON CAPITATION REIMBURSEMENT SYSTEMS
WHEREAS, Texas osteopathic physicians are concerned with the concept of managed care but are opposed to capitated
reimbursement systems, and
WHEREAS, capitation could potentially reward physicians for withholding care from their patients and eliminates the physicians
role of being the patient’s advocate, and
WHEREAS, physicians should be allowed to make quality medical decisions based on the needs and interests of the patient and
not solely on the financial arrangements and gains of a managed care organization, therefore
BE IT RESOLVED, that the TOMA House of Delegates goes on record supporting fee-for-service, hourly wages, salary bonuses
based upon work performed, or expense reimbursement as physician payment methods in Texas.
RESOLUTION 01-31-revised & reaffirmed 06; reaffirmed 11
BECOMING A POSITIVE ROLE MODEL
WHEREAS, obesity is rapidly reaching epidemic proportions in the United States; and
WHEREAS, one in every five children in the US is now obsess; and
WHEREAS, the adverse health effects of obesity and causing healthcare related expenses to rise at an alarming rate; now
therefore
BE IT RESOLVED, that the Texas Osteopathic Medical Association recommends that all Osteopathic Physicians become a
positive role model by Getting Fit and Staying Fit for Life; and
BE IT FURTHER RESOLVED, that all Osteopathic Physicians encourage their immediate family and office personnel to
become pro-active in Fit for Life plans.
RESOLUTION 10-17
BUNDLING OF OMT INTO CAPITATION FEE FOR OFFICE VISIT
WHEREAS, managed care reimbursement for health care services is becoming more common and has a great impact on the
medical practice of osteopathic physicians, and
WHEREAS, many managed care insurers do not reimburse osteopathic physicians for performing OMT and consider OMT as
part of a routine office visit fee, and
WHEREAS, OMT should be reimbursed as a separate medically accepted procedure from the office visit as per the codes for
OMT in the AMA Physicians’ Current Procedural Terminology Handbook, therefore
BE IT RESOLVED, that the TOMA House of Delegates calls on the AOA to negotiate and use whatever resources are necessary,
including federal legislation, to get the managed care industry to recognize that OMT is a distinct and specific form of treatment
and should not be bundled into the capitation fee for office visits.
RESOLUTION 02-15 reaffirmed 07
BUSINESS TAX ON PHYSICIAN PRACTICES
WHEREAS, the Texas Legislature seeks to change the finance system for public education by considering a business tax that
would extend to forms of individual business organizations to include professional services, including physician practices; and
WHEREAS, physicians have contributed to the well-being of Texans by providing health careservices to many through the
Medicare, Medicaid, CHIP and workers compensation public payor programs even though reimbursement rates do not cover their
cost of providing that service; and
WHEREAS, the services provided by physicians through these public payor health programs have already resulted in budgetary
cost savings to the State of Texas; now therefore
BE IT RESOLVED, that the TOMA House of Delegates supports the efforts of the Legislature to change the finance system for
public education through a new business tax, which would include physician practices, if such legislation includes a deduction or
credit for physician practices in that business tax for revenues received from services for ALL public payor health programs,
including Medicare, Medicaid, CHIP, workers compensation, military insurance, and uncompensated care; and
BE IT FURTHER RESOLVED, that this support is contingent upon the inclusion of ALL the public payor health programs,
including Medicare, Medicaid, Children’s Health Insurance Program (CHIP), workers compensation, military insurance, and
uncompensated care, in any deduction or credit computation in the business tax; and
BE IT FURTHER RESOLVED, that the Texas Osteopathic Medical Association work with other healthcare professional
organizations in the State of Texas to present a unified approach for Texas medicine in this effort.
RESOLUTION 06-20; reaffirmed 11
BYLAWS AMENDMENT ESTABLISHING A SEPARATE TOMA DISTRICT FOR MILITARY PERSONNEL IN
TEXAS
WHEREAS, the Texas Osteopathic Medical Association (TOMA) recognizes and supports all branches of the U.S. Military; and
WHEREAS, the Military and Veterans Affairs Committee has had as one of its primary focus the identification of and interaction
with active duty military osteopathic physicians assigned to military installations in the State of Texas; and
WHEREAS, those substantial efforts have met with very little success for various reasons; and
WHEREAS, it is believed that active duty military physicians can and will have a far better grasp of the location and interests of
their constituents and therefore facilitate liaison with TOMA; now therefore
BE IT RESOLVED, that a separate TOMA district be established that is comprised solely of active duty osteopathic military
physicians who are members of the Texas Osteopathic Medical Association
RESOLUTION 11-09
4
CENTERS FOR MEDICARE AND MEDICAID SERVICES AGREEMENT WITH THE STATE OF TEXAS
WHEREAS, many citizens of Texas benefit from the Centers for Medicare and Medicaid Services (CMS) administered Medicaid
and Children’s Health Insurance Program (CHIP); and
WHEREAS, the citizens of Texas pay taxes that in part support federal funding of Medicaid and CHIP and Texans deserve full
benefit of these taxes; and
WHEREAS, there are potential adverse effects on access to care of citizens, particularly our most vulnerable citizens – the
children of Texas; and
WHEREAS, several options including waiver, opt out, and coalition are currently being considered by the State of Texas; now
therefore
BE IT RESOLVED, that the Texas Osteopathic Medical Association House of Delegates supports all citizens of Texas having
access to medical care, including those currently receiving Medicaid and CHIP as well as those eligible and not enrolled; and
BE IT FURTHER RESOLVED that the Texas Osteopathic Medical Association House of Delegates goes on record requesting
that the State of Texas continue accepting at least current levels of federal funding supporting Medicaid and CHIP.
RESOLUTION 11 -02
CHANGE IN ADMINISTRATIVE GUIDE SECTION 15 SUB-SECTION 3
WHEREAS, the TOMA Bylaws currently allow the executive committee the authority to approve or establish temporary policy
positions between annual House of Delegates meetings, and
WHEREAS, the TOMA Bylaws currently allow that the Executive Committee may transact the business of the Board of Trustees
between the meetings of the Board, and
WHEREAS, the TOMA Administrative Guide, Section 15 Sub-section 3 states (the executive committee) “Shall be responsible to
the Board of Trustees”, now therefore be it
RESOLVED, that a change to the TOMA Administrative Guide, Section 15 Sub-section 3, be made as follows:
Add new language to the existent statement ANY ACTION PASSED IN AN EXECUTIVE COMMITTEE MEETING
WILL BE BROUGHT TO THE FULL BOARD AT THEIR NEXT MEETING FOR CONSIDERATION AND/OR
RATIFICATION. THESE BOARD RATIFIED ACTIONS WILL THEN BE PRESENTED TO THE HOUSE OF
DELEGATES AT THEIR NEXT MEETING FOR CONSIDERATION AND/OR RATIFICATION.
RESOLUTION 10-21
CHANGE IN CRITERIA FOR LIFE MEMBERSHIP
WHEREAS, the TOMA Bylaws currently require that a member seeking Life Membership shall have reached the age of sixtyfive years of age; and
WHEREAS, the AOA requirement for Life Membership is seventy years; and
WHEREAS, the membership of TOMA is aging to the extent that the number of members turning sixty-five years of age in the
next five years will have a significant impact on the TOMA budget; now therefore be it
RESOLVED, that the TOMA Membership Services Committee requests that the TOMA House of Delegates authorize a Bylaws
Amendment raising the requirement for Life Membership to seventy years of age
RESOLUTION 10-01
CHILDREN’S HEALTH INSURANCE PROGRAM (CHIP)
WHEREAS, the Texas Osteopathic Medical Association (TOMA) supported the implementation of the Texas Children’s Health
Insurance Program (CHIP), and
WHEREAS, eligibility is set at 200 percent of the federal poverty level, and
WHEREAS, the Texas Health and Human Services Commission (THHSC) oversees the program and its child-specific, benefit
package, therefore
BE IT RESOLVED, that the TOMA House of Delegates goes on record supporting CHIP, and
BE IT FURTHER RESOLVED, that the TOMA House of Delegates calls upon the Executive Director of TOMA to exercise
vigilance in ensuring that appropriate medical services, including osteopathic manipulative treatment (OMT) are available to
CHIP - eligible children.
RESOLUTION 01-08-revised & reaffirmed 06; reaffirmed 11
CHILDHOOD AND ADOLESCENT SMOKING
WHEREAS, Children and adolescents who smoke is of great concern to Osteopathic Physicians; and
WHEREAS, the dangers of smoking are well established; and
WHEREAS, children and adolescents who smoke suffer higher percentages of depression, anxiety, ADHD, and substance abuse;
not therefore
BE IT RESOLVED, that the TOMA House of Delegates encourages primary care providers to warn their minor patients and their
parents of the dangers of smoking; and
BE IT FURTHER RESOLVED, that the Texas Osteopathic Medical Association encourages providers and healthcare agencies to
offer educational programs on prevention and treatment of tobacco use.
RESOLUTION 05-10 reaffirmed 10
CHILDHOOD SEXUAL EXPOSURE
WHEREAS, childhood and adolescent sexual relationships contribute to numerous problems including unwanted pregnancy and
sexually transmitted diseases; and
WHEREAS, many children and adolescents are not properly educated about the dangers of inappropriate sexual relationships;
and
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WHEREAS, primary care physicians are in a position to discuss the dangers of inappropriate sexual relationships with their
patients; now therefore
BE IT RESOLVED, that the TOMA House of Delegates encourages primary care physicians to discuss the dangers of
inappropriate sexual relationships with their patients, both children/adolescents and their parents.
RESOLUTION 05-13 reaffirmed 10
CLINICAL EDUCATION P ROGRAM FOR OSTEOPATHIC PRECEPTORS
WHEREAS, the Texas College of Osteopathic Medicine has stated that there are an inadequate number of “quality” pre-graduate
clinical sites for osteopathic medical students to receive traditional osteopathic training in all fields; and
WHEREAS, the Texas College of Osteopathic Medicine has not defined the term “quality pre-clinical sites”; now therefore be it
RESOLVED, that Texas Osteopathic physicians utilize all Osteopathic Postgraduate Training Institutions (OPTI’s) and the
resources of the American Osteopathic Association to develop ongoing continuing medical education programs for osteopathic
preceptors to create quality pre- and post-graduate training sites.
RESOLUTION 09 -14
CME CREDITS
WHEREAS, the AOA Department of CME requires that 1-A credit be provided by speakers who are osteopathic speakers; now
therefore
BE IT RESOLVED, be it resolved that the TOMA House of Delegates encourages TOMA members to provide their services as
professional speakers; and
BE IT FURTHER RESOLVED, that the TOMA House of Delegates calls upon the pharmaceutical industry to actively seek
AOA as well as ACCME approval of CME materials which they provide to physicians.
RESOLUTION 00-21 revised & reaffirmed 05, reaffirmed 10
CME - OSTEOPATHIC ORIENTATION
WHEREAS, American Osteopathic Association (AOA) approved Category 1 CME credits are needed to satisfy the continuing
medical educational requirements of osteopathic physicians, and
WHEREAS, the availability of approved AOA CME programs within the State of Texas is highly desirable, and
WHEREAS, osteopathic specialties have specific CME requirements for their members, therefore
BE IT RESOLVED, that the TOMA House of Delegates goes on record supporting the policy that at least one lecture, with the
content relating to t he principles, philosophy, and practices of Osteopathic medicine, be included in each clinical day at all
TOMA conventions and scientific seminars.
RESOLUTION 00-13 revised & reaffirmed 05, revised & reaffirmed 10
CMS COMMUNICATION WITH PHYSICIANS
WHEREAS, Medicare is continually issuing updated coding regulations that physicians and their staff must use in order to obtain
payment and to meet standards designed to curb program fraud and abuse; and
WHEREAS, the Health Care Financing Administration (CMS) has now twice published “essential coding information, the
documentation guidelines for single and multi-system comprehensive evaluation and management services and the Correct
Coding Initiative which sets Medicare standards for the bundling of services" without funding the distribution of that information
to physicians; and
WHEREAS, communicating with physicians enhances the efficiency of the Medicare program by reducing the number of claims
that have to be reprocessed because of errors or that have to be returned to physicians as unprocessable; and
WHEREAS, failure to provide physicians with necessary coding and billing information hampers the government’s efforts to
detect fraudulent and abusive practices by increasing the number of inadvertent coding and billing errors; therefore
BE IT RESOLVED, that the Texas Osteopathic Medical Association House of Delegates requests that the leadership of the
American Osteopathic Association meet with Health Care Financing Administration officials to request that CMS provide
thorough, current, written information on the preparation and coding of Medicare claims to all physicians prior to the
implementation of any new policies or programs.
RESOLUTION 04-17 reaffirmed 09
COLLABORATION BETWEEN TOMA AND THE TEXAS ASSOCIATION OF PHYSICIAN ASSISTANTS (TAPA)
BE IT RESOLVED, that the Texas Osteopathic Medical Association goes on record to encourage further collaboration between
TOMA and TAPA.
RESOLUTION 06-05; reaffirmed 11
COMMUNITY EDUCATION
WHEREAS, childhood obesity is increasing at an alarming rate in the United States; and
WHEREAS, childhood obesity contributes to an increased risk of a number of healthcare issues including diabetes, joint
problems, cardiac problems, and the risk of early death; and
WHEREAS, there are numerous resources in communities including community centers, healthcare clinics, hospitals, and
healthcare organizations; now therefore
BE IT RESOLVED, that the Texas Osteopathic Medical Association recommends that local organizations work together to
actively provide and promote educational classes in nutrition, healthy choices, the importance of exercise, and parenting in order
to positively impact the deleterious results of childhood obesity.
RESOLUTION 10-10
6
CONFLICT OF INTEREST OF PHARMACY BASED PROVIDERS
WHEREAS, retail outlets with in-store pharmacies have instituted in-store clinics staffed by mid-level providers (PA’s and NP’s)
to see patients; and
WHEREAS, protocols for treatment of various illnesses by in-store clinics are being dictated by store management with profit
margin in mind instead of the best interests of the patient; and
WHEREAS, employees of in-store clinics are often not allowed to visit with pharmaceutical representatives who might share
updates for improved quality of patient care; and
WHEREAS, the primary goal of any retail business is to maximize profits; and
WHEREAS, clinics in retail outlets with in-store pharmacies providers are in direct competition with primary care physicians;
and
WHEREAS, clinics in retail outlets with in-store pharmacies do not take after-hours calls, leaving primary care physicians
responsible for a non-compensated service; and
WHEREAS, bodily fluids are being handled in clinics in retail outlets without proper protection for either patients or retail outlet
employees; and
WHEREAS, the precedent for avoiding conflict of interest has long been observed in retail optical outlets, as by law there must
be a separate entrance to see an optometrist; now therefore be it
RESOLVED, that the Texas Osteopathic Medical Association is opposed to the operation of clinics in establishments where
pharmaceuticals are sold.
RESOLUTION 09-04
CONTAGIOUS DISEASE AND INCREASED RISK SECONDARY TO POOR HYGIENE
WHEREAS, all contagious diseases are spread predominantly through close association and poor hygiene; and
WHEREAS, hospitals, nursing homes, nursery schools, and day care facilities are prime examples of close quarters where
contagious diseases are easily spread; now therefore be it
RESOLVED, that the Texas Osteopathic Medical Association recommends that residents, students, employees and visitors to
hospitals, nursing homes, nursery schools and day care facilities are educated on the positive health benefits of hand washing,
covering the mouth if coughing or sneezing, and improved hygiene in general; and be it further
RESOLVED, that the Texas Osteopathic Medical Association further recommends that young children and infants have limited
exposure to contagious diseases and poor hygiene.
RESOLUTION 09-09
CONTINUED SUPPORT OF CAREFUL SCRUTINY OF INFECTIOUS DISEASES AMONT THOSE IMMIGRATING
FROM FOREIGN COUNTRIES
WHEREAS, some individuals immigrating to the United States have not been adequately vaccinated against contagious/
infectious diseases; and
WHEREAS, many of these diseases are very costly to treat and debilitating; and
WHEREAS, the spread of diseases such as Pertussis to infants and babies who are not yet protected causes a significant health
risk; and
WHEREAS, this problem is more pronounced in those states bordering Mexico; now therefore
BE IT RESOLVED, that the Texas Osteopathic Medical Association encourages all government authorities and healthcare
workers involved with immigration to detect and prevent the spread of contagious/infectious diseases from other countries into
the United States; and
BE IT FURTHER RESOLVED, that this resolution be forwarded to the American Osteopathic Association for their
consideration.
RESOLUTION 10-15
CONTINUED SUPPORT OF COMBATING BIO-TERRORISM ACTIVITIES
WHEREAS, bio-terrorism remains a threat to the United States; and
WHEREAS, the result of bio-terrorism can be so widespread and devastating both financially and medically, with unknown
consequences including dismemberment and death; now therefore
BE IT RESOLVED, that the Texas Osteopathic Medical Association recommends the continued support of any and all efforts to
prevent future acts of bio-terrorism in the United States; and
BE IT FURTHER RESOLVED, that this resolution be forwarded to the American Osteopathic Association for their
consideration.
RESOLUTION 10-13
CONVENTION SITES
WHEREAS, it is important that the Texas Osteopathic Medical Association manage its financial resources in the most prudent
manner possible, and
WHEREAS, the physician members of the association are concerned with managing the fiscal affairs of the association in an
appropriate manner, thus enabling increases in annual dues to be avoided when possible, and
WHEREAS, the cost of doing business continues to rise both due to the Texas economy and many other forces, and
WHEREAS, greater than 60 percent of the osteopathic physicians in Texas reside in the Dallas-Fort Worth metroplex and
another significant percentage reside within an hour of the metroplex, and
WHEREAS, the average attendance at the annual convention over the last 15 years has been 35 percent higher in the metroplex,
and
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WHEREAS, the average number of exhibits at the annual convention has been 20 percent higher when held in the metroplex,
now therefore
BE IT RESOLVED, that the Texas Osteopathic Medical Association hold its annual convention and House of Delegates meeting
in the metroplex area every other year when feasible commencing with the 1995 convention.
RESOLUTION 01-35 revised & reaffirmed 06; reaffirmed 11
CONVERSION FACTOR FOR MEDICARE FEE SCHEDULE
WHEREAS, dramatic reduction in Medicare reimbursement as a result of lowering the conversion factor threatens seniors’
access to quality physician services, and
WHEREAS, the sustainable growth rate (SGR) should be replaced with a new factor that more fully accounts for changes in the
costs of providing physicians’ services, and
WHEREAS, the SGR exacerbates Medicare’s problem of paying different amounts for the same service depending on where it is
provided, therefore
BE IT RESOLVED, that the Texas Osteopathic Medical Association House of Delegates supports federal legislation that the
SGR system be replaced with an annual update based on factors influencing the unit costs of efficiently providing physician
services
RESOLUTION 02-11 revised & reaffirmed 07
CORPORATE PRACTICE OF MEDICINE
WHEREAS, the Texas Medical Board (TMB) defines the corporate practice of medicine (CPOM) as “a legal doctrine, which
generally prohibits corporations, entities or individuals (i.e. non-physicians) from practicing medicine”. Section 165.156 of the
Medical Practice Act makes it unlawful for any individual, partnership, trust, association or corporation by use of any letters,
words, or terms, as an affix on stationary or advertisements or in any other manner, to indicate the individual, partnership, trust,
association or corporation is entitled to practice medicine if the individual or entity is not licensed to do so; and
WHEREAS, the TMB further interprets a general summary of the CPOM doctrine that prohibits physicians from entering into
partnerships, employee relationships, fee splitting, or other situations with non-physicians where the physician's practice of
medicine is in any way controlled or directed by, or fees shared with a non-physician. Generally, physicians may enter into
independent contractor arrangements with non-physicians; and
WHEREAS, the fundamental purposes of this statute, in general, are to ensure that only physicians are licensed to provide
medical services, as opposed to corporate entities, and also to maintain physicians' independent medical judgment; and
WHEREAS, maintaining the physician’s independent medical judgment is critical. It ensures that a patient’s medical needs come
before the hospital or governmental entity’s business needs. If the physician were to become an employee of a hospital,
insurance company, or any other entity not licensed to practice medicine, the patient’s health and well-being could be
compromised. Business considerations, not medical needs, could lead to poor patient care decisions; and
WHEREAS, the premise underlying the doctrine is that it will protect patients from potential abuses because commercialized
medicine would ultimately divide a physician’s loyalty between profits and the delivery of quality patient care; and
WHEREAS, the Texas Attorney General opined that a corporation which employs a licensed physician to treat patients and itself
receives the fee is unlawfully practicing medicine and the physician so employed is subject to having his license revoked,
suspended or canceled; and
WHEREAS, laypersons may not form management companies to provide exclusive management services, including securing
contracts of employment, in exchange for a percentage of net profits; and
WHEREAS, many people in this country get their care in community hospitals, particularly those in the smaller cities, the
creation of specialty hospitals has the potential to take patients away from the community hospitals, patients who have Medicare
or other insurance and whose financial reimbursements support community hospitals. Community hospitals cost-shift from the
emergency room, which loses money, and all the indigent care that these hospitals take care of. The specialty hospitals aren't
going to be taking care of indigents. The only way community hospitals can pay for the care they provide as the safety net for all
people is through orthopedic and cardiovascular and those kinds of procedures. If those procedures are skimmed off by the
specialty hospitals, there's no money left; and
WHEREAS, medical schools may employ physicians, as can other physicians. Nonprofit health care corporations (commonly
referred to as 501[a] corporations) sponsored by hospitals and hospital districts also may employ physicians. Under each of these
avenues, however, a licensed physician or physicians are ultimately responsible for patient care. In the case of 501(a) nonprofit
corporations, even if the organizing entity is a hospital, these corporations must have a physician board of directors. Rules
governing their operation are designed to ensure that physicians remain in charge of medical decisions; and
WHEREAS, physicians should work for the patient, not the insurance company, hospital, or anyone else who is not directly
responsible for the care of the patient; and
WHEREAS, physicians licensed to practice medicine in Texas have met stringent qualifications. They have earned the right to be
trusted to apply their expertise to provide the appropriate medical care for their patients. Physicians should not be under the
control of a lay administrator whose focus is the budget and economic health of a corporate entity; and
WHEREAS, in theory, hospitals are supposed to make staff appointments and grant privileges based on a physician's clinical
competence, as judged by the medical staff leadership. But with many hospitals facing increasing competition, rising costs, and
other financial pressures, a growing number are using "economic credentialing"—rather than clinical skill—as a criterion for
making staff appointments. These hospitals are using staff privileges to reward physicians likely to bring in lucrative business
and punish those with financial interests in competing facilities. While Medicare, Medicaid, and JCAHO regulations all require
8
hospitals to appraise physicians' professional competence when making staff appointments, they don't specifically prohibit
consideration of financial interests in competing hospitals as appropriate criteria in such decisions; now, therefore
BE IT RESOLVED, the Texas Osteopathic Medical Association (TOMA) opposes efforts to broaden the corporate practice of
medicine beyond the current exceptions for medical schools, 501(a) corporations and federally qualified health centers; and
BE IT FURTHER RESOLVED, that TOMA work with the Texas Medical Board to maintain current information on the
sponsorship, governance, and membership of 501(a) corporations.
RESOLUTION 10-19
COVERAGE OF THE CONSULTATION BY A PHYSICIAN PRIOR TO SCREENING COLONOSCOPY
WHEREAS, 1) colorectal cancer is the second leading cause of deaths from cancer in the U.S. causing the deaths of 58,000
Americans annually
2) colorectal cancer equally affects men and women
3) up to 90% of colorectal cancer could be prevented by screening
4) the benefit for colorectal cancer screening has been available to patients covered by Medicare since January 1, 1998
5) the Medicare benefit for screening colonoscopy became effective July 1, 2001
6) Medicare beneficiaries have underutilized thie benefit thus leading to increased morbidity and mortality from
colorectal cancer
7) screening colonoscopy requires extensive preparation which should be suited to the patient’s medical condition and
preference
8) screening colonoscopy is an invasive procedure with defined risks and benefits and requires sedation
9) the visit to the specialist for evaluation and discussion prior to the scheduling of colonoscopy is not covered by the
current
legislation that was fashioned in a manner similar to mammography benefits
10) the Digestive Disease National Coalition (25 physician, nurse and patient organizations) supports this proposal,
now therefore
BE IT RESOLVED, that the Texas Osteopathic Medical Association support coverage under Medicare benefits for the
physician’s visit in advance of the procedure by a physician to evaluate the patient and discuss the need for screening, risks and
benefits, options and preparation for colonoscopy.
RESOLUTION 05-17, revised & reaffirmed 10
CREATION OF AN OMT DEPARTMENT IN REGIONAL VETERANS ADMINISTRATION CENTERS
WHEREAS, Osteopathic Manipulative Treatment (OMT) has been proven as an excellent adjunct of care in the treatment of
patients, and Osteopathic Physicians are specifically trained to utilize OMT for diagnosis and treatment of many somatic
expressions of disease states; and
WHEREAS, the Physical Medicine Department of the Regional VA Hospitals must independently contract with non-staff,
outside practitioners (chiropractors) if a manipulation consultation is requested; and
WHEREAS, a Regional VA Hospital Osteopathic Staff Physician could be available for the consultation and care of the patient
to provide OMT; now therefore
BE IT RESOLVED that the Texas Osteopathic Medical Association supports and recommends creation of a policy on the use of
Osteopathic Manipulative Medicine within regional VA Centers
RESOLUTION 05-04, revised & reaffirmed 10
CREATION/PROMOTION OF AOA APPROVED RESIDENCIES IN TEXAS
WHEREAS, the American Osteopathic Association established the Osteopathic Postdoctoral Training Institutions (OPTI) in
1995, and
WHEREAS, each OPTI is a community-based training consortium comprised of at least one college of osteopathic medicine and
one hospital, and
WHEREAS other hospitals and ambulatory care facilities may also partner within an OPTI. Community-based healthcare
facilities such as ambulatory care clinics, rehabilitation centers and surgical centers may now have the resources and support
necessary to provide physician training with an OPTI's assistance, and
WHEREAS, osteopathic medical students in Texas are seeking allopathically accredited (ACGME) residencies over
osteopathically accredited residencies by a greater than 7:1 ratio, and
WHEREAS, osteopathically accredited training programs have been left with vacant slots through the matching process; now
therefore
BE IT RESOLVED, the Texas Osteopathic Medical Association continue to serve as a conduit to all OPTI’s, nationwide, to
identify, assist in the creation and promote osteopathic post graduate training programs, statewide, with emphasis on rural
primary care programs.
RESOLUTION 07-01
CRIMINAL LITIGATION FOR CLINICAL MISTAKES
WHEREAS, the threat of criminal prosecution for clinical mistakes could result in physicians being reluctant to treat the sickest
patients, and
WHEREAS, access to care for patients who have a high risk of a bad outcome could be restricted, therefore
BE IT RESOLVED, that the TOMA House of Delegates goes on record opposing criminal prosecution of clinical decision making and support model state legislation to prohibit such cases.
9
RESOLUTION 03-40 reaffirmed 08
DATA BANK
WHEREAS, the National Practitioners Data Bank completed its first year of operation on September 1, 1991, and
WHEREAS, failing to report medical malpractice payments will, as of June 1991, put hospitals at risk up to $10,000 in fines, and
WHEREAS, the same fine applies for violating the confidentiality of data bank information, and
WHEREAS, there is still much concern over who can query the data bank and whether there are adequate safeguards to protect
the confidential information stored there, therefore
BE IT RESOLVED, that the TOMA House of Delegates urges the American Osteopathic Association to push for development of
appropriate safeguards in the National Practitioner Data Bank to protect the confidentiality of stored data.
RESOLUTION 02-16 reaffirmed 07
DEATH PENALTY AND LETHAL INJECTION
WHEREAS, the goal of osteopathic physicians is to save, not take human life, and
WHEREAS, the death penalty is enforced by lethal injection in many states, including Texas, and some osteopathic physicians
provide health care services at Texas penal facilities; and as a condition of their employment, are required to perform certain
tasks, therefore
BE IT RESOLVED, that the TOMA House of Delegates goes on record as being against osteopathic physicians being required to
administer lethal injections to carry out death sentences in Texas penal facilities.
RESOLUTION 00-22 revised & reaffirmed 05, reaffirmed 10
DENIAL OF OMT REIMBURSEMENT TO D.O.’S IN TARRANT COUNTY
UNDER TEXAS MEDICAID MANAGED CARE
WHEREAS, the Texas Department of Health applied and received a federal waiver to start a pilot Medicaid managed care
program in Tarrant County that only had a capitation model and not a primary care case management model (PCCM) for
physician reimbursement purposes, and
WHEREAS, a federal waiver only last five (5) years without renewal, and
WHEREAS, the Texas Legislature specified that all covered Medicaid services prior to implementation of the Texas Medicaid
managed care pilots would remain covered services after implementation of the pilots, and
WHEREAS, osteopathic manipulative therapy (OMT) was a covered Medicaid service prior to implementation of the pilot
managed care program in Tarrant County, but not after implementation of the capitated model, and
WHEREAS, all D.O.’s in the other pilot program counties in Texas had the option of the PCCM managed care model with the
continued reimbursement for OMT with the exception of Tarrant County for more than five (5) years, therefore
BE IT RESOLVED, that the TOMA House of Delegates goes on record supporting the use of all appropriate corrective actions,
including legal remedies such as “recoupment”, to allow osteopathic physicians in Tarrant County to be reimbursed separately for
OMT performed on Medicaid patients under the capitation model of managed care.
RESOLUTION 01-13 revised & reaffirmed 06; reaffirmed 11
DENIAL OR LIMITATION OF HEALTH CARE COVERAGE BASED ON GENETIC INFORMATION
WHEREAS, Texas osteopathic physicians are very concerned with the potential for misuse of genetic research, and
WHEREAS, everyone could be found to have pre-existing medical conditions based on genetic information since almost
everyone has gene mutations that predispose them to certain illnesses, and
WHEREAS, legislation is needed that would prevent health care insurers from using genetic data in deciding whether to hire or
fire someone unless they can prove the information is job related, and
WHEREAS, health insurers and employers should be required to obtain written informed consent for the request, collection, or
disclosure of genetic information from an individual and releasing that information to a third party, therefore
BE IT RESOLVED, that the TOMA House of Delegates goes on record supporting legislation to ban genetic discrimination by
employers and health care insurers.
RESOLUTION 02-17 reaffirmed 07
DEPRESSION AWARENESS IN MEDICAL STUDENTS
WHEREAS, according to a study by Schwenk et al, the “Prevalence of moderate to severe depression was 14.3%” amongst a
survey of medical students, with further data supporting that medical students, despite their environment and training, are less
likely to receive appropriate treatment.
Schwenk TL, Davis L, Wimsatt LA. Depression, stigma, and suicidal ideation in medical students. JAMA. 2010;304(11):1181–1190,
pmid:20841531; and
WHEREAS, according to a study in 2005 “medical students had higher depression rates than the general population, and women
students had higher rates than men”
Dahlin M, Joneborg N, Runeson B. “Stress and depression among medical students: a cross-sectional study.” Medical Education Jun. 2005: 594604; and
WHEREAS, new research shows that “suicidal ideation ha[s] a strong relationship with both personal distress (quality of life and
depressive symptoms) and professional distress (burnout)”, and “burnout and suicidal ideation among US medical students.”
Annals of Internal Medicine. 2008;149:334-341; and
WHEREAS, due to the rigors and competitive nature of medical school, medical students are much more likely to suffer from
depression than the average person. The average person has a 10% chance of becoming depressed whereas medical students
have a 21.2% chance. Thus, an increase in awareness and funding for research will be benefit for the medical community as a
whole, US news report Jan 30th 2009; and
10
WHEREAS, the relationship between depression and suicidal ideation is well recognized, the association between burnout and
suicidal ideation has not been researched thoroughly, and
WHEREAS, burnout is a very common form of distress among medical students; and
WHEREAS, with the existence of school counseling and the resources to provide adequate information and guidance in terms of
depression treatment and awareness , the school is already prepared to decide where and how much funding is necessary; and
WHEREAS, depression and burnout among U.S. medical students is associated with unprofessional conduct and decreased
altruistic views regarding physicians’ responsibility to society… Dyrbye LN et al. Relationship between burnout and professional
conduct and attitudes among US medical students. JAMA. September 2010; 304(11):1173-1180; and
WHEREAS, UC-SF School of Medicine performed a survey in which 49 out 322 1st and 2nd year medical students described
themselves as being depressed. Rosenthal, Jule, and Susan Okie. "White Coat, Mood Indigo - Depression in Medical School." New England
Journal of Medicine. 353.11 (2005): 1085-1088; and
WHEREAS medical students are more likely to suffer from depression than the general population ; the overall depression rate
for medical students is 21.2 percent, more than double the commonly reported rate of about 10 percent for the general
population.; and
WHEREAS, according to the New England Journal of Medicine, “Medical students are more prone to depression than their
nonmedical peers” http://www.nejm.org/doi/pdf/10.1056/NEJMp058183; and
WHEREAS, it has been recognized in peer-reviewed studies that nearly 1 in 4 medical students suffering from depression or
depression-related symptoms do not seek medical attention; additionally, nearly 30% of medical students with suicidal ideation
fail to seek medical attention. Rosenthal, Julie M and Okie, Susan, "White Coat, Mood Indigo - Depression in Medical School", New England
Journal of Medicine, 353;11, 15 September 2005; and
WHEREAS, the lifetime prevalence of major depression by DSM-III criteria of medical students was 15%, three times greater
than the rate in the general population. Zoccolilo, Mark, George E. Murphy, and Richard D. Wetzel. “Depression among Medical
Students.” Journal of Affective Disorders 11.1 (1986): 91-96; now therefore
BE IT RESOLVED, that the Texas Osteopathic Medical Association House of Delegates recommends that there be increased
awareness for depression amongst medical students and to provide treatment options for those affected; and
BE IT FURTHER RESOLVED, that this be forwarded to the American Osteopathic Association for consideration.
RESOLUTION 11-10
DIABETIC MEALS FOR STUDENTS
WHEREAS, more and more school age children are being identified as diabetic, and
WHEREAS, proper nutrition is necessary for the successful control of diabetes mellitus, therefore
BE IT RESOLVED, that the Texas Osteopathic Medical Association House of Delegates goes on record supporting school
menus that include American Diabetes Association (ADA) approved diabetic meals and beverages
RESOLUTION 00-06 revised & reaffirmed 05, revised & reaffirmed 10
DIABETICS CONFINED TO CORRECTIONAL INSTITUTIONS
WHEREAS, the incidence of diabetes mellitus is increasing in the general population, and
WHEREAS, the incidence of diabetes mellitus is also increasing in the inmates confined in all institutions, and
WHEREAS, the availability of American Diabetes Association (ADA) approved diabetic meals and beverages for diabetic
inmates is crucial to the successful treatment of diabetes mellitus, therefore
BE IT RESOLVED, that the Texas Osteopathic Medical Association House of Delegates goes on record supporting the
availability of ADA diabetic meals and beverages for diabetic inmates, who are under the care of a licensed physician, and
confined in all correctional institutions
RESOLUTION 00-05 revised & reaffirmed 05, revised & reaffirmed 10
DIETARY SUPPLEMENTS
WHEREAS, since enactment of the Dietary Supplement Health and Education Act of 1994 (DSHEA), makers of dietary
supplements no longer have to test their products for purity, safety, or effectiveness before marketing them for human
consumption, and
WHEREAS, there is a need to classify as drugs all dietary supplements that are precursors or metabolites of anabolic steroids,
and
WHEREAS, under DSHEA, the Food and Drug Administration’s (FDA) mandate is to remove unsafe ingredients and products
from the market, therefore
BE IT RESOLVED, that the Texas Osteopathic Medical Association House of Delegates calls upon the American Osteopathic
Association to request that the U.S. Congress amend DSHEA so that dietary supplements will undergo premarket safety and
efficacy evaluation by the Food and Drug Administration
RESOLUTION 02-01 revised & reaffirmed 07
DISASTER RELIEF
WHEREAS, unexpected natural and man-made disasters can occur suddenly precipitating an urgent need of medical assistance,
and
WHEREAS, at times there may be a need for physicians from states outside of the disaster area who do not have a license to
practice medicine in the affected state; and
WHEREAS, state medical boards have often restricted the ability of out-of-state Physician volunteers to provide medical
assistance; and
WHEREAS, osteopathic physicians have shown their willingness to assist disaster victims; now therefore
11
BE IT RESOLVED, That the TOMA House of Delegates encourages the Federal government to establish a national emergency
interstate physician (MD/DO) volunteer list that can be used to hasten aid to disaster victims; and
BE IT FURTHER RESOLVED, that this resolution be forwarded to the American Osteopathic Association House of Delegates.
RESOLUTION 06-07’ reaffirmed 11
DISPARITIES BETWEEN RURAL AND URBAN PRACTICE
WHEREAS, currently physician work adjustment factors result in severe inequities between rural and urban localities under the
Medicare physician fee schedule, and
WHEREAS, there are currently 43 Medicare localities with a physician work adjuster below 1.000, and
WHEREAS, “physician work” is defined by Centers for Medicare & Medicaid Services (CMS) as the amount of time, skill, and
intensity a physician puts into a patient visit, and
WHEREAS, this definition of “physician work” is not influenced by location, therefore
BE IT RESOLVED, that the Texas Osteopathic Medical Association House of Delegates supports Federal legislation that would
establish a minimum geographic cost-of-practice index value for physicians’ services of 1.000
RESOLUTION 02-02 revised & reaffirmed 07
DOMESTIC VIOLENCE
WHEREAS, osteopathic primary care physicians see various kinds of domestic abuse in their patients; now therefore
BE IT RESOLVED, that the TOMA House of Delegates encourages osteopathic primary care physicians to aggressively look for
and report all possible cases of abuse and neglect; and
BE IT FURTHER RESOLVED, that the TOMA House of Delegates encourages osteopathic primary care physicians to educate
their patients concerning the dangers of domestic abuse and how to protect themselves.
RESOLUTION 05-12, revised 10
DRUG INDUSTRY GIFTS
WHEREAS, the American Osteopathic Association (AOA) is adopting guidelines for physicians dealing with drug companies,
and
WHEREAS, the Pharmaceutical Manufacturer's Association (PhMA) has adopted guidelines for companies, and
WHEREAS, unacceptable gifts include cash, subsidies for travel, lodging or personal expenses, or in compensation of time spent
for physicians attending conferences or meetings; payment for token focus groups, token consulting or advisory services; and
gifts with "strings attached" such as those given in relation to a physician's prescribing practices, and
WHEREAS, acceptable gifts include textbooks and other educational gifts not of substantial value; work-related gifts of minimal
value (i.e., pens, note-pads and penlights); subsidies to underwrite the costs of CME conferences or professional meetings;
scholarships for medical students and residents to attend educational conferences, if selection and payment is made by the
academic institution; reasonable compensation and reimbursement of expenses sustained by consultants; and modest meals,
usually in conjunction with educational programs, therefore
BE IT RESOLVED, that the TOMA House of Delegates goes on record supporting the AOA and PhMA guidelines on drug
industry gifts.
RESOLUTION 02-18 reaffirmed 07
DRUG SAMPLES
WHEREAS, Texas osteopathic physicians support the use of drug samples for patient care, and
WHEREAS, drug samples are very important in holding down the cost of medical care, and
WHEREAS, the pharmaceutical companies continue to promote and encourage the use of their drugs after the patents have
expired, therefore
BE IT RESOLVED, that the TOMA House of Delegates calls upon the pharmaceutical industry to continue the distribution of
drug samples to physicians, including those drugs whose patents have expired, in order to hold down medical costs, and
BE IT FURTHER RESOLVED, that the TOMA House of Delegates continue to defend and support legislation that allows Texas
physicians to provide drug samples free-of-charge to patients.
RESOLUTION 04-22 reaffirmed 09
DUE PROCESS FOR ALLEGED IMPAIRED PHYSICIANS
WHEREAS, it is possible for a hospital administration to suspend the medical staff privileges of a physician or for a managed
care organization or insurer to remove a physician from its approved provider panel based solely upon an assertion of impairment
due to the existence of a presumed psychiatric diagnosis or an allegation of disruptive physician behavior; and
WHEREAS, it is possible for such an administrative decision to be made without a reasonable fact-finding hearing of the
allegations or an appropriate clinical evaluation of the physician; and
WHEREAS, the assertion of physician impairment requires that there be actual or likely potential harm to patients; therefore
BE IT RESOLVED, that the Texas Osteopathic Medical Association House of Delegates adopt the policy that, except in the case
of summary suspension necessary to protect patients from imminent harm, no adverse action be taken against the privileges of a
physician by a hospital, managed care organization or insurer based on a claim of physician impairment without a suitable due
process hearing in accordance with medical staff bylaws to determine the facts related to the allegations of impairment and,
where appropriate, a careful clinical evaluation of the physician.
RESOLUTION 04-20 reaffirmed 09
ELECTRONIC DEATH CERTIFICATES
WHEREAS, the State of Texas now requires that death certificates be filled out online through the electronic death record; and
WHEREAS, the electronic death record can be very confusing, redundant and difficult to navigate; and
12
WHEREAS, there are only two employees dedicated to helping funeral homes, state officials and physicians in the State of
Texas, making it impossible to get a timely answer when problems arise with the system; now therefore be it
RESOLVED, that the Texas Osteopathic Medical Association requests the Department of State Health Services to implement
the following changes;
1) assign additional employees to help with electronic death record
2) revise electronic death record to make it less confusing, redundant and difficult to navigate
3) allow funeral homes to utilize paper death certificates in case of problems with the system that cannot be resolved
in a timely manner
4) provide education throughout the State of Texas on how to properly use electronic death record; and be it further
RESOLVED, that if the Department of State Health Services is unable to implement the changes requested above it rescind the
requirement that death certificates be completed online.
RESOLUTION 09 -07
ELECTRONIC PRESCRIBING FOR SCHEDULED PHARMACEUTICALS
WHEREAS, the Center for Medicare and Medicaid Services (CMS) has encouraged physicians to use electronic medical record
technologies; and
WHEREAS, many physicians now use electronic prescribing to order prescriptions for patients; and
WHEREAS, the Drug Enforcement Administration (DEA) currently prohibits the electronic prescription of any scheduled
pharmaceuticals; and
WHEREAS, the Drug Enforcement Administration (DEA) has yet to revise its policy and allow schedule III, IV and V
pharmaceuticals to be prescribed using electronic prescribing technologies, which would make its rules consistent with other
types of prescription ordering methods for scheduled medications, such as telephone and hand-written prescriptions; and
WHEREAS, this prohibition, enforced by the DEA, creates inconvenience and limited access for patients; and inefficiency for
physicians who use electronic prescribing technologies; now therefore be it
RESOLVED, that the Texas Osteopathic Medical Association requests action from the Drug Enforcement Administration (DEA)
to change the policy that prohibits electronic prescription of any scheduled pharmaceuticals, and open schedule III, IV and V
pharmaceuticals to electronic prescription; and be it further
RESOLVED, that this resolution be passed on to the American Osteopathic Association for action at the national level.
RESOLUTION 09-05
ENCOURAGING PATIENT PARTICIPATION IN THEIR HEALTHCARE
WHEREAS, all medical care providers see patients who are not putting forth the effort to stay or get healthy; and
WHEREAS, a number of these patients consume an inordinate amount of money because of the unhealthy effects of their failure
to participate in their healthcare; now therefore
BE IT RESOLVED, that the Texas Osteopathic Medical Association recommends that all insurance companies consider the
establishment of a system for rewarding those patients who are trying to stay healthy as a means of decreasing the amount of
money spent on healthcare; and
BE IT FURTHER RESOLVED, that this resolution be forwarded to the American Osteopathic Association for their
consideration.
RESOLUTION 10-09
ENVIRONMENTAL HEALTH
WHEREAS, Texas osteopathic physicians are very concerned over the pollution of Texas air, land, and water and the resulting
adverse consequences this pollution of our environment has on the health and well-being of Texans, and
WHEREAS, Texans and Mexicans living along the banks of the Rio Grande River depend upon this body of water for their
source of drinking water, and
WHEREAS, clean air and clean water is the objective of both Americans and Mexicans living along this river, and this objective
can only be achieved by both countries working together towards a common goal, therefore
BE IT RESOLVED, that the TOMA House of Delegates goes on record supporting a combined effort on the part of state, federal,
and Mexican authorities to clean up the environment along the Rio Grande.
RESOLUTION 04-23 reaffirmed 09
ESTABLISHMENT OF AN EMERGENCY MEDICINE RESIDENCY PROGRAM IN TEXAS
WHEREAS, Texas has a leading osteopathic medical school, The Texas College of Osteopathic Medicine, as well as in many
other states such as Arizona, California, Florida, Illinois, Iowa, Georgia, Pennsylvania, Tennessee, Michigan, Missouri, New
York, Oklahoma, Ohio, Washington, South Carolina, Kentucky, Colorado, Nevada, New Jersey, Maine, Virginia, West Virginia,
and Mississippi, and in which most years several of the graduates pursue post-graduate training in emergency medicine (EM),
and
WHEREAS, according to the ACOEP website, there are forty-four osteopathic Emergency Medicine residencies in the following
states: Arizona, California, Florida, Illinois, Michigan, Missouri, New Jersey, New York, Ohio, Oklahoma, Pennsylvania, Rhode
Island, and West Virginia. Of these, Michigan lists thirteen programs, Pennsylvania lists eight, and Ohio has six. There are no
osteopathic Emergency Medicine residencies in Texas. As a result, Texas may not usually regain these graduates to work in
Texas, and
WHEREAS, there are many medical centers in Texas that would be able to meet ACOEP basic educational standards, and
although funding would be an obvious hurdle, the University of North Texas Health Science Center/Texas College of
Osteopathic Medicine may be able provide significant assistance and guidance, and
13
WHEREAS, although ACOEP has relatively few members in Texas, there are several graduates of the Texas College of
Osteopathic Medicine who could be potential faculty/leadership for a residency program, and
WHEREAS, the University of North Texas Health Science Center/Texas College of Osteopathic Medicine’s current Rural
Osteopathic Medical Education program (ROME) could also provide a unique perspective that is currently missing from
Emergency Medicine education, now therefore
BE IT RESOLVED, that the Texas Osteopathic Medical Association House of Delegates encourage the University of North
Texas Health Science Center / Texas College of Osteopathic Medicine to pursue the establishment of an emergency medicine
residency in Texas.
RESOLUTION 11-03
ESTABLISHMENT OF TCOM MSGA’S TOMA RELATIONS COMMITTEE
WHEREAS, the Texas Osteopathic Medical Association (TOMA) seeks to foster closer ties with the student body of the Texas
College of Osteopathic Medicine (TCOM); and
WHEREAS, the TOMA encourages student participation in its organizational functions, and
WHEREAS, the TOMA seeks to increase the number of on campus student activities; and
WHEREAS, one liaison between the TOMA and the student body at TCOM are the TCOM Medical Student Government
Association (MSGA) President and four other MSGA members; and
WHEREAS, the MSGA members, charged with multiple duties, are rarely able to devote their full attention and efforts to the
promotion of TOMA; and
WHEREAS, the sole route to gaining a student leadership position in TOMA activities is to be elected to a class officer position
entailing other duties; and
WHEREAS, the TOMA is unique among on campus organizations in that it is an organization which represents all osteopathic
physicians and medical students interests; and
WHEREAS, the TOMA is similarly unique in that all students at TCOM automatically receive membership, and full benefits
thereof, without cost; and
WHEREAS, the TOMA should standout from other student organizations on the campus of TCOM;
BE IT RESOLVED, that the TOMA renews its pledge to build a strong student presence within its organization by increasing the
number of student related activities and member presence on campus; and that TOMA recommends to the TCOM MSGA that
their bylaws be re-written to provide for the election of two (2) students from each medical school class to serve as
TCOM/TOMA Relations Committee officers; and that the suggested changes to the MSGA bylaws include the provision that the
MSGA TOMA relations committee be composed solely of the eight (8) elected TCOM/TOMA Relations Committee officers;
and that this committee be charged with the promotion of active membership in the TOMA and the organization of TOMA
activities for the students of the TCOM; and that the MSGA’s TOMA Relations Committee be co-chaired by the MSGA
President and one of the eight (8) elected representatives, to be selected by that committee; and that the suggested changes to the
MSGA bylaws give the responsibility of alternate delegate to the TOMA House of Delegates (HOD) and alternate student
member of the TOMA Board of Trustees to the elected co-chair of the TOMA Relations Committee.
RESOLUTION 01-25 revised & reaffirmed 06; reaffirmed 11
EXPANDING SCOPE OF RETAIL CLINICS
WHEREAS, retail clinics have been in existence since 2006; and
WHEREAS, these clinics were to be located in pharmacies and emphasize acute low level care with diagnoses consistent with
minor medical problems, for example strep throat, urinary tract infections and other conditions utilizing CPT Codes of 99201,
99202, 99211, and 99213; and
WHEREAS, the clinics were to correlate care with the patient’s physician and send records so that the physician could provide
appropriate follow-up and chronic care.; and
WHEREAS, retail clinics have consistently employed nurse practitioners and physician assistants to see patients, with rare cases
of physician interaction; and
WHEREAS, a recent Wall Street Journal article indicated that retail clinics in Walgreen’s have started offering intravenous
drug infusions for asthma and osteoporosis, and Walgreen’s and CVS have started offering programs for chronic care
consultations and treatment for hypertension and diabetes and
WHEREAS, chronic care with multiple return visits and multiple interdisciplinary diseases should be monitored by direct
physician care; now therefore
BE IT RESOLVED, that the Texas Osteopathic Medical Association (TOMA) opposes any expansion by retail clinics into
programs offering patient care for chronic and complex conditions; and
BE IT FURTHER RESOLVED, that this resolutions be sent to the American Osteopathic Association for consideration.
RESOLUTION 10-03
FLAME RETARDANT CLOTHING FOR CHILDREN
WHEREAS, fire and burn-related injuries are the third most common cause of unintentional injury and death in the U.S. at 6,000
per year, and one-third of these injuries involve infant sleepwear; and
WHEREAS, these burns covered 30% of the total body surface area and required an average hospital stay of seventy (70) days;
and
WHEREAS, the manufacturers of flame retardant sleep and lounge clothing are no longer required to follow the federal
Flammable Fabrics Act of 1967; and
14
WHEREAS, inhalation injury may cause pulmonary conditions such as hypoxemia, asphyxia, carbon monoxide poisoning,
central nervous system injury and death; therefore
BE IT RESOLVED, that the Texas Osteopathic Medical Association’s House of Delegates supports federal legislation that
requires all children’s sleep and lounge clothing to be flame retardant.
RESOLUTION 03-15 revised & reaffirmed 08
GENERIC SUBSTITUTION OF TYPE B DRUGS
WHEREAS, Texas osteopathic physicians are concerned over the issue of generic substitutions for brand name drug products,
and
WHEREAS, the federal government has passed Medicaid legislation that caps reimbursement of generics dispensed at 150
percent of the lowest priced generic drug product available, and
WHEREAS, there are two basic classification categories into which multisource drugs have been placed by the FDA (type "A"
and type "B"), and
WHEREAS, "A" codes are drug products that are considered to be "therapeutically equivalent" to other pharmaceutically
equivalent products and "B" codes are drug products the FDA does not at this time consider to be "therapeutically equivalent" to
other pharmaceutically equivalent products, and
WHEREAS, the Texas Pharmacy Act specifies that the substitution can only be made with "generically equivalent drug
products", and
WHEREAS, "generically equivalent" means a drug has the identical amounts of the same active chemical ingredients in the same
dosage from (pharmaceutically equivalent) and when administered in the same amounts, will provide the same therapeutic effect,
identical in duration and intensity (therapeutically equivalent), therefore
BE IT RESOLVED, that the TOMA House of Delegates goes on record opposing generic substitution for brand name products
with type "B" drug products.
RESOLUTION 03-27 reaffirmed 08
GROUP B STREP IN NEONATES
WHEREAS, the Centers for Disease Control and the American College of Obstetricians and Gynecologists recommend that
intra-partum antimicrobial prophylaxis(IAP) is not indicated for negative vaginal and rectal Group B Strep(GBS) screening
culture in late gestation regardless of intra-partum risk factors; and
WHEREAS, the Centers for Disease Control and the American College of Obstetricians and Gynecologists recommend that
vaginal and rectal GBS cultures be collected at 35-37 weeks gestation for all pregnant women; and
WHEREAS, some infants that are GBS negative at 35-37 weeks gestation develop overwhelming GBS sepsis during the intrapartum period, and either die or suffer serious sequelae; and
WHEREAS, GBS is fatal to 5-15% of newborns who contract the infection during the birth process; and
WHEREAS, infants who survive can be left with speech, hearing, and vision problems, as well as mental retardation; and
WHEREAS, pregnant women can transmit GBS to their newborns at birth; and
WHEREAS, 10-30% of pregnant women are colonized with GBS in their genital tract; and
WHEREAS, people can carry GBS in their bodies without developing symptoms or knowing they carry the bacterium; and
WHEREAS, GBS in infants can be prevented by giving the mother antibiotics during labor; now therefore
BE IT RESOLVED, that the Texas Osteopathic Medical Association House of Delegates recommends that all pregnant women
be cultured at 35-37 weeks gestation for Group B Strep and be screened at onset of labor; and
BE IT FURTHER RESOLVED, that healthcare providers attending all births be prepared to administer antibiotics during the
birth process as needed; and
BE IT FURTHER RESOLVED, that this resolution be forwarded to the American Osteopathic Association for action
BIBLIOGRAPHY:
Centers for Disease Control
American College of Obstetricians and Gynecologists
Committee on Infectious Diseases, American Academy of Pediatrics(2006), Red Book, 2006, 28th Edition
American College of Obstetricians and Gynecologists and American Academy of Pediatrics(2008), Guidelines for Perinatal Care, 6th Edition
RESOLUTION 11-14
GUIDELINES FOR NUTRITIONAL SUPPLEMENTS
WHEREAS, osteopathic physicians treat the Whole Person and not just symptoms; and
WHEREAS, osteopathic physicians prescribe a number of nutritional supplements to their patients as a way to improve health
and prevent illness; and
WHEREAS, there is no oversight or regulation of products labeled as nutritional supplements; now therefore
BE IT RESOLVED, that the TOMA House of Delegates petition the Food and Drug Administration to establish guidelines and
regulations for manufacturers and distributors of nutritional supplements; and
BE IT FURTHER RESOLVED, that this resolution be forwarded to the American Osteopathic Association House of Delegates.
RESOLUTION 06-03; reaffirmed 11
HEALTH CARE FOR U.S. VETERANS
WHEREAS, U.S. Veterans from World II, Korea, and Vietnam are reaching the age when multiple disabilities from chronic
diseases are causing them to seek health services from veterans hospitals and clinics; and
WHEREAS, many Veterans are living on fixed incomes that do not provide enough funds to purchase private health insurance
plans; and
15
WHEREAS, the federal government has instituted a “means” test as a way to cut back funding for Veterans causing the ranks of
Americans without adequate health insurance to swell; and
WHEREAS, the federal government promised Veterans who joined the Armed Forces prior to 1956 permanent, full medical
coverage; therefore
BE IT RESOLVED, that the Texas Osteopathic Medical Association’s House of Delegates goes on record supporting adequate
health care funding by the federal government to take care of all U.S. Veterans at veterans hospitals and clinics or alternate health
care sites
RESOLUTION 03-08 revised & reaffirmed 08
HEPATITIS B VACCINATIONS FOR TEXAS HEALTH CARE WORKERS
WHEREAS, under the Occupational Safety and Health Administration's bloodborne pathogen standards, by July 5, 1992,
employers must provide at no cost, hepatitis B vaccination to all employees who have occupational exposure during the course of
performing their duties, and
WHEREAS, the goal of OSHA is to provide safe working conditions and to immunize as many employees as possible against
bloodborne pathogens in order to protect the health and welfare of the general public, and
WHEREAS, the Texas Department of Health (TDH) is equipped to handle mass immunization and to provide testing for
bloodborne diseases, and
WHEREAS, the TDH can offer the lowest cost to employers of health care workers for these OSHA required services, therefore
BE IT RESOLVED, in the interest of public health, that the TOMA House of Delegates instruct its executive director to contact
officials with the TDH and key members of the Texas legislature, for the purpose of attaining authorization for Texas health care
workers to receive hepatitis B recombinant vaccinations at TDH cost, provided that the final cost of the immunization is borne by
individual employers.
RESOLUTION 02-19 reaffirmed 07
HIGH RISK OF DEATH FROM PERTUSSIS IN INFANTS UNDER SIX MONTHS OF AGE
WHEREAS, Pertussis is highly contagious and may cause death in infants under six months of age as they are not fully protected
until the third series of vaccinations; and
WHEREAS, adolescents and adults who are in close approximation to the infants may have Pertussis and be unaware of it; and
WHEREAS, infected adolescents and adults may infect under-immunized and immune-deficient infants and children, causing the
possibility of death and/or a very large financial burden on the caretakers; now therefore be it
RESOLVED, that the Texas Osteopathic Medical Association recommends increased awareness of the need for everyone to be
vaccinated against Pertussis; and be it further
RESOLVED, that the Texas Osteopathic Medical Association recommends that all pregnant women be immunized as soon as
possible after delivery to prevent possible infection of their newborn.
RESOLUTION 09-08
HONORING SENATOR JANE NELSON
WHEREAS, Senator Jane Nelson is a distinguished graduate of the University of North Texas; and
WHEREAS, Senator Nelson has many years’ experience as an educator; and has been a resolute advocate for education in the
State of Texas; and
WHEREAS, Senator Nelson is an advocate for quality healthcare in the State of Texas; and
WHEREAS, Senator Nelson has defended the University of North Texas Health Science Center-Texas College of Osteopathic
Medicine; and
WHEREAS, Senator Nelson has followed conservative fiscal stewardship concerning the taxpayers’ money; now therefore
BE IT RESOLVED, the Texas Osteopathic Medical Association House of Delegates honors Texas State Senator Jane Nelson of
Flower Mound, Texas for;

Vigorously supporting the Texas College of Osteopathic Medicine

working to balance the State budget while protecting The Texas College of Osteopathic Medicine from those who
would endanger it by diluting its resources

protecting, for the people of Texas, continued access to unique and quality Osteopathic Medical care; and
BE IT FURTHER RESOLVED, that the Texas Osteopathic Medical Association House of Delegates requests that the
Advocates for the Texas Osteopathic Medical Association grant Senator Nelson Lifetime Status as an advocate.
RESOLUTION 11-18
HONORING SENATOR ROBERT F. “BOB” DEUELL, M.D.
WHEREAS, during the 82nd Texas Legislature Senator Robert F. "Bob" Deuell, M.D. sacrificed countless hours to the
improvement of the health care and the well being of the people of Texas and,
WHEREAS, his clear insight, experience as a Family Physician and dedication to 6 delivery of much needed primary care in
Texas has driven him to support the Texas College of Osteopathic Medicine (Fort Worth) as "a jewel in our medical education
system" and as the Texas medical school leading “in new graduates entering primary care” and
WHEREAS, with his full understanding of national trends and data and also as a good steward of Texas Taxpayer money, Dr.
Deuell advocates creation of Graduate Medical Education residency programs as the most cost effective means of bringing
physicians to areas of Texas and,
WHEREAS, in a Letter to the Editor of a Fort Worth newspaper Senator Deuell challenged many of the misconceptions being
propagated in the Tarrant County community and pointed out that an "archaic assumption" was being leveraged in the UNT
campaign to bring an M.D. medical school onto their Health Science Center campus in Fort Worth and,
16
WHEREAS, Senator Deuell countered inaccurate remarks made by the Fort Worth Star-Telegram about an MD school being
brought to the University of North Texas Health Science Center (UNT HSC) by stating publicly in a letter to the editor that, “no
amount of discussion or persuasion can turn a bad idea into a good one”; now therefore
BE IT RESOLVED, that the Texas Osteopathic Medical Association House of Delegates makes known its gratitude to Senator
Robert F. Deuell, M.D. for his wisdom, foresight and perseverance in protecting primary care in Texas by defending the integrity
of the Texas College of Osteopathic Medicine
BE IT FURTHER RESOLVED, that the Texas Osteopathic Medical Association House of Delegates honor Senator Bob Deuell,
M.D. as a great friend of primary care in Texas and of the Texas College of Osteopathic Medicine; and
BE IT FURTHER RESOLVED, that The Texas Osteopathic Medical Association commends Senator Bob Deuell, M.D. for:
 Faithfully representing the interests of the People of The Great State of Texas.
 Helping to ensure access to high Quality Osteopathic Medical Education for the students at The Texas College of
Osteopathic Medicine.
 Helping to ensure access to high quality Osteopathic Medical care for the people of The Great State of Texas and
 Serving the needs of his patients as a Family Physician for over 23 years
Letter to the Editor
By State Sen. Bob Deuell
To: Fort Worth Star-Telegram
Re: "UNTHSC disappointed but determined to go forward" 3.19.11
In your March 19 editorial "UNTHSC disappointed but determined to go forward," your criticism of Senator Jane Nelson for not
trying to persuade the legislature to allow the University of North Texas Health Science Center in Fort Worth to add an allopathic
(M.D.) degree is not justified.
Sen. Nelson has discussed this issue with members of the Texas Senate, but no amount of discussion or persuasion can turn a bad
idea into a good one; no matter how well-intentioned.
Texas College of Osteopathic Medicine is a jewel in our medical education system and, at a time when primary care physicians
are sorely needed, TCOM leads the state's medical schools in new graduates entering primary care.
The Senate Finance Committee listened to Dr. Scott Ransom describe UNTHSC's fine accomplishments and then turn around
and disparage his own "brand" by advocating for the allopathic school. Committee members were not impressed.
The erroneous assumption on the part of UNT Chancellor Lee Jackson, the regents, and Dr. Ransom and his administration is
based on the archaic assumption that it is a negative for a hospital to be associated with an osteopathic medical school. Rather
than promote the good reputation and outstanding legacy of UNTHSC, they have chosen to perpetuate that misconception.
Officials at UNTHSC should be commended for raising $25 million as seed money, but they raised their money on false
assumptions and expectations. In addition, I might add that $25 million is not nearly enough to run the school for five years. That
money and the taxpayers' money would be better spent enhancing TCOM and ensuring the institution continues to produce
quality graduates that go into primary care specialties. Texas will be better served.
Bob Deuell, M.D.
Member, Texas Senate
Greenville, TX
RESOLUTION 11-25
HOST DISTRICT
BE IT RESOLVED, that the TOMA House of Delegates expresses sincere appreciation to TOMA District 5 for serving as the
host district for the 2011 TOMA/TXACOFP Joint Convention to be held in Dallas, TX June 15-19, 2011.
RESOLUTION 11-34
HPV
WHEREAS Osteopathic physicians have always been the forerunners in the concept of preventative medicine and holistic care;
and
WHEREAS over the last 7-8 decades, numerous vaccines have been proven to be both efficacious and safe for use in the
prevention of communicable diseases; and
WHEREAS an extensive study (1921 women) conducted by the Centers for Disease Control and Prevention in 2003-2004
reported that 27% of women in the US are currently infected with the Human Papillomavirus “HPV”; and
WHEREAS it is estimated that 70% of all cases of cervical cancer (AIS and CIN3) are directly related to an infection with types
16 and 18 of HPV, and 90% of all cases of genital warts are caused by an infection with types 6 and 11 of HPV, which together
represent 3.4 % of the patient population infected with HPV; and
WHEREAS there is currently a vaccine on the market to offer protection against the four types of viruses causing these
pathologies, and is recommended for girls and young women ages 9 to 26; and
WHEREAS the vaccine is clearly not intended to be a panacea, but only to supplement in the prevention of disease, osteopathic
physicians should continue to promote and encourage women to obtain their recommended pap smears and gynecological exams
which remain the foremost means of preventing cervical cancer; now therefore
BE IT RESOLVED that the Texas Osteopathic Medical Association encourages the voluntary administration of an efficacious
and safe HPV vaccine to the female population ages 9 to 26 as a means to help prevent cervical cancer.
RESOLUTION 07-08
INCLUSION OF THE BENEFIT FOR SCREENING FOR COLORECTAL CANCER IN ALL HEALTH PLANS
WHEREAS, 1) colorectal cancer (CRC) is the second leading cause of deaths from cancer in the U.S. causing the deaths of
58,000 Americans annually
2) colorectal cancer equally affects men and women
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3) up to 90% of colorectal cancer could be prevented by screening colonoscopy
4) the benefit for colorectal cancer screening has been available to patients covered by Medicare since January 1, 1998
5) the American Cancer Society supports health plan coverage for the full range of CRC screening tests
6) the Digestive Disease National Coalition (25 physician, nurse and patient organizations) supports the inclusion of
full range of CRC screening in all health plans
7) HEDIS, a monitoring system for about 70% of health plans in the US has a standard including screening for CRC,
now therefore
BE IT RESOLVED, that the Texas Osteopathic Medical Association supports health plan coverage for the full range of CRC
screening tests
RESOLUTION 05-18, revised & reaffirmed 10
INCREASING OSTEOPATHIC GME TRAINING OPPORTUNITIES IN THE STATE OF TEXAS
WHEREAS, graduates from Osteopathic medical schools are increasingly choosing specialties other than primary care while the
majority of OGME training opportunities in Texas are in Family Medicine; and
WHEREAS, a goal of TOMA is to encourage Osteopathic medical students to complete Osteopathic GME training in Texas; and
WHEREAS, there are insufficient Osteopathic training positions in Texas to accommodate the current graduating class from
TCOM; and
WHEREAS, TCOM is working to increase class sizes in the coming years and these graduates must choose between moving to
another state or completing an ACGME approved program; and
WHEREAS, many physicians choose to practice near their GME training institution; and
WHEREAS, AOA/ACGME dual-accredited programs have shown success with Family Medicine; and
WHEREAS, the Federal Government no longer provides funding for new positions at existing residency programs; and
WHEREAS, Centers for Medicare/Medicaid Services (CMS) has capped new funding for GME training purposes; and
WHEREAS, the current system forces hospitals and training programs to increase GME positions at their own expense; now
therefore be it
RESOLVED, that TOMA work with the AOA to encourage legislative and non-legislative changes to increase funding for GME
programs; and be it further
RESOLVED, that the increased funding be directed toward increasing osteopathic residency positions at existing GME
programs, the opening of new osteopathic GME programs including dual-accredited programs, and all other avenues.
RESOLUTION 08-02
IN-STORE CLINICS
WHEREAS, many pharmacies and stores with a pharmacy inside are starting to add in-store clinics with mid-level healthcare
personnel examining and treating patients; and
WHEREAS, many of these facilities do not have a designated and separate bathroom for patients or a sink for healthcare
personnel. Patients use the public bathroom in the store and then walk down the aisles of the facility with contaminated and
infectious body fluids. Healthcare personnel have no way of cleaning their hands of body fluids or blood spillage except for
alcohol hand wipes. Many body fluids such as gastric contents and respiratory tract mucous need to be removed with soap and
water; and
WHEREAS, most in-store clinics do not have a separate room for patient privacy, but instead have a table and chairs open to
public view or a small curtain separating the general public from private medical concerns; now therefore
BE IT RESOLVED, that the TOMA House of Delegates supports the following requirements for
any facility that maintains an in-store clinic:
1) it must provide a designated and separate bathroom for patients, and a sink for healthcare personnel
2) it must provide a room with a door to assure patient privacy
RESOLUTION 06-11
INSURANCE COMPANY CONTRACTS
WHEREAS, many insurance companies are making exclusive contracts with larger regional hospitals to the exclusion of
physicians, as well as smaller rural hospitals, and
WHEREAS, this deprives the patient of access to local and rural hospitals and physicians, and
WHEREAS, this is very detrimental to the future of rural health care,
BE IT RESOLVED, that the Texas Osteopathic Medical Association House of Delegates supports legislation on the state and
federal level providing for free choice by the patient of hospital and physician.
RESOLUTION 03-28 reaffirmed 08
INSURANCE COVERAGE FOR INJECTABLES
WHEREAS, Texas osteopathic physicians are very concerned with health care policies by third party payors that discourage the
use of injectable medications in physicians’ offices; and
WHEREAS, injectable medications are medically necessary in certain situations, especially when oral medication cannot be
taken, and they help keep patients out of the hospital emergency room; and
WHEREAS, third party payors list injectable medication under covered services but pay much less than the acquisition cost to
the physician for many of these drugs; and
WHEREAS, because these injectables are listed as covered services, the physician cannot have the patient pay the difference
between the third party payor reimbursement and the actual acquisition cost of the medication; and
WHEREAS, the physician’s only choice is to give the patient the injectable at a price below the acquisition cost or to not give the
injectable; therefore
18
BE IT RESOLVED, that the Texas Osteopathic Medical Association’s House of Delegates calls upon TOMA staff to work to
change third party payor policies on injectables so that once the price of the drug falls below the actual acquisition cost, it will no
longer be considered a covered service.
RESOLUTION 03-12 reaffirmed 08
INTERNET EXPOSURE TO PORNOGRAPHY BY CHILDREN
WHEREAS, the majority of our children have easy access to the internet; and
WHEREAS, it is very difficult for parents to constantly monitor their children’s exploration of the internet; and
WHEREAS, the internet allows easy access to sites that may be unsuitable for children; now therefore
BE IT RESOLVED, that the Texas Osteopathic Medical Association recommends the continued education of both parents and
children on the dangers of unsupervised exploration on the internet.
RESOLUTION 10-16
INVOLVEMENT OF YOUNG PHYSICIANS
BE IT RESOLVED, that the Texas Osteopathic Medical Association House of Delegates, and the Texas Osteopathic Medical
Association Board of Trustees, explore and develop methodologies designed to encourage younger Texas Osteopathic Medical
Association members to actively participate in the policy making body of this Association.
RESOLUTION 04-21 reaffirmed 09
LACK OF MEDICARE COVERAGE FOR DIABETES & LIPID SCREENING
WHEREAS, diabetes and lipid disorders can lead to serious medical complications before symptoms arise, and
WHEREAS, Medicare will not reimburse for screening lab tests for these diseases, and
WHEREAS, it is not only better patient care, but also saves tax dollars by preventing expensive treatment of these complications,
therefore
BE IT RESOLVED, that the TOMA House of Delegates supports dialog with CMS and Congress to cover screening blood
sugars and lipid profiles in order to prevent complications of these diseases, and
BE IT FURTHER RESOLVED, that the TOMA House of Delegates forward this resolution to the AOA House of Delegates for
its consideration and adoption.
RESOLUTION 01-23 reaffirmed 06; reaffirmed 11
LATEX ALLERGY
WHEREAS, latex allergy is a documented and well known medical condition, and
WHEREAS, health care providers are at a significant risk of developing latex allergy and suffer from its consequences secondary
to repeated exposure; and
WHEREAS, recent studies have reported that between 8% and 17% of health care workers and patients are currently sensitized
by the latex allergy; and
WHEREAS, given the sometimes urgent and emergent care necessitated by patients without the opportunity on behalf of health
care providers to procure non-latex products; and
WHEREAS, health care workers, as part of their duty, will use latex containing products, regardless of known allergy or product
warning; therefore
BE IT RESOLVED, that the Texas Osteopathic Medical Association House of Delegates strongly encourages Texas health care
facilities to provide non-latex alternatives in areas of patient care, and
RESOLUTION 04-19 revised & reaffirmed 09
LEGAL AGE AND THE YOUNG ADULT WITH SPECIAL NEEDS
WHEREAS: Parents who have special needs young adults may not realize the importance of having legal guardianship, and
WHEREAS: Special needs young adults may suddenly be in need of EMERGENCY care, and
WHEREAS: Special needs young adults may or may not be able to express them selves verbally, and
WHEREAS: Special needs young adults may not be able to sign for themselves, or fully understand the consequences, and
WHEREAS; the parents of some of these special needs young adults may not realize the need for legal guardianship, therefore
BE IT RESOLVED, that the Texas Osteopathic Medical Association recommends that all parents or providers of special needs
young adults over the age of 18 have legal guardianship, and power of attorney so that they may be able to sign consent forms,
get test results, and provide adequate care in a timely fashion.
RESOLUTION 11-28
MANAGED CARE ADMINISTRATIVE ISSUES
WHEREAS, some managed care plans coerce physicians to participate in all of their company’s products by linking the products
together, and
WHEREAS, some health plans use this “tied products of all products” policy to force providers to accept the unreasonable
contract provisions of one product in order to have access to patients covered by a product with more favorable provisions, and
WHEREAS, some managed care plans are trying to reduce costs by requiring that special physicians called hospitalists attend
covered beneficiaries when they are admitted to a hospital, and
WHEREAS, legislation was approved that requires health plans to pay clean claims within 45 days, or pay 85 percent of the
undisputed amount when an audit is to be performed; however, there is controversy over what constitutes a clean claim, and
WHEREAS, it is common for each managed care organization to have their own definition of “medical necessity” that is
different from all others, therefore
19
BE IT RESOLVED, that the TOMA House of Delegates goes on record approving the following policies: (1) seek a prohibition
on “tied products” – products linked together in order to force providers to use them instead of a product that would be a more
favorable provision; (2) oppose the mandated use of hospitalists by managed care organizations (3) call for increased penalties
for failure to comply with prompt pay legislation; (4) support legislation that provides a statutory definition of “medical
necessity;” and, (5) support legislation that states the physician determines what prescription medication is appropriate for the
patient - not a formulary that is based on cost only.
RESOLUTION 01-02 revised & reaffirmed 06; reaffirmed 11
MEDICARE PROVIDER MANDATORY
WHEREAS, Texas osteopathic physicians are sympathetic to the plight of low income patients, and
WHEREAS, most Texas osteopathic physicians do consider the financial resources of their Medicare patients prior to making a
decision to accept or not to accept assignment on Medicare health care claims, and
WHEREAS, mandatory participation in state or federally funded health care programs as a condition of licensure in any state
amounts to indentured servitude for physicians, and
WHEREAS, “freedom of choice” in health care decisions should be a right enjoyed by all free Americans including physicians,
therefore
BE IT RESOLVED, that the TOMA House of Delegates goes on record opposing any attempt to tie licensure in the State of
Texas to mandatory participation in state or federally funded health care programs.
RESOLUTION 03-29 revised & reaffirmed 08
MANDATORY PROFICIENCY TESTING OF PHYSICIANS
WHEREAS, Texas osteopathic physicians are very concerned with the quality of health care delivered to the citizens of Texas;
and
WHEREAS, Texas osteopathic physicians support continuing medical education (CME) for all physicians through their
certifying boards; and
WHEREAS, there is a public demand to require mandatory proficiency testing of all physicians by the Texas State Board of
Medical Examiners (TSBME) in order to retain a Texas medical license; and
WHEREAS, no other professional group has been singled out for mandatory proficiency testing in order to retain a Texas license;
therefore
BE IT RESOLVED, that the Texas Osteopathic Medical Association’s House of Delegates opposes the concept of mandatory
proficiency testing as a condition of licensure for any professional group unless it applies to all professional groups in the State of
Texas.
RESOLUTION 03-09 reaffirmed 08
MEDICAID MANAGED CARE
WHEREAS, the Texas Legislature mandated that the Texas Medicaid program convert to a managed care system by 1999, and
WHEREAS, the Texas Department of Health & Human Services will determine the type of health care system to be offered to
Medicaid patients, and
WHEREAS, all Medicaid patients should have a choice of either an HMO or the Primary Care Case Management (PCCM) model
for health care, and
WHEREAS, the PCCM model uses a "manager of care" who is reimbursed the Medicaid fee schedule plus a $3 monthly case
management fee to coordinate care for the patient while HMO's will contract directly with physicians on a prepaid basis, and,
WHEREAS, without patient and physician support for the PCCM, the state will select the HMO-only model because of
anticipated greater cost savings, therefore
BE IT RESOLVED, that the TOMA House of Delegates goes on record supporting the right of Medicaid patients to have choice
in how they receive health care, and
BE IT FURTHER RESOLVED, that the TOMA House of Delegates supports the Primary Care Case Management (PCCM)
model for health care and opposes an HMO-only option for Medicaid patients in Texas.
RESOLUTION 01-34 revised & reaffirmed 06; reaffirmed 11
MEDICAID MANAGED CARE PCCM MODEL
WHEREAS, The Texas Health and Human Services Commission (HHSC) has proposed expanding Medicaid managed care
statewide; and
WHEREAS, there is a proposal to repeal the Primary Care Case Management (PCCM) model; and
WHEREAS, the proposal states the PCCM model will be repealed in communities where there is sufficient HMO capacity; and
WHEREAS, the Medicaid managed care framework proposed by HHSC is purely cost-motivated; and
WHEREAS, if the PCCM model is repealed, it may threaten patient access to specialty care; therefore
BE IT RESOLVED, that the TOMA House of Delegates re-affirms its support for the Medicaid PCCM Model.
RESOLUTION 04-04 reaffirmed 09
MEDICAID PATIENTS USAGE OF EMERGENCY ROOMS
WHEREAS, many physicians must provide extensive coverage to local hospital emergency rooms, and
WHEREAS, many Medicaid patients have historically used the hospital emergency room when they could use a doctor's office,
therefore
BE IT RESOLVED that the TOMA House of Delegates request TOMA work with the Texas Department of Human Resources
to: (1) educate their clients on the appropriate use of emergency rooms; (2) encourage early "lock-in" for those patients identified
20
as over utilizing hospital emergency rooms; and (3) eliminate penalties to the physician for the patients’ inappropriate use of
emergency rooms, (i.e., do not reduce reimbursement to 60 percent for non-emergent visits).
RESOLUTION 02-20 reaffirmed 07
MEDICAL ETHICS
WHEREAS, Texas osteopathic physicians are confronted by serious issues as they enter new millennium, therefore
BE IT RESOLVED, that TOMA adopt the position that actively practicing physicians should play the major role in the
development and instruction of medical ethics.
RESOLUTION 00-23 revised & reaffirmed 05, reaffirmed 10
MEDICAL INSURANCE COVERAGE FOR SURGERY IN CASES OF CHRONIC GINGIVITIS
WHEREAS, many insurance companies will not reimburse for diagnoses involving the teeth and gums, and
WHEREAS, there are systemic diseases associated with chronic gingival infection, i.e. bacteremia, cardiac valvular disease,
septic arthritis, general debility and aggravation of diabetes mellitus, and
WHEREAS, lack of insurance coverage for diseases of teeth and gums can result in worsening of systemic diseases for patients
who cannot afford out of pocket expenditures, therefore
BE IT RESOLVED, that the TOMA House of Delegates support the concept that medical insurance coverage should include
surgical treatment of chronic gingivitis.
RESOLUTION 01-16 revised & reaffirmed 06; reaffirmed 11
MEDICAL MALPRACTICE LIABILITY REFORM
WHEREAS, Texas is one of the nation’s most expensive states to purchase medical malpractice liability insurance, and
WHEREAS, all physicians are facing large premium increases while some specialists are facing doubled premium rate increases,
and
WHEREAS, in some high-risk areas of practice, physicians may have to limit or eliminate their practice of certain procedures
because of the increased risk and premium, therefore
BE IT RESOLVED, that the TOMA House of Delegates supports tort reform by the Legislature that would include the following:
(1) limiting the amount on non-economic damages that can be awarded; (2) imposing a more reasonable time limit on when a
minor can bring an action; (3) greater enforcement of the cost bond and expert report requirements; (4) greater enforcement of the
frivolous suits provision; (5) giving full credit for a settling defendant; and (6) imposing a sliding scale on lawyer contingency
fees.
RESOLUTION 01-10 reaffirmed 06; reaffirmed 11
MEDICAL STAFF BYLAWS
WHEREAS, Texas osteopathic physicians are aware of the need for harmony in the relationship between medical staff and
hospital governing bodies, and
WHEREAS, the Joint Commission on Accreditation of Healthcare Organizations (JCAHO) standards state that the medical staff
bylaws establish a framework for self-governance of medical staff activities, and accountability to the governing body, and
WHEREAS, Medicare's Conditions of Participation require governing bodies to ensure that the medical staff is accountable to the
governing body for the quality of patient care, approve medical staff bylaws, and to determine the composition of the medical
staff,; now therefore
BE IT RESOLVED, the TOMA House of Delegates oppose any state regulation that would allow hospital governing boards to
appoint a medical director who has authority over the medical staff; and
BE IT FURTHER RESOLVED, the TOMA House of Delegates oppose the concept that hospital and corporate bylaws can
supersede legitimate functions of the medical staff as spelled out in medical staff bylaws; and
BE IT FURTHER RESOLVED, that the TOMA House of Delegates goes on record opposing unilateral changing of hospital
medical staff bylaws or any attempt to destroy medical staff self-governance.
RESOLUTION 03-30 revised and reaffirmed 08
MEDICAL STAFF PRIVILEGES
WHEREAS, osteopathic physicians are comparably educated, through osteopathic medical schools and post graduate training,
and
WHEREAS, osteopathic physicians enjoy staff and departmental privileges at the majority of hospitals in Texas, and
WHEREAS, the CMS rules require non-discrimination based on degree, now therefore
BE IT RESOLVED, that the TOMA House of Delegates goes on record seeking to end discrimination related to hospital medical
staff or departmental privileges based solely upon certification, fellowship or membership in a specialty body or society or
number of years in post graduate training.
RESOLUTION 00-15 reaffirmed 05, reaffirmed 10
MEDICAID AND CHIP ON SAME FORMULARY
WHEREAS, Medicaid and CHIP are not using the same formulary and many medications are approved on one insurance but
require prior authorization or are not on the formulary at all on the other. Both insurances are supplied by the State of Texas and
it would make sense for both to carry the same formulary; and
WHEREAS, patients often switch between Medicaid and CHIP and pharmacies have to call physician offices to change
medications because of patient insurance changes; and
WHEREAS, less administrative hassle would foster greater physician participation in Medicaid and CHIP; now therefore
21
BE IT RESOLVED, that the Texas Osteopathic Medical Association House of Delegates supports Medicaid and Children’s
Health Insurance Program using the same formulary
RESOLUTION 11-16
MEDICARE EVALUATION AND MANAGEMENT RULES
WHEREAS, Medicare documentation guidelines for evaluation and management (E&M) services that were developed by the
AMA and the Health Care Financing Administration (CMS) has met opposition from physicians, and
WHEREAS, proper E&M documentation is necessary and should be related to the care provided and should not include heavy
negative documentation to satisfy government initiatives, and
WHEREAS, under current regulations, the E&M coding level for a new patient visit must be set at the lowest level reached in
any of the three key areas – history, examination, and complexity, and
WHEREAS, CMS insists that a pattern of billing that establishes likely fraudulent intent would be necessary before a physician
could be exposed to civil or criminal penalties, therefore
BE IT RESOLVED, that the TOMA House of Delegates goes on record supporting the development of Medicare E&M
documentation rules that will only require documentation which is directly related to the health care provided, and
BE IT FURTHER RESOLVED, that the TOMA House of Delegates goes on record opposing Medicare carriers from punishing
physicians who have made honest coding mistakes for fraud and abuse.
RESOLUTION 03-41 reaffirmed 08
MEDICARE INJECTABLES
WHEREAS, the rates of reimbursements for Medicare services for drugs and biologicals are very disturbing to Texas osteopathic
physicians, and
WHEREAS, reimbursement for drugs and biologicals will be based on the lower of the estimated acquisition cost or the national
average generic wholesale price for the drug, and
WHEREAS, the use of national generic wholesale price will lead to reimbursement rates below the actual acquisition cost to
Texas osteopathic physicians for drugs, and
WHEREAS, Medicare recipients will be forced to go to hospital emergency rooms for injectable medications they were once
able to receive in their doctors' offices, and
WHEREAS, this policy will increase the costs of health care without improving the quality of that care, therefore
BE IT RESOLVED, that the TOMA House of Delegates goes on record supporting the use of the estimated acquisition cost to
calculate reimbursement for Medicare drugs and biologicals in Texas, and
BE IT FURTHER RESOLVED, that the TOMA House of Delegates calls upon Medicare Part B of Blue Cross-Blue Shield of
Texas to conduct a survey of Texas physicians to determine the estimated acquisition costs of covered Medicare injectables.
RESOLUTION 04-30 reaffirmed 09
MEDICARE PRIVATE CONTRACTS
WHEREAS, the Balanced Budget Act of 1997 permits physicians to privately contract with seniors for Medicare covered
services, and
WHEREAS, by signing the contract the physician cannot participate in Medicare whatsoever for the following two years, and
WHEREAS, Medicare reimbursement is on average only 70% of that under private plans, and
WHEREAS, Medicare private contracting is being reframed as a physician reimbursement question rather than a patients’ rights
matter, therefore
BE IT RESOLVED, that the TOMA House of Delegates goes on record supporting private contracting between seniors and their
physicians for Medicare covered services without the two year nonparticipation requirement.
RESOLUTION 03-42 reaffirmed 08
MEDICARE RESOURCE BASED RELATIVE VALUE SCALE FOR OMT
WHEREAS, Osteopathic Manipulative Treatment (OMT) is the hallmark of the osteopathic medical profession, and
WHEREAS, just because a physician is identified as an osteopathic physician does not mean that he or she utilizes OMT in their
medical practice, and
WHEREAS, the relative values for OMT published in the Federal Register on November 25, 1991 were set extremely low and
were fragmented without any relationship between the various OMT codes, and
WHEREAS, the data collected by the Harvard group was not limited to D.O.s who actively use OMT on the majority of their
patients, therefore
BE IT RESOLVED, that the TOMA House of Delegates urges the American Osteopathic Association to insist that any future
national surveys by Medicare regarding OMT only be sent to D.O.s who use OMT as an integral part of their medical practice.
RESOLUTION 02-21 reaffirmed 07
MEDICARE - SCREENS
WHEREAS, Texas osteopathic physicians are concerned over Medicare screening parameters as to their fairness and relevancy
to medical practice, and
WHEREAS, there is a lack of knowledge on the part of physicians as to what is required in order to comply with the screening
parameters, therefore
BE IT RESOLVED, that the TOMA House of Delegates calls upon CMS to change its policy prohibiting public disclosure of all
Medicare screening parameters, and
BE IT FURTHER RESOLVED, that the TOMA House of Delegates calls upon CMS to involve osteopathic physicians in the
development of screening parameters and especially those dealing with osteopathic procedures.
RESOLUTION 00-24 revised & reaffirmed 05, reaffirmed 10
22
MEDICATION FOR NEEDY ELDERLY PATIENTS
WHEREAS, the high cost of prescription drugs poses an economic burden upon elderly patients, and
WHEREAS, a win-win solution for needy elderly patients with chronic diseases, who require daily maintenance medication, and
the Pharmaceutical Industry is possible, and
WHEREAS, at least 30 days prior to expiration date on the medication to treat chronic diseases, the Pharmaceutical Industry
could ship them to volunteer distribution centers where they would be processed and provided to needy elderly patients on the
basis of financial need, and
WHEREAS, the Pharmaceutical Industry should receive a form of indemnification protection for this specific activity from the
federal government, in return for their donation of these medications to needy elderly patients, therefore
BE IT RESOLVED, that the TOMA House of Delegates goes on record supporting the U.S. Congress approve a form of
indemnification protection for those pharmaceutical companies that donate near-expired maintenance medication to volunteer
distribution centers for distribution to elderly patients on the basis of financial need.
RESOLUTION 01-14 revised & reaffirmed 06; reaffirmed 11
MEMBERSHIP IN THE TMF HEALTH QUALITY INSTITUTE IS AUTOMATIC FOR ALL MEMBERS OF THE
TEXAS OSTEOPATHIC MEDICAL ASSOCIATION
WHEREAS, the TMF Health Quality Institute is the premier healthcare quality improvement organization in Texas; and
WHEREAS, the TMF Health Quality Institute partners with healthcare providers to ensure that every patient receives the right
care, every time; and
WHEREAS, the Mission of the TMF Health Quality Institute is to make measurable improvements in the quality and deliver of
healthcare; and
WHEREAS, it is a benefit of TOMA membership to have membership in the TMF Health Quality Institute; now therefore;
BE IT RESOLVED, that membership in the TMF Health Quality Institute (TMF HQI) shall be an attribute of membership in the
Texas Osteopathic Medical Association (TOMA). After the date of this resolution, all members of TOMA are members of TMF
HQI. Within 180 days of this resolution, each member of TOMA shall be notified of his/her membership in TMF HQI and given
the opportunity to opt-out of that membership; and
BE IT FURTHER RESOLVED, that this member benefit will be reflected each year on TOMA dues invoices.
RESOLUTION 11-08
MODIFICATION OF HEALTH CARE FORMS WITH PHYSICIANS
SIGNATURE BLOCK ENDING WITH SUFFIX M.D./D.O.
WHEREAS, Texas osteopathic physicians are proud of their unique heritage and the fact that they are fully licensed Texas
physicians, and
WHEREAS, most medical forms, including those from home health care and some state agencies, require a physician's signature,
and
WHEREAS, many of these medical forms have only one preprinted signature block identifying the signer as an M.D., and
WHEREAS, the Texas Medical Practice Act and the Texas Healing Identification Act legally requires osteopathic physicians to
identify themselves using the D.O. degree, and
WHEREAS, Texas D.O.s dislike the practice of crossing out M.D. on preprinted medical forms prior to signing them, therefore
BE IT RESOLVED, that the TOMA House of Delegates directs the Executive Director of TOMA to contact the appropriate
health care officials or agencies in Texas for the purpose of requesting that all health care agencies in Texas require their vendors
to refrain from the use of preprinted medical forms with single signature blocks which specify M.D. only, and
BE IT FURTHER RESOLVED, that the TOMA House of Delegates goes on record supporting the modification of existing
health care forms so that the physician signature block on these forms will end with the suffix, M.D./D.O.
RESOLUTION 01-40 reaffirmed 06; reaffirmed 11
NATIONAL CLINICAL TRIALS REGISTRY
WHEREAS, multiple research companies are performing research on medications and patient care and it is difficult to access this
information; and
WHEREAS, many of the results are not available for public review; and
WHEREAS, evidence-based medicine is an important result of published research; and
WHEREAS, many of the research studies have faults including, but not limited to, entities such as small number of patients, not
double-blinded, not significant time for evaluation, unexpected high mortality and morbidity; and sponsors may try to conceal
this information; and
WHEREAS, available review of all completed and published medical research would allow appropriate evaluation of all results
by all interested parties; and
WHEREAS, formation of a National Clinical Trials Registry that is easily accessible via electronic database would improve
medical therapy and patient care; now therefore
BE IT RESOLVED, that the TOMA House of Delegates supports the National Clinical Trials Registry of all evidence-based
medical research
RESOLUTION 05-05, revised & reaffirmed 10
NATIONAL INSTITUTES OF HEALTH GRANTS
WHEREAS, the National Institutes of Health (NIH) annually invests over $28 billion in medical research; and
WHEREAS, 83% of NIH funding is awarded through almost 50,000 competitive grants to more than 325,000 researchers at over
3,000 universities and medical schools; and
23
WHEREAS, 215 Research Condition and Disease Categories (RCDC) are funded yearly with the funding between $1 million
and $9 billion annually; and
WHEREAS, there is no specific category for osteopathic medicine; and
WHEREAS, in the most recent report for fiscal year 2005, the top 50 medical schools, located in 25 separate states with 1 to 7
schools per state, receive over $9 billion annually; and
WHEREAS, none of those schools are osteopathic medical schools; now therefore be it
RESOLVED, that the Texas Osteopathic Medical Association House of Delegates encourages osteopathic medical schools and
all osteopathic physicians to pursue National Institutes of Health (NIH) funding for osteopathic research as well as the 215
Research Condition and Disease Categories (RCDC’s) available; and be it further
RESOLVED, that the Texas Osteopathic Medical Association requests that the National Institutes of Health (NIH) include in
the Research Condition and Disease Categories (RCDC’s) a category specific to osteopathic research, and that the NIH
encourage all osteopathic medical schools to apply for grants; and be it further
RESOLVED, that this resolution be forwarded to the American Osteopathic Association for their consideration
Information on http://report.nih.gov/award/HistoricRankInfo.cfm
RESOLUTION 09-02
NEW CATEGORY OF MEMBERSHIP
WHEREAS, the mortgage on the TOMA Building is approximately $140,000; and
WHEREAS, it is the intent of the TOMA Past Presidents to retire the mortgage in 2006, or as
soon as possible; now therefore
BE IT RESOLVED, that a group of Past Presidents be formed called the “Pillars of TOMA; and
BE IT FURTHER RESOLVED, that this group can only consist of a maximum of twelve (12) Past Presidents and/or active
members of TOMA at the invitation of the Board; and
BE IT FURTHER RESOLVED, that each Past President who becomes a “Pillar of TOMA” will make a tax-deductible donation
of at least $10,000 to the TOMA Foundation, or other suitable vehicle to assure the donor that the amount given is tax-deductible;
and
BE IT FURTHER RESOLVED, that each Past President who becomes a “Pillar of TOMA” will not be required to pay any
registration fees for any future TOMA educational meetings or seminars; and
BE IT FURTHER RESOLVED, that a suitable plaque identifying him/her as a “Pillar of TOMA” be created for his/her office,
and another suitable form of recognition be placed in the TOMA Building identifying all “Pillars of TOMA”; and
BE IT FURTHER RESOLVED, that a suitable permanent identification badge be created to be worn at all TOMA meetings to
identify him/her as a “Pillar of TOMA”; and
BE IT FURTHER RESOLVED, that a new category of membership called “Pillar of TOMA” be created and added to the Bylaws
of TOMA by amendment.
RESOLUTION 06-13; reaffirmed 11
NEW RULE ON MEDICARE CONSULTS
WHEREAS, as of January 17, 2006 Medicare requires both the ordering physician and the consulting specialist to document the
reason for patient consultation in their medical records; and
WHEREAS, without this documentation Medicare will not pay for the consultation; and
WHEREAS, this new rule places the consulting physician at the mercy of the primary care or referring physician for payment;
and
WHEREAS, the specialist’s reimbursement is now contingent upon the primary care physician’s willingness to provide
additional documentation when there is no financial gain; and
WHEREAS, if Medicare pays a specialist for a consultation then later discovers during an audit that the primary care physician
did not document the reason for the consultation in the patient’s medical record, Medicare will attempt to recoup the payment
from the specialist; and
WHEREAS, the specialist is now under the extra burden of having to insure documentation by someone out of their office
control; and
WHEREAS, according to Medicare Transmittal 788, Request 2415, issued December 20, 2005 the initial referral may be verbal;
however the requesting and consulting physician must document the conversation and the reason for the consult in the patient’s
medical record; now therefore
BE IT RESOLVED, that the TOMA House of Delegates goes on record requesting that the Center for Medicaid and Medicare
Services reconsider; and
BE IT FURTHER RESOLVED, that the American Osteopathic Association requests that the CMS reverse this documentation
requirement.
RESOLUTION 06-12; reaffirmed 11
NURSE PRACTITIONER LICENSE UNDER THE TEXAS MEDICAL BOARD
WHEREAS, the Texas Medical Board licenses and monitors medical practitioners in the state in accordance with the Medical
Practice Act of the state; and
WHEREAS, the Mission of the Texas Medical Board is to protect and enhance public health and safety by establishing standards
of excellence through education, discipline and licensure; and
WHEREAS, in the State of Texas all Physicians and Physician Assistants are under the auspices of the Texas Medical Board
because they provide direct patient medical care and have prescriptive authority; and
WHEREAS, direct medical care activities are performed daily in medical settings including outpatient offices, nursing homes,
home health, and hospital settings; and
24
WHEREAS, Advanced Practice Nurses (APN’s) have prescriptive authority in a controlled setting of Physician supervision and
direct medical treatment plans, much like Physician Assistants; and
WHEREAS, Registered Nurses who are not Advanced Nurse Practitioners are not licensed to write prescriptions nor direct
medical treatment plans; now therefore be it
RESOLVED, that TOMA seek legislation to place Advanced Practice Nurses (APN’s) who provide direct patient care and
with prescriptive authority in the State of Texas under the authority, licensure and discipline of the Texas Medical Board.
RESOLUTION 08-04
OBESITY IN CHILDREN AND ADOLESCENTS
WHEREAS, obesity is becoming a national epidemic and at least one in four children in the U.S. is overweight and this ratio is
rising; and
WHEREAS, obesity contributes to increased mortality, cardiovascular disease, cholesterol and other blood related problems,
diabetes, high blood pressure, stroke, joint problems and mobility, psychological and physiological problems; and
WHEREAS, since obesity can be life-threatening/disabling, doctors, teachers, school nurses and dieticians should begin teaching
families about the hazards of obesity from infancy through adulthood; and
WHEREAS, heart healthy meals should be offered in day-care, head-start, nursery and school settings; and
WHEREAS, fast food establishments and restaurants should list the grams of fat, amount of cholesterol, fiber intake and calories per
serving; and
WHEREAS, physicians need to talk to families regularly concerning fat and cholesterol intake, fiber intake, folic acid and iron,
exercise, and recommended servings/size of servings per day; and
WHEREAS, a recommendation to decrease the use of soft drinks, drinks with sugar and artificial sugar and increase the
consumption of water should be included in educational handouts; therefore
BE IT RESOLVED, that the Texas Osteopathic Medical Association’s House of Delegates urges Texas osteopathic physicians as
well as parents, grandparents, schools, day care centers, and fast food restaurants to take action to help prolong the lives of
children without significant health-related illness as a result of obesity.
RESOLUTION 03-14 reaffirmed 08
OBTAINING PRESCRIPTIONS FROM AN INTERNET PHARMACY CAN BE RISKY
WHEREAS, new Internet pharmacies are providing customers with prescription medications at patients’ request based on an online consultation without the benefit of a physical examination or personal encounter with a licensed physician; and
WHEREAS, pharmaceutical treatments can be dangerous when distributed without the supervision of and interaction with a
physician in an established physician-patient relationship; and
WHEREAS, pharmaceutical sales over the Internet do not have the same safety factors and regulations required of brick and
mortar pharmacy sales; and
WHEREAS, pharmaceuticals should be dispensed only with a prescription from a physician who is responsible for the patient’s
care in an established physician-patient relationship that includes standard practice of medicine (i.e. physical examination); now
therefore
BE IT RESOLVED, that the TOMA House of Delegates encourages the Texas Legislature to pass legislation discouraging
Internet pharmacies from providing prescriptions based on on-line consultation and/or telephone consultation, and/or make such
practices illegal.
RESOLUTION 06-14; reaffirmed 11
OMT BEING GROUPED WITH NON-PHYSICIANS FOR REIMBURSEMENT
WHEREAS, Texas osteopathic physicians expected to be reimbursed for osteopathic manipulative treatments (OMT) in addition
to any other physical medicine modalities provided to their patients, and
WHEREAS, Texas osteopathic physicians also expect to be reimbursed for OMT along with the office visit when a separate
identifiable problem is identified, and
WHEREAS, many insurers are lumping together the office visit, OMT, and physical medicine modalities under global codes for
reimbursement purposes, and
WHEREAS, under these global code fees, the sum of the whole is less than the sum of the individual components included in the
global fees, and
WHEREAS, many insurers are placing OMT under the broad heading of manipulation and placing OMT administered by an
osteopathic physician together with non-physician administered manipulations, therefore
BE IT RESOLVED, that the TOMA House of Delegates goes on record opposing the bundling of OMT with office visits,
physical medicine modalities, or any other procedure for reimbursement purposes.
RESOLUTION 01-39 reaffirmed 06; reaffirmed 11
OMT IN VETERANS HOSPITALS AND CLINICS
WHEREAS, osteopathic physicians are trained to utilize Osteopathic Manipulative Treatment (OMT) in the diagnosis and
treatment of patients; and
WHEREAS, OMT is recognized by a majority of third-party payors for reimbursement purposes; and
WHEREAS, OMT is a physician administered health care service which is beneficial and cost-effective; and
WHEREAS, osteopathic physicians working in veterans hospitals and clinics are prohibited from utilizing OMT for diagnosis
and treatment of patients, and are also prohibited from documenting OMT findings in medical records; therefore
25
BE IT RESOLVED, that the Texas Osteopathic Medical Association’s House of Delegates calls upon the U.S. Veterans
Administration to reverse the policy of prohibiting the use and documentation of OMT by physicians in all of its health care
facilities
RESOLUTION 03-07 revised & reaffirmed 08
OMT REIMBURSEMENT
WHEREAS, Texas osteopathic physicians are concerned over some recent trends of third party payers to lump osteopathic
manipulative treatment (OMT) together with office visits as part of global fees, and
WHEREAS, data on the therapeutic and cost-effectiveness of OMT is necessary for accurate statistical purposes, and
WHEREAS, insurance claim forms for reimbursement purposes should accurately reflect the specific medical services rendered
by physicians to patients, therefore
BE IT RESOLVED, that the TOMA House of Delegates goes on record supporting the policy that OMT is a recognized, specific
therapeutic modality supplied by osteopathic physicians to patients and therefore should be listed as a separate entity for
reimbursement purposes on all insurance claim forms, and
BE IT FURTHER RESOLVED, that the TOMA House of Delegates goes on record opposing the lumping of OMT with office
visits as part of global fees.
RESOLUTION 04-24 reaffirmed 09
ON SITE LAB WORK
WHEREAS, many managed care companies routinely prohibit the performance of reasonable on site diagnostic tests and require
referral to off site providers for these diagnostic tests, and
WHEREAS, these practices can result in unnecessary delays in diagnostic and treatment of a patient’s condition and illness, and
WHEREAS, these delays in diagnosis and treatment can have serious deleterious effects on the patient’s health, therefore
BE IT RESOLVED, that the TOMA House of Delegates recommends that legislation be enacted that requires managed care
companies to pay for appropriate on site testing at a rate equal to the contracted rate paid for the same service to off site
providers.
RESOLUTION 01-19 reaffirmed 06
OPPOSITION TO INDEPENDENT PRACTICE OF MEDICINE
BY LIMITED-LICENSE PRACTITIONERS
WHEREAS, despite the projected physician surplus in the United States, Texas osteopathic medical students are still expected to
make a lifetime investment of their time, energy, and money towards a course of study which will eventually lead to full
licensure as osteopathic physicians as opposed to other less demanding health care career choices, and
WHEREAS, Texas osteopathic physicians are proud of their training and medical education including medical school,
postgraduate and continuing medical education and,
WHEREAS, federal and state legislation, such as the federal rule requiring involvement of limited-license practitioners in rural
health clinics, continues to promote the use of Physician Assistants and Advanced Nurse Practitioners in order to hold down
medical costs and increase patient access to health care services, and
WHEREAS, the Texas Legislature continues to consider and pass legislation that expands the scope of practice of limitedpractice practitioners in Texas, and
WHEREAS, the legislation may be based and justified on a fiduciary rather than a medical basis, and
WHEREAS, the people of the state of Texas expect that medical care be rendered or supervised by a duly licensed physician,
therefore,
BE IT RESOLVED, that the TOMA House of Delegates directs the Executive Director and Board of Trustees to vigorously
opposed all legislation that would allow or incrementally permit the independent practice of medicine by limited-license
practitioners, and
BE IT FURTHER RESOLVED, that TOMA express our position to legislators, state agencies, the Texas Medical Board, the
Texas State Board of Pharmacy, the Texas State Board of Nurse Examiners, Board of Psychology Examiners, and the people of
Texas by whatever means available to protect and ensure that high quality medical care is delivered throughout Texas.
RESOLUTION 01-30 reaffirmed 06; reaffirmed 11
OPPOSITION TO USE OF READMISSION RATES BY CMS AS A CRITERION FOR RANKING THE QUALITY OF
CARE PROVIDED BY PHYSICIANS AND HOSPITALS
WHEREAS, the Centers for Medicare and Medicaid Services publishes readmission rates to hospitals of patients with chronic
conditions including Myocardial infarction, Congestive Heart Failure, Pneumonia and Chronic Obstructive Pulmonary Disease;
and
WHEREAS, the Centers for Medicare and Medicaid Services has announced that it intends to use readmission rates as a criterion
for reimbursement for hospitals and physicians; and
WHEREAS, readmission rates to hospitals have been associated with many variables that are beyond the control of the physician
and the hospital; now therefore
BE IT RESOLVED, that the Texas Osteopathic Medical Association House of Delegates is opposed to the use of readmission
rates as a criterion for deciding reimbursement for hospitals and physicians; and
BE IT FURTHER RESOLVED, that the Texas Osteopathic Medical Association House of Delegates is opposed to the use of
readmission rates as a criterion for ranking the quality of care provided by physicians and hospitals; and
BE IT FURTHER RESOLVED, that this resolution be forwarded to the American Osteopathic Association House of Delegates
for consideration
RESOLUTION 11-13
26
OSHA REGULATIONS
WHEREAS, the Occupational Safety and Health Administration (OSHA) is looking at physician offices under the bloodborne
pathogen standards, and
WHEREAS, OSHA officials through its general-duty clause, which obligates all employers to provide work places that are "free
from recognized hazards causing or likely to case death or serious physical harm" to employees, have assessed fines against
physicians, therefore
BE IT RESOLVED, that the TOMA House of Delegates urges the American Osteopathic Association to insist that OSHA places
the emphasis on education and training to create a safe work place rather than on punitive fines when enforcing the new
bloodborne-pathogen regulations.
RESOLUTION 02-22 reaffirmed 07
OSTEOPATHIC CURRICULA
WHEREAS, Texas osteopathic physicians are confronted by serious issues as they enter the new millennium, and
WHEREAS, the TOMA Long Range Planning Committee met for the purpose of establishing goals for TOMA, therefore,
BE IT RESOLVED, that the TOMA House of Delegates adopt the following resolution -- That actively practicing osteopathic
physicians shall continue to have input to planning and development of curricula in osteopathic colleges, to ensure that these
curricula are relevant to the provision of primary health care, and that osteopathic philosophy, principles and practice continue to
be incorporated in the teaching of all clinical fields.
RESOLUTION 00-26 revised & reaffirmed 05, reaffirmed 10
OSTEOPATHIC EXCEPTIONALISM IN MEDICAL EDUCATION
WHEREAS, the Texas College of Osteopathic Medicine (TCOM) was founded by visionary members of the Texas Osteopathic
Medical Association (TOMA) in 1970, funded for the first years of operation through private donations of Texas D.O.s and
eventually graduated the first students from TCOM; and
WHEREAS, In 1975, after obtaining certification as a (privately funded) osteopathic medical school, TOMA facilitated and
supported the transfer of TCOM to North Texas State University (now UNT), in order to become a state supported institution;
and
WHEREAS, TCOM has always strived to be the best quality osteopathic institution through decades of hard work, selfimprovement and dedication to the highest standards in osteopathic medical education; and
WHEREAS, TCOM, under previous administrations, achieved excellence and, by many standards, was without peer in
osteopathic medical education, USMLE scores and quality of graduates with dedication to osteopathic principles; and
WHEREAS, in 2008 the UNT Chancellor and Regents and UNT Health Science Center (HSC) Administration betrayed the best
interest of TCOM with the decision to place an M.D. medical school on the Fort Worth campus of the UNT HSC; and therefore
BE IT RESOLVED, that the Texas Osteopathic Medical Association House of Delegates supports and strongly advises that the
University of North Texas Board of Regents put into place a UNT HSC President and UNT HSC administrative team, including
all TCOM Deans, who believe in the osteopathic difference and osteopathic exceptionalism and can again achieve highest
quality, osteopathically oriented medical education
RESOLUTION 11-26
OSTEOPATHIC MANIPULATIVE TREATMENT - INSURANCE PREJUDICES
WHEREAS, some insurers are refusing coverage to applicants who indicate prior osteopathic treatments, and
WHEREAS, some insurers consider osteopathic manipulative treatment as denoting a pre-existing condition prejudicing
qualification for full coverage, and
WHEREAS, too often, incomplete understanding of the osteopathic concept is held by officers of decision in the individual
carrier, therefore
BE IT RESOLVED, that the TOMA House of Delegates goes on record instructing the Executive Director of TOMA to actively
seek out and communicate with those third party payers who consider prior osteopathic manipulative treatments evidence of preexisting chronic conditions.
RESOLUTION 00-27 revised & reaffirmed 05, reaffirmed 10
OSTEOPATHIC MEDICAL CENTER OF TEXAS
WHEREAS, the Osteopathic Profession and the people of Texas were well served through decades of healthcare services and
emergency care through the Osteopathic Medical Center of Texas (OMCT) in Fort Worth; and
WHEREAS, hundreds of thousands of patient encounters and millions of dollars of un-reimbursed medical services were
provided to the people of Texas through the OMCT; and
WHEREAS, the Board of OMCT acted in good faith including those times marked by very difficult economic challenges; now
therefore be it
RESOLVED, that the TOMA House of Delegates empowers the TOMA Board of Trustees to monitor the OMCT Board
situation and take appropriate actions to support the Board of OMCT.
RESOLUTION 08-09
OSTEOPATHIC PALPATORY DIAGNOSIS
WHEREAS, Texas osteopathic physicians are well aware that the health care dollar is shrinking, and
WHEREAS, third-party payers are placing more limitations on covered services rather than classifying previously covered
services as "non-covered" services, and
WHEREAS, the Texas Medicaid Program has placed limitations on the utilization of osteopathic manipulative therapy (OMT) to
acute musculoskeletal conditions for reimbursement purposes, therefore
27
BE IT RESOLVED, that the TOMA House of Delegates goes on record opposing the use of the term "acute" in the context of
some specific period of time, and supports the proposition that "acute" and "chronic" musculoskeletal problems be defined on the
basis of osteopathic palpatory diagnostic findings, and
BE IT FURTHER RESOLVED, that the TOMA House of Delegates oppose and seek to change the policy of third-party payers
to restrict OMT reimbursement to only "acute" musculoskeletal problems; and
BE IT FURTHER RESOLVED, that the TOMA House of Delegates submit a similar resolution to the American Osteopathic
Association House of Delegates for adoption.
RESOLUTION 03-32 revised & reaffirmed 08
OSTEOPATHIC POLITICAL ASPIRATION
WHEREAS, Texas osteopathic physicians are confronted by serious issues, and
WHEREAS, the TOMA Long Range Planning Committee met for the purpose of establishing goals for TOMA, therefore
BE IT RESOLVED, that TOMA encourage political activism by osteopathic physicians and research the possibility of electing a
D.O. to the legislature.
RESOLUTION 00-28 revised & reaffirmed 05, reaffirmed 10
OSTEOPATHIC REPRESENTATION ON DIVISION OF WORKERS’ COMPENSATION OF THE TEXAS
DEPARTMENT OF INSURANCE (TDI) COMMITTEES
WHEREAS, Texas osteopathic physicians support osteopathic representation on all medical related committees of the Texas
Workers' Compensation Commission, and
WHEREAS, in the past, many policies and regulations adopted by the Texas Workers' Compensation Commission, were found to
be objectionable to Texas osteopathic physicians after they were drafted by special advisory committees of the Commission that
had no osteopathic physicians as members, therefore
BE IT RESOLVED, that the TOMA House of Delegates calls upon the Division of Workers’ Compensation of the Texas
Department of Insurance to ensure osteopathic physician representation on all special medical advisory committees created by the
Commission, and
BE IT FURTHER RESOLVED, that the TOMA House of Delegates calls upon the Division of Workers’ Compensation of the
Texas Department of Insurance to always develop separate guidelines for osteopathic manipulative therapy from those of
physical therapy and to plainly state to third party carriers that OMT is not physical therapy.
RESOLUTION 04-31 revised & reaffirmed 09
OSTEOPATHIC TRAINING
WHEREAS, Texas osteopathic physicians are confronted by serious issues, now therefore
BE IT RESOLVED, that TOMA affirms the need for continuity in the osteopathic profession's mission to train superior family
and general practitioners.
RESOLUTION 00-29 revised & reaffirmed 05, reaffirmed 10
OSTEOPATHIC TREATMENTS FOR H1N1 (SWINE) INFLUENZE PANDEMIC
WHEREAS, April and May, 2009 have demonstrated a growing pandemic of the Swine flu; and
WHEREAS, the Spanish flu of 1919 ravaged the United States with estimated loss of life from fifty (50) to one hundred (100)
million; and
WHEREAS, the Osteopathic treatment method of Lymphatic Pump historically made a significant difference in positive
outcomes of those patients affected; and
WHEREAS, this technique can be easily taught to both health care providers as well as non-health care providers; now therefore
be it
RESOLVED, that the Texas Osteopathic Medical Association (TOMA) supports the active use of the Lymphatic Pump
Technique as a supplemental treatment technique in the Swine flu pandemic, and calls of Texas Osteopathic Physicians to
provide the active instruction of this technique to as many health and non-health care providers as soon as possible; and be it
further
RESOLVED, that this resolution be forwarded to the American Osteopathic Association as soon as possible for implementation
in the national setting
RESOLUTION 09-18
OSTEOPATHS AND ALLOPATHS
WHEREAS, Texas osteopathic physicians are proud of their profession, and
WHEREAS, medical publications pride themselves on their accuracy and good grammar, and
WHEREAS, osteopathic physicians are often referred to as "osteopaths" in medical publications while medical doctors (M.D.'s)
are almost never referred to as "allopaths", and
WHEREAS, Texas osteopathic physicians are fully licensed to practice medicine and surgery and prefer "osteopathic physician"
or their initials "D.O." to identify their school of medicine, and
WHEREAS, the use of the term "osteopath" is often perceived in a negative light by the reading public and contributes to the
public misconception of osteopathic medicine and physicians, therefore
BE IT RESOLVED, that the TOMA House of Delegates goes on record encouraging all medical publications to avoid the use of
the term "osteopath" unless it is used in conjunction with the term "allopath" in order to help avoid public confusion regarding
osteopathic physicians.
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RESOLUTION 00-30 revised & reaffirmed 05, reaffirmed 10
OVERRIDES FOR PRESCRIPTION MEDICATIONS
WHEREAS, physicians and their patients know which medications work best for the patient; and
WHEREAS, insurance providers have a restricted formulary which may change based on rebates from manufacturers; and
WHEREAS, many of these plans require the physician to request an override; and
WHEREAS, many times the hold time is excessive; and
WHEREAS, it is detrimental to quality patient care to keep changing medications based on rebates; now therefore
BE IT RESOLVED, that the TOMA House of Delegates support legislative efforts to: 1) decrease the hold time for physicians
and staff for requesting overrides from insurance pharmacy plans, 2) require insurance pharmacy plans to allow patients to stay
on medications that they are already on that are working well; 3) make it easier for a physician to request an override
RESOLUTION 05-01, revised & reaffirmed 10
PARENTING EDUCATION
WHEREAS, the Texas Osteopathic Medical Association is concerned for the well-being of the family and this issue is an integral
part of our heritage; and
WHEREAS, there are many one parent families with that parent working; and
WHEREAS, outside influences affect children and adolescents; and
WHEREAS, some parents are abdicating their parenting responsibilities; therefore
BE IT RESOLVED, that the TOMA House of Delegate encourages and supports
parenting education to be made available throughout the state.
RESOLUTION 04-12 reaffirmed 09
PARENTING EDUCATION
WHEREAS, the Texas Osteopathic Medical Association is primarily composed of family practitioners and our concern for the
wellbeing of the family is and always has been an integral part of our heritage; and
WHEREAS, there are parents who lack the knowledge of adequately parent their children; now therefore
BE IT RESOLVED, that the TOMA House of Delegates encourages parenting education be made available through local school
systems, county health departments, hospital systems, and other local agencies.
RESOLUTION 05-08, reaffirmed 10
PATIENT ACCESS IN RURAL AREAS
WHEREAS, managed care enrollees in rural areas of Texas have no local network physicians or hospitals to provide medical
care, and
WHEREAS, some managed care enrollees must travel long distances to see the nearest network physicians or hospitals, and
WHEREAS, health care plans should guarantee adequate access to providers in an enrollees "proximate area," therefore
BE IT RESOLVED, the TOMA House of Delegates support legislation on the state and federal level that would require all
managed health care plans to allow their enrollees who live more than 20 miles from the nearest network physician or hospital to
utilize a local provider of their choice, at no extra charge.
RESOLUTION 00-31 reaffirmed 05, reaffirmed 10
PATIENT DIRECTIVE & DURABLE POWER OF ATTORNEY
WHEREAS, Texas osteopathic physicians support the concept of LIVING WILLS and DURABLE POWER OF ATTORNEY
FOR HEALTH CARE, and
WHEREAS, by law these two documents are available to citizens of Texas, and
WHEREAS, the percentage of completed patient directives and DURABLE POWER OF ATTORNEY FOR HEALTH CARE
forms are very low is South Texas compared to the remainder of the State, and
WHEREAS, the patient directive and DURABLE POWER OF ATTORNEY FOR HEALTH CARE forms are currently
produced in English only and not in Spanish, and
WHEREAS, there are no readily available videos in Spanish or English explaining the pros and cons of patient directives and
DURABLE POWER OF ATTORNEY FOR HEALTH CARE for patients and their families to view in the privacy of doctor’s
offices, hospitals, or nursing homes, therefore
BE IT RESOLVED, that the TOMA House of Delegates goes on record supporting the concept of written patient directives and
DURABLE POWER OF ATTORNEY FOR HEALTH CARE forms being produced in both English and Spanish, and
BE IT FURTHER RESOLVED, that the TOMA House of Delegates goes on record supporting the production of videos in
Spanish and English explaining patient directives and DURABLE POWER OF ATTORNEY FOR HEALTH CARE to be
utilized in physician offices, hospitals, and nursing homes.
RESOLUTION 01-28 reaffirmed 06; reaffirmed 11
PATIENT PROTECTION IN MANAGED CARE PLANS
WHEREAS, many health plans are obtaining information about patients’ medical history from a variety of sources in attempts to
identify high risk enrollees, and
WHEREAS, information about patients’ genetic code or pharmaceutical usage could be used to exclude certain people from
obtaining health insurance coverage, and
WHEREAS, pharmacy benefit managers (PBM’s) are prohibited from selling patients lists in Texas that contain information
through which the identity of a patient is disclosed, but are not prohibited from using medication information for marketing
purposes, and
29
WHEREAS, health plans often attempt to lower costs of prescription drugs by using drug formularies which may restrict a
physician’s ability to prescribe the most appropriate medication due to the patient’s insurance coverage, and
WHEREAS, some health plans are requiring enrollees to secure prior approval from the health plan before calling 9-1-1 and
going to emergency rooms, therefore
BE IT RESOLVED, that the TOMA House of Delegates supports adequate safeguards for medical and other records that contain
confidential, often highly sensitive patient information that can be used to exclude patients with certain illnesses from obtaining
coverage or to give health plan data that can be used to restrict drug formularies or allow direct marketing of pharmaceuticals to
patients, and
BE IT FURTHER RESOLVED, that the TOMA House of Delegates works to prohibit health plans from requiring prior
authorization to call 911.
RESOLUTION 01-03 revised & reaffirmed 06; reaffirmed 11
PATIENT’S RIGHT OF REFERRAL
WHEREAS, federal “Stark” laws already severely limit, restrict and define appropriate physician
ownership of and self-referral to medical facilities; and
WHEREAS, physicians often invest in specialty hospitals, owned by consortiums of physicians and other investors; and
WHEREAS, these specialty hospitals tend to be “centers of excellence” in their arenas of specialized care and offer highest
quality service to patients; now therefore
BE IT RESOLVED, that the TOMA House of Delegates supports the patient’s right of free choice when seeking medical/surgical
services at a hospital or institution where the referring physician(s) has fully disclosed all such financial interest to the patient;
and
BE IT FURTHER RESOLVED, that the TOMA House of Delegates supports the right of physicians to refer appropriate patients
to institutions where they have partial ownership, investment, or other financial interests provided that such financial interests
have been fully disclosed to the patient and do not violate existing laws; and
BE IT FURTHER RESOLVED, that the TOMA House of Delegates opposes additional legislation that seeks to restrict the
patient’s right to seek medical/surgical services or the physician’s right to provide such services, at quality institutions based
strictly on physician financial involvement with those institutions.
RESOLUTION 06-23; reaffirmed 11
PAYMENT FOR INFLUENZA VACCINE
WHEREAS, the Centers for Medicare and Medicaid Services (CMS), as well as the American Osteopathic Association
(American Osteopathic Association), encourage Medicare beneficiaries to obtain the influenza vaccine yearly; and
WHEREAS, many Medicare beneficiaries see a primary care physician on a regular basis; and
WHEREAS, the cost to physicians for obtaining the influenza vaccine has been rising yearly but the payment from CMS has not
kept pace with those increased costs; therefore
BE IT RESOLVED, that the Texas Osteopathic Medical Association’s House of Delegates calls upon the CMS to increase the
current payments by 150% to physicians who supply the influenza vaccine to Medicare beneficiaries.
RESOLUTION 03-11 reaffirmed 08
PEDIATRIC AND ADULT OBESITY
WHEREAS, osteopathic physicians are aware that obesity in children and adults in the U.S. is a major epidemic which has not
been adequately addressed by the osteopathic medical community; and
WHEREAS, osteopathic medical schools have curricula that are less than adequate on nutritional education; and
WHEREAS, obesity has been proven to be a co-morbid factor in cardiovascular disease, degeneration joint disease, Type II
diabetes mellitus and other serious illnesses; and
WHEREAS, it is time for all osteopathic physicians to take a leadership role in weighing all patients, calculating and discussing
with them the significance of their Body Mass Index (BMI) in attaining and maintaining an appropriate weight for optimal health
and wellness; therefore
BE IT RESOLVED, that the Texas Osteopathic Medical Association’s House of Delegates goes on record supporting a campaign
within the state of Texas to educate osteopathic physicians, students, patients and the general population; with special emphasis
on elementary, middle and high school students, regarding the seriousness of obesity and the importance of proper nutrition and
exercise; and
BE IT FURTHER RESOLVED, that the TOMA House of Delegates encourages all osteopathic physicians to do a BMI and
provide nutritional information to all of their patients at least annually.
RESOLUTION 03-05 reaffirmed 08
PEER REVIEW
WHEREAS, peer review under the Medicare program (PRO) requires that there be D.O. review of D.O.s whenever possible, for
both Medicare and Medicaid cases, and,
WHEREAS, no statutory language guaranteeing this review exists for Medicaid cases reviewed by an entity other than the PRO,
therefore
BE IT RESOLVED, that the TOMA House of Delegates goes on record supporting federal legislation which would guarantee
that D.O.s be represented on all appeal level cases reviewing D.O.s.
RESOLUTION 00-17 revised & reaffirmed 05, reaffirmed 10
PEER REVIEW BY TMF
WHEREAS, Texas osteopathic physicians support the Texas Medical Foundation (TMF) which is a physician-directed, statewide
medical peer review organization in Texas, and
30
WHEREAS, in the past the TMF negotiated with the Texas Department of Health and Human Services (TDHHS) to provide peer
review of Medicaid health care claims under a system of review similar to that of Medicare, and
WHEREAS, the TDHHS has decided to conduct its own peer review of Medicaid health care claims, therefore
BE IT RESOLVED, that the TOMA House of Delegates continues to support independent physician-directed peer review of
Medicaid health care claims, and
BE IT FURTHER RESOLVED, that the TOMA House of Delegates calls on the TDHHS to conduct peer review in a manner that
will closely resemble the Medicare peer review guidelines, which includes the provision that osteopathic physicians be reviewed
by other osteopathic physicians.
RESOLUTION 04-25 reaffirmed 09
PEER REVIEW FOR THE TEXAS MEDICAL BOARD
WHEREAS, the current method of Peer Review from the Texas Medical Board has come under criticism: and
WHEREAS, there is no input from the medical societies in choosing the Peer Review physicians for the Texas Medical Board;
and
WHEREAS, there is no mechanism in place for having Osteopathic Physician reviewed by Osteopathic Physicians; and
WHEREAS, an Osteopathic physician is distinct in training and philosophy from the Allopathic physician; now therefore be it
RESOLVED, that the Texas Osteopathic Medical Association work with the Texas Medical Board to provide the names of
Osteopathic physicians who are qualified and willing to perform Peer Review for the Texas Medical Board.
RESOLUTION 08-06
PHYSICAL EDUCATION IN SCHOOLS AS A DETERRENT TO OBESITY AND
TYPE 2 DIABETES
WHEREAS, osteopathic physicians treat the whole patient and not just symptoms; and
WHEREAS, Diabetes Type 2 has become epidemic in our State and is a byproduct of Obesity; and
WHEREAS, obesity in our Texas children has become epidemic and is largely due to a lack of daily exercise; and
WHEREAS, daily exercise and a vigorous lifestyle from early childhood can prevent childhood obesity and many cases of Type
2 Diabetes; and
WHEREAS, there is compulsory school attendance for Texas children from age 5 through age 17 for a minimum of 180 days
each year; and
WHEREAS, the schools have physical custody of the children throughout the majority of their waking hours for 180 days of each
year; now therefore
BE IT RESOLVED,that the TOMA House of Delegates recommend to the Texas Legislature that they mandate to the School
Boards a school curriculum change that requires one hour of physical education daily for grades Pre-K through grade 6 and three
hours per week for grades 7-12 for children enrolled in public school to help prevent many cases of obesity and Diabetes Type 2
and promote a Vigorous Healthy Lifestyle for Texas Children.
RESOLUTION 06-02; reaffirmed 11
PHYSICIAN DIRECTED PEER REVIEW
WHEREAS, Texas osteopathic physicians support the concept of physician directed medical peer review to enhance and assure
quality health care, and
WHEREAS, the practice of medicine cannot be categorized as an exact science, and
WHEREAS, Texas osteopathic physician involvement in the peer review process is based on the confidentially of medical
records, due process for the potentially sanctioned health care providers, and the use of education, whenever feasible, rather than
punitive measures to correct inappropriate patterns of medical care, therefore
BE IT RESOLVED, that the TOMA House of Delegates goes on record as supporting physician directed medical peer review
that guarantees confidentiality of medical records, due process for all potentially sanctioned health care providers, and
educational rather than punitive methods to correct inappropriate patterns of medical care when an imminent danger to patients
does not exist.
RESOLUTION 03-33 reaffirmed 08
PHYSICIAN OFFICE LABORATORIES
WHEREAS, a primary concern of osteopathic physicians in Texas is high quality medical care for all Texans, therefore
BE IT RESOLVED, that the TOMA of Delegates work to assure that physician office laboratory certification, which may be
required by federal or state legislation, be as non-intrusive as possible into the practice of medicine, and such legislation shall
provide for reimbursement to the provider to cover the cost incurred by complying with state regulation, and
BE IT FURTHER RESOLVED, that the TOMA House of Delegates seeks assurances that access to such laboratory tests, as the
physician would deem medically necessary, not be limited by unnecessary regulations.
RESOLUTION 00-18 revised & reaffirmed 05, reaffirmed 10
POINT-OF-SERVICE PLANS AND THE FREEDOM TO CHOOSE
WHEREAS, osteopathic physicians support the patient's freedom to choose any physician, primary care or specialist, and
WHEREAS, many managed health care plans require patients to see primary care physicians before they can see a specialist, and
WHEREAS, some managed health care plans have responded to patient's concerns by offering point-of-service
(POS) plans which allow enrollees to use out-of-network providers in addition to the in-network physicians, and
WHEREAS, premiums for POS plans are slightly higher than straight HMO premiums and are paid by the
employee; however, the patient has the option to see any physician without prior approval and still receive some level of
reimbursement, therefore
31
BE IT RESOLVED, that the TOMA House of Delegates support legislation on the state and federal level that would require all
managed health care plans to offer their enrollees the option of point-of-service plans.
RESOLUTION 00-32 revised & reaffirmed 05, reaffirmed 10
POLICY STATEMENTS
WHEREAS, the Texas Osteopathic Medical Association's House of Delegates is the policy-making body of the osteopathic
profession in Texas and
WHEREAS, each year at its annual meeting, the House considers policy statements submitted by members, departments,
committees and the TOMA Board of Trustees and
WHEREAS, it is important for individuals both inside and outside the osteopathic family to be aware of the policy statements
adopted by the TOMA House of Delegates.
NOW, THEREFORE, BE IT RESOLVED, that the policy statements be printed in their entirety, when adopted, as a standard
feature in the TOMA Annual Directory, and
BE IT FURTHER RESOLVED, that the policy statements relating to health care, health planning and health delivery be
reviewed by the TOMA House of Delegates every five years or as often as deemed necessary by the Resolutions Committee for
affirmation, revision or deletion.
RESOLUTION 03-34 reaffirmed 08
POSITION STATEMENT OF THE TEXAS OSTEOPATHIC MEDICAL ASSOCIATION REGARDING THE TEXAS
MEDICAL BOARD
WHEREAS, Osteopathic physicians in the State of Texas strongly support the Texas Medical Board (TMB), and believe it is
important for Texas to have a strong, effective medical board acting not only as an advocate for the citizens of Texas but also as
an advocate for the physicians of Texas; and,
WHEREAS, the Texas State Senate passed in the 2003 Texas Legislative session Senate Bill 104, (SB104) which outlines the
statutory responsibility for the TMB as it specifically relates to disciplinary matters, which are as listed: 1. Quality of care issues,
2. Sexual misconduct, and 3. Impairment issues; and,
WHEREAS, the TMB is critical to the ongoing maintenance of the tort reforms passed in the 2003 Legislative session; and,
WHEREAS, the Texas Osteopathic Medical Association (TOMA) and its membership encourages the TMB to maintain a level
playing field of fairness and to focus on the issues outlined in SB104 with openness and transparency utilized in the disciplinary
process; and
WHEREAS, the Texas Osteopathic Medical Association (TOMA) realizes that the TMB has been under increasing scrutiny and
that TOMA appreciates the service that the members of this board voluntarily give to the citizens of our state; and,
WHEREAS, any functional organization will always have an opportunity for improvement as a normal process and due course;
and,
WHEREAS, Texas Osteopathic physicians want to support the TMB but may find it hard to do when the perception is that there
is unfairness or uneven-ness in the system; and,
WHEREAS, in the light of the many issues and questions Texas osteopathic physicians have with the disciplinary process, and
that physicians desire a fair and balanced focus on openness and transparency in that process; now therefore be it,
RESOLVED, that the Texas Osteopathic Medical Association supports the Texas Medical Board; and be it further
RESOLVED, that TOMA supports the statutory law amendments that would be effected by the Texas Legislature as specifically
listed in the TOMA White Paper Attachment.
In response to a growing concern and outcry from osteopathic physicians across our state, Texas Osteopathic Medical
Association (TOMA) developed a position statement for the association concerning the activities of the Texas Medical Board
(TMB).
There are several points to consider. These include maintaining the tort reform measures passed in 2003 and an assortment of
issues concerning the transparency of TMB operations and proceedings. These include anonymous complaints, disciplinary
procedures, State Office of Administrative Hearings findings, deferred adjudication, case review and the listing of physicians’
names in news releases for minor infractions.
To encourage the continuance of a strong board which operates in a balanced manner, the Texas Osteopathic Medical
Association offers the following recommendations for TMB reform:
1. The Texas Medical Board should look back to Senate Bill 104 also passed in the 2003 legislative session and re-focus
its investigative and disciplinary efforts on those allegation priorities highlighted in that legislation: sexual misconduct, impaired
physicians, and quality of care. The resources of the Board are not unlimited and therefore should be focused on those areas
where the most can be done to protect public safety.
2. TOMA supports the Board’s efforts to continue to improve the efficiency and timeliness of the licensing process.
Everyone in Texas benefits from a faster process, particularly since our state is now such an attractive place in which to practice
medicine.
3. So many complaints about the Board and its processes, particularly in licensing, can be summarized as a single deficit:
customer service. We urge the board and leadership to thoroughly revamp its communication, responsiveness, and timeliness
with which the Board relates to its physician stakeholders. The board should be as effective in physician service and licensing as
it is in pursuing disciplinary action.
32
4. TOMA suggests a fair and balanced focus on openness and transparency in its processes of dealing with physicians.
Discipline where appropriate; warning where it can resolve the issue; educate where necessary; support where needed, and
facilitate a win-win culture for both the public and the physicians.
5. TOMA asks the Board to recognize that disciplinary action against any license-holder threatens not only his or her
livelihood but also his or her professional and personal standing. Discipline, even in cases not related to patient care or safety,
should never be taken lightly or for financial reasons.
6. TOMA suggests that there are a significant number of legal, operational, and administrative changes and additions that
merit serious consideration by the Legislature and by the Board. These changes listed in Addendum A would greatly enhance the
fairness and transparency of the current operations and restore confidence in the Board by those it licenses.
7. TOMA recommends that the Legislature provide for an increased budget of $12,000,000 or similar amount that would
allow for the TMB to comply with the provisions of SB 104 and the efficient handling of licensure.
The osteopathic physicians of Texas support the TMB. However, we believe that the TMB should and can conduct itself with
more effectiveness, efficiency, and transparency. Physicians find it difficult to support a board which they perceive to be unfair.
It is imperative that the TMB is a strong and effective body, concerned primarily with the health and safety of the citizens of
Texas. Therefore, the TMB should utilize its resources efficiently, by focusing its efforts on issues of sexual misconduct,
impaired physicians and quality of care, where the Legislature has already given direction and where public safety would be wellserved. TOMA physicians are, however, pleased with the TMB’s efforts to expedite the licensing process which benefits all
citizens of Texas and is an example of how effective the TMB can be.
-----------------------------------------------------------------------------------------------------------Addendum A: Suggested Legal, Operational and Administrative Changes to the Texas Medical Board
An Administrative Law Judge at the State Office of Administrative Hearings should be made the final decision maker on
contested licensing and disciplinary cases.
Allow for pre-filing mediation at the State Office of Administrative Hearings and establish a deferred adjudication system for
minor violations and/or first time offenders.
Disclosure of Board experts to defendant physicians and defendant physician's counsel prior to Informal Settlement Conference
(ISC) to allow for possible impeachment or demonstration of bias, so as to present a more fair defense.
Reinstitute the private reprimand or adopt a warning mechanism that does not constitute disciplinary action and establish a preapproval system for advertising to lower the number of complaints on this subject and give physicians a higher comfort level for
this aspect of their business.
Create a statewide privately operated impairment diversion program to take needless burden off the agency and to make impaired
doctors more likely to seek help without fear of disciplinary action.
Allow defense attorneys, defendant physicians and license applicants a special right of access to their respective files so that they
can properly and thoroughly present their cases. It is a basic legal right for the accused to face their accuser(s) in legal
proceedings against them.
Establish an Open Records and Open Meetings monitor from the public to oversee and report on open government issues of the
Texas Medical Board. Establish a statute of limitations on certain types of cases such as record-keeping and minor violations, but
not on more serious matters which involve criminal activity. Establish a legislative mechanism for oversight of the Texas
Medical Board Executive Director such as confirmation by the Senate at the first opportunity.
RESOLUTION 08-05
POST GRADUATE STIPENDS
WHEREAS, Texas osteopathic physicians are confronted by serious issues as they enter the new millennium, therefore
BE IT RESOLVED, that TOMA affirms its support in maintaining and enhancing the quality of teaching programs, and also
urges teaching hospitals to pay competitive stipends for post graduate training.
RESOLUTION 00-33 revised & reaffirmed 05, reaffirmed 10
PRE-CERTIFICATION OF PRE-TERM AND RESCUE DRUGS
WHEREAS, the physicians of the Texas Osteopathic Medical Association are extremely concerned that the Texas Health and
Human Services Commission’s Pharmacy and Therapeutics Committee is requiring that the pre-term labor medications, diabetic
and rescue medicines be pre-certified prior to dispensing; and
WHEREAS, these medicines must be administered on an emergency basis in order to prevent pre-term labor and other morbidity
and mortality outcomes; therefore
BE IT RESOLVED, that the TOMA House of Delegates goes on record demanding that
the Texas Health and Human Services Commission’s Pharmacy and Therapeutics Committee reconsider and reverse their
decision to require pre-certification of pre-term labor prevention medications, diabetic and rescue medicines for the health of the
patients of the State of Texas; and
BE IT FURTHER RESOLVED, that the TOMA House of Delegates asks the physician members of TOMA to consider
contacting their Texas Senator and Representative as soon as possible regarding this issue.
33
RESOLUTION 04-15 reaffirmed 09
PRESCRIBING PHARMACISTS
WHEREAS, there is a trend on the part of organized pharmacists to secure prescribing privileges of non-prescription drugs; and
WHEREAS, pharmacists do not possess training adequate to permit them to manage the many complexities of multi-system
diseases; and
WHEREAS, the practice of pharmacists "diagnosing and treating" illnesses could delay needed medical treatment thereby
endangering the patient's health; and
WHEREAS, the present physician-pharmacist relationship is a good and acceptable system; therefore
BE IT RESOLVED, that the Texas Osteopathic Medical Association vigorously oppose any legislation or regulation which
would grant prescribing privileges to pharmacists.
RESOLUTION 02-23 reaffirmed 07
PRESCRIPTIONS FOR PSYCHOTROPIC MEDICATIONS BY PSYCHOLOGISTS
WHEREAS, many patients who receive therapy from psychologists are also taking one or more
prescription drugs; and
WHEREAS, psychotropic medications have many drug interactions and adverse reactions; and
WHEREAS, physicians have the appropriate training to recognize and deal with drug interactions and multiple disease processes;
now therefore
BE IT RESOLVED, that the TOMA House of Delegates is opposed to all legislation that would grant prescription authority to
psychologists; and
BE IT FURTHER RESOLVED,that this resolution be forwarded to the American Osteopathic Association House of Delegates
for action at the federal level.
RESOLUTION 06-08; reaffirmed 11
PROFESSIONAL LIABILITY INSURANCE
WHEREAS, the high cost and limited availability of professional liability insurance is forcing some physicians to stop offering
higher-risk services or to leave Texas in search of lower premiums, and
WHEREAS, this will ultimately compromise the availability and quality of healthcare services in various regions of Texas, and
WHEREAS, it is important to help Texas get effective tort reform and to work to get a nationwide federal tort reform law passed,
and
WHEREAS, it is also important to not let new theories circumvent existing Texas law governing medical practice, therefore
BE IT RESOLVED, that the Texas Osteopathic Medical Association House of Delegates calls upon the Texas Legislature to
continue to make effective tort reform a high priority.
RESOLUTION 00-05 revised & reaffirmed 05, reaffirmed 10
PROMPT PAY LEGISLATION
WHEREAS, physicians who accept insurance for reimbursement purposes are entitled to prompt payment of “clean claims”
submitted to insurers within a reasonable time frame (45 days), and
WHEREAS, physicians have overhead expenses that must be paid on a daily or weekly basis and cannot afford to subsidize
insurers by waiting for prolonged periods of time to get reimbursed, therefore
BE IT RESOLVED, that the Texas Osteopathic Medical Association House of Delegates urges the Texas Legislature, the
Governor of Texas, and the Texas Insurance Commissioner in the strongest possible terms to pass and implement Prompt Pay
Legislation in Texas that includes appropriate fines, maximum allowable interest, and penalties for non-compliance by insurers.
RESOLUTION 02-06 reaffirmed 07
PROMPT PAY L EGISLATION TO INCLUDE MEDICAID PROGRAMS
WHEREAS, Medicaid currently reimburses at lower rates than private insurance; and
WHEREAS, the only advantage to a physician to take Medicaid patients is if the state’s prompt pay requirements apply to those
patients; and
WHEREAS, if Medicaid does not promptly pay a claim and it is not subject to penalties from prompt pay legislation, Medicaid
can hold monies indefinitely; and
WHEREAS, prompt pay requirements would increase physician participation in the Medicaid program; now therefore
BE IT RESOLVED, that the Texas Osteopathic Medical Association House of Delegates work to ensure that prompt pay
legislation already in effect include state Medicaid programs so that if a physician files a clean claim and the state does not pay
promptly the state is subject to paying the physician interest on the past-due claim, thereby encouraging more physicians to
accept Medicaid.
RESOLUTION 11-15
PROPER NUTRITION IN TEXAS SCHOOLS
WHEREAS, proper nutrition is an important key to the prevention of chronic health problems, and
WHEREAS, the practice and teaching of proper nutrition should begin at an early age, and,
WHEREAS, Texas children require nutritional food to attain and maintain healthy bodies and minds so they can achieve their full
potential in life, therefore
BE IT RESOLVED, that the TOMA House of Delegates calls upon the State of Texas to provide instruction in proper nutrition to
all Texas students, and
BE IT FURTHER RESOLVED, that Texas schools be required to prepare nutritional, well-balanced, and healthful school meals.
34
RESOLUTION 03-21 reaffirmed 08
PROTECTION FOR FREQUENT BLOOD DONORS FROM DEPLETION OF IRON
WHEREAS, frequent blood donors are at risk of depletion of iron stores; and
WHEREAS, depletion of iron stores could lead to serious health risks; and
WHEREAS, Hgb/Hct tests do not necessarily reflect depletion of iron stores; now therefore
BE IT RESOLVED, that the TOMA House of Delegates encourages blood banks to establish guidelines to identify frequent
blood donors, and institute the necessary testing to monitor their blood iron stores; and
BE IT FURTHER RESOLVED, that this resolution be forwarded to the American Osteopathic Association House of Delegates
for action at the federal level.
RESOLUTION 06-09; reaffirmed 11
QUALITY MEDICAL CARE FOR THE MEDICARE POPULATION OF THE U.S.
WHEREAS, the number of individuals in the United States eligible for Medicare is growing exponentially; and
WHEREAS, individuals sixty five years of age and older are living longer; and
WHEREAS, as the population ages, their need for medical care increases; and
WHEREAS, Congress continues to address the issue of payments to physicians providing care to Medicare patients by
proposing cuts and then postponing them as evidenced by the recent proposed 21% cut in Medicare payments that was
postponed; and
WHEREAS, this lack of a comprehensive plan to fund Medicare could lead to a shortage of physicians willing to provide
Medicare services which would adversely affect the quality of medical care provided to Medicare recipients; now therefore
BE IT RESOLVED, that the Texas Osteopathic Medical Association supports a comprehensive approach to Medicare funding
that includes the following provisions:
1) Authorize payments to physicians treating Medicare patients that allow them to provide quality healthcare, cover their
costs, and make a reasonable profit
2) Establish payment rates so that physicians will be able to provide continuing medical care to their Medicare patients
3) Anticipate and plan for the increasing numbers of individuals who will be utilizing Medicare as the population of the US
continues to grow and age
4) Ensure that the highest quality healthcare will continue to be made available to Medicare recipients; and
BE IT FURTHER RESOLVED, that this resolution be forwarded to the American Osteopathic Association for their
consideration.
RESOLUTION 10-05
RECOMMENDATIONS FOR IMPROVING PHYSICIAN SUPPLY IN RURAL TEXAS
WHEREAS, the Texas Osteopathic Medical Association is committed to providing the highest quality healthcare for citizens of
Texas living in rural areas; and
WHEREAS, the Texas College of Osteopathic Medicine has an Office of Rural Medical Education committed to preparing
students for future practice in Rural Texas, and
WHEREAS, the Texas Medical Association (TMA) Committee on Physician Distribution and Health Care Access has developed
recommendations for Rural Physician Workforce Policy; and
WHEREAS, the TOMA Rural Health Committee (TOMA RHC) has reviewed these “recommendations for improving the
physician supply in rural Texas”; now therefore
BE IT RESOLVED, that the Texas Osteopathic Medical Association House of Delegates supports the TMA Committee on
Physician Distribution and Health Care Access report “Recommendations for Improving Physician Supply in Rural Texas, 2011”
(Report attached) and the 25 specific recommendations listed; and
BE IT FURTHER RESOLVED, that this resolution be forwarded to the American Osteopathic Association for possible adoption
of the recommendations in an effort to improve rural physician supply.
RESOLUTION 11-01
REDUCING STRESS IN CHILDREN AND ADOLESCENTS
WHEREAS, Texas osteopathic physicians are very concerned with the negative impact that stress has on health and wellness;
and
WHEREAS, there are many events that contribute to increased stress in families such as the War on Terror, economic downturn,
divorce, loss of home, loss of job, etc.; and
WHEREAS, there are healthy ways for families to improve their emotional well-being; therefore
BE IT RESOLVED, that the Texas Osteopathic Medical Association’s House of Delegates goes on record supporting activities
that prevent family stress and promote health and well-being such as, but not limited to: family reading, home cooking,
gardening as a family, participating in the youth organizations; participation in community activities to help provide a safe place
after school for children and adolescents; and, participation in family-centered indoor and outdoor games and activities.
RESOLUTION 03-06 reaffirmed 08
RE-INTRODUCTION OF NUTRITION AND HEALTHY CHOICES FOR BETTER HEALTH IN PUBLIC SCHOOLS
WHEREAS, childhood obesity is increasing at an alarming rate in the United States; and
WHEREAS, the adverse effects of poor choices versus healthy choices in nutrition along with a lack of exercise are contributing
to this increase in childhood obesity; and
WHEREAS, childhood obesity causes a number of health care problems; and
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WHEREAS, increased health care problems increase the cost of health care; now therefore
BE IT RESOLVED, that the Texas Osteopathic Medical Association recommends that all public schools be required to teach
nutrition and healthy choices in the class room.
RESOLUTION 10-07
REORGANIZATION OF TEXAS WORKERS’ COMPENSATION COMMISSION
WHEREAS, the Texas Legislature enacted HB 7 to reorganize the Texas Workers’ Compensation Commission under the Texas
Department of Insurance; and
WHEREAS, HB 7 was designed to both encourage more physicians to participate in Workers’ Commission and simplify the
process of treating injured workers in Texas; and
WHEREAS, many Osteopathic Physicians want to participate in treating the injured workers of Texas with respect and dignity;
now therefore
BE IT RESOLVED, that the Texas Osteopathic Medical Association requests the Texas Department of Insurance to provide the
leadership and manpower necessary to expedite the implementation of HB 7 to simplify the process of treating injured workers in
Texas; now therefore
BE IT RESOLVED, that the Texas Osteopathic Medical Association requests the Texas Department of Insurance to simplify the
process of treating injured workers in Texas.
RESOLUTION 07-07
REPORTING OF ILLEGAL IMMIGRANTS TO IMMIGRATION AND NATURALIZATION SERVICE
WHEREAS, provisions in two federal laws restrict preventive services and primary care to legal and illegal immigrants and
could result in health care providers reporting illegal immigrants to the Immigration and Naturalization Service (INS) for possible
deportation, and
WHEREAS, the Welfare Reform Act gives states greater discretion in denying Medicaid coverage to legal and illegal
immigrants, and
WHEREAS, contagious diseases do not discriminate between citizens and non-citizens, and
WHEREAS, physicians should be especially vigilant in states with high numbers of immigrants, and
WHEREAS, infectious diseases such as tuberculosis and measles are on the rise among this segment of the population, therefore.
BE IT RESOLVED, that the TOMA House of Delegates requests the AOA, through the Council on Federal Health Programs,
petition CMS to review and modify its rules and regulations to insure that physicians are indemnified and therefore not held
responsible to identify the legal resident status of any patient, and
BE IT FURTHER RESOLVED, that the TOMA House of Delegates requests the AOA, through the Council on Federal Health
Programs, petition CMS to place the interests of U.S. public health as the primary consideration in determining who receives
health care services.
RESOLUTION 02-24 reaffirmed 07
REIMBURSEMENT FOR COLORECTAL CANCER SCREENING
WHEREAS, colorectal cancer (CRC) is the second leading cause of cancer deaths in the United States, and
WHEREAS, CRC affects women and men with equal frequency, and
WHEREAS, CRC is one of the most preventable and curable types of cancer, when detected early, and
WHEREAS, as many as 25,000-30,000 lives would be saved each year if men and women age 50 years and older (those at
average risk for developing the disease) were screened annually for CRC, therefore
BE IT RESOLVED, that the TOMA House of Delegates recommends that it be mandated by law that all private payers should
join Medicare in reimbursing for CRC screening.
RESOLUTION 03-43 reaffirmed 08
RESIDENCY PROGRAMS IN NON-HOSPITAL SETTINGS
WHEREAS: The current residency slots are not enough to allow our Osteopathic physicians to stay in the states in which they
have trained, and
WHEREAS: Many of our graduating physicians are forced to seek non-Osteopathic residency slots, and
WHEREAS: Many of these graduates will do out-patient practice only, and
WHEREAS: Our current residency programs provide both out patient and hospital training, therefore
BE IT RESOLVED: That Texas Osteopathic Medical Association recommends the immediate exploration of out-patient
residency programs for our Primary Care Physicians.
RESOLUTION 11-29
RESPONSE TO PROPOSED AOA BYLAWS CHANGE ALTERING THE COMPOSITION OF STUDENT
REPRESENTATION AT THE AOA HOUSE OF DELEGATES
WHEREAS, the Student Osteopathic Medical Association (SOMA) has presented a resolution that has been referred to the AOA
Committee on Constitution and Bylaws calling for a Bylaws change in Article V, Section 10 mandating that the student
representatives to the AOA House of Delegates would “alternate between the president of the school’s SOMA chapter and the
Student Government president, one of whom will serve as a delegate, with the other serving as the alternate delegate”; and
WHEREAS, currently this section of the Bylaws defines that students are to be represented by “the student council’s president
and such president’s alternate elected by such student council” – a provision that does not exclude SOMA leadership; and
36
WHEREAS, the proposed Bylaws change would no longer allow TOMA student representatives to serve as student delegates at
the AOA House of Delegates; and
WHEREAS, SOMA student delegates voting alike as a singular entity, as some SOMA officers have indicated they will do if the
Bylaws change is adopted, do not represent a particular state or osteopathic medical school, and thus create an imbalance in the
democratic system present in the AOA House of Delegates; and
WHEREAS, SOMA is already represented in the AOA House of Delegates by one member of the SOMA Board, in a fashion
similar to that of the specialty colleges; and
WHEREAS, that approving the proposed Bylaws change will create an inequitable voting environment at the AOA House of
Delegates in which SOMA, a student organization, would be able to exert undue voting influence that may or may not represent
the best interest of the various states and their respective medical schools; and
BE IT FURTHER RESOLVED, that the TOMA House of Delegates recommends opposition to the SOMA proposed bylaw
change to the AOA, and that TOMA supports the current bylaw structures.
RESOLUTION 06-16; reaffirmed 11
RESTORE FUNDING FOR STATEWIDE PRECEPTORSHIP PROGRAM
WHEREAS, primary care (internal medicine, family medicine and pediatrics) is the foundation for healthcare delivery in the
State of Texas; and
WHEREAS, Texas has an acute and chronic shortage of primary care physicians in the state (23 counties in Texas have no
doctor); and
WHEREAS, the Texas Higher Education Coordinating Board has legislative oversight for funding preceptorship programs to
interest medical students early in their studies in becoming primary care physicians. Many students travel from their medical
school for a month and must stay in another town. There are many great opportunities to learn from a physician in a small town;
and
WHEREAS, statistics from the National Center for the Analysis of Healthcare Data (NCAHD) in 2009 show that for osteopathic
physicians in Texas 54% are in primary care, 14% are in a rural county, and 24% are in medically underserved areas; and
WHEREAS, these programs have a proven track record of success in recruiting students to become primary care physicians; and
WHEREAS, recent empirical research has shown participation in the Texas Statewide Family Practice Preceptorship Program
(TSFPPP) was associated with an increased choice of a family practice residency as well as a 44% increase in preceptors willing
to teach medical students; now therefore
BE IT RESOLVED, that the Texas Osteopathic Medical Association House of Delegates strongly encourages the Texas
Legislature to continue funding for the Statewide Preceptorship program and to restore to its pre-2003 level of $2 million to
ensure the program continues to produce high quality primary care physicians for Texas.
RESOLUTION 11-17
“ROLL OF HONOR” FOR TOMA’S HOUSE OF DELEGATES WITH
20 YEARS OR MORE OF SERVICE
WHEREAS, it is appropriate to honor those osteopathic physicians with 20 or more years of service in the TOMA House of
Delegates, and
WHEREAS, the nominations for this “Roll of Honor” should come from the appropriate TOMA District, and
WHEREAS, if the terms of service were divided between different districts, the last district in which the nominee served as a
delegate would be the district listed, and
WHEREAS, the “Roll of Honor” should be prominently displayed on viewing screens during all TOMA House of Delegates
meetings so that current delegates can view them, therefore
BE IT RESOLVED, that the TOMA House of Delegates authorizes its Speaker to appoint an Ad Hoc Committee of the House to
handle the administrative duties associated with the development and periodic updating of a “Roll of Honor” for osteopathic
physicians with 20 or more years of service in the TOMA House of Delegates.
RESOLUTION 02-14 reaffirmed 07
SCHOOL COUNSELING FOR “AT RISK” STUDENTS
WHEREAS, the State of Texas spends large sums of money on the building and maintenance of its penal institutions, and
WHEREAS, in many respects, funds could be utilized for crime prevention programs rather than for incarceration of criminals,
and
WHEREAS, some criminal behavior begins at a very early age and is preventable if identified and treated in the early stages,
therefore
BE IT RESOLVED, that the TOMA House of Delegates calls upon the State of Texas to increase the funding for school
counseling programs designed to identify “at-risk” Texas students to help prevent development of criminal behavior.
RESOLUTION 03-22 reaffirmed 08
SCOPE OF PRACTICE
WHEREAS, legislation to expand the practice of limited-license practitioners is routinely considered by the Texas Legislature,
and
WHEREAS, the main thrust of such legislation is to broaden these limited-license practitioners legally authorized scope of
practice beyond their formal education and clinical experience, therefore
BE IT RESOLVED, the TOMA House of Delegates opposes expanding the scope of practice of non-physician clinicians without
the benefit of an osteopathic or allopathic degree, including but not limited to: (1) Chiropractors seeking prescriptive authority,
hospital privileges and ability to perform invasive diagnostic procedures; (2) Acupuncturists seeking independent practice and
37
prescriptive authority; (3) Lay midwives seeking licensure; (4) Medical laboratory technologists seeking licensure and requesting
authority to supervise pathology labs; (5) Physical therapists seeking direct access to patients without physician referral; (6)
Physical therapists seeking to perform spinal manipulation; (7) Naturopathic practitioners seeking designation as physicians and
separate licensure status; and (8) Psychologists seeking prescriptive authority.
RESOLUTION 01-05 revised & reaffirmed 06; reaffirmed 11
SELECTION PROCESS FOR NEW OSTEOPATHIC MEDICAL STUDENTS FOR THE UNIVERSITY OF NORTH
TEXAS HEALTH SCIENCE CENTER, TEXAS COLLEGE OF OSTEOPATHIC MEDICINE
WHEREAS, the state charter for the University of North Texas Health Science Center/Texas College of Osteopathic Medicine
(TCOM) dictates the emphasis of osteopathic medical education to be for the promotion and graduation of osteopathic physicians
with emphasis on primary care, and
WHEREAS, osteopathic medicine has traditionally provided primary care for patients and the majority of TCOM graduates go
into primary care, and
WHEREAS, no one understands better the demands of being an osteopathic physician than a practicing osteopathic physician;
and thus osteopathic physician recommendations concerning possible new osteopathic medical students should be considered,
and
WHEREAS, because of the continued, dedicated support of Texas osteopathic physicians, who participate in helping to educate
osteopathic medical students in their extern rotations, preceptorships, internships and residencies, the Texas College of
Osteopathic Medicine has continued to grow and prosper, and
WHEREAS, the osteopathic physicians of Texas, wish to continue to be able to support, and be proud of our osteopathic medical
school, the Texas College of Osteopathic Medicine, therefore
BE IT RESOLVED, that the osteopathic physicians of the Texas Osteopathic Medical Association request and encourage both
the University of North Texas Health Science Center/Texas College of Osteopathic Medicine's Administration and Admission
Committee to give consideration to the letters of recommendation from osteopathic physicians, in the selection process for entry
into the freshman class at TCOM.
RESOLUTION 01-33 reaffirmed 06; reaffirmed 11
SENIOR PRESCRIPTION DRUG DISCOUNTS
WHEREAS, some pharmaceutical companies currently offer low-income senior citizen discounts on their prescription drugs, and
WHEREAS, these senior citizen discounts are based on income limits and charge seniors a modest co-payment, and
WHEREAS, many seniors have no drug coverage at all, and
WHEREAS, Congress has not passed a prescription drug proposal for seniors yet, therefore
BE IT RESOLVED, that the Texas Osteopathic Medical Association House of Delegates supports pharmaceutical company
programs that provide senior citizens with discounts on prescription drugs for a modest co-payment
RESOLUTION 02-07 revised & reaffirmed 07
SMOKING BAN LEGISLATION
WHEREAS, secondhand smoke is a serious health hazard costing taxpayers, employers and consumers millions of dollars
annually in Texas; and
WHEREAS, a statewide comprehensive ban on smoking in the workplace and other public places would result in enormous
savings in reduced costs for smoking-related illnesses such as lung cancer, stroke, cardiovascular and respiratory diseases; now
therefore
BE IT RESOLVED, that the Texas Osteopathic Medical Association House of Delegates supports the following bills proposed to
the Eighty-Second Texas Legislature; House Bill 670 by Crownover and Senate Bill 355 by Ellis/Van de Putte relating to
elimination of smoking in certain workplaces and public places, providing penalties.
RESOLUTION 11-05
SPECIALTY GRADUATE MEDICAL EDUCATION PROGRAMS EMPHASIZING AWAY ROTATIONS
WHEREAS, in applying for a rotation out-of-state and the extensive process involved in its coordination, the applicant implies a
vested interest in the pursuit of furthering his or her medical education and career in that area; and
WHEREAS, the average medical student debt of 2010 graduates was $157,944 and has been increasing every year
http://www.ama-assn.org/ama/pub/about-ama/our-people/member-groups-sections/medical-student-section/advocacypolicy/medical-student-debt.shtml; and
WHEREAS, away rotations being required to be considered for specialty programs creates an unnecessary step in the process of
qualified applicants. Doing away with such a requirement will allow for uniformity in the application and match program, which
in turn will better the overall matching processing; and
WHEREAS, many TCOM students believe they must have an audition rotation to receive an interview at an osteopathic
residency program; and
WHEREAS, the cost of an away rotation is expensive and the student could spend his/her elective months in an away rotation
without receiving an invitation to an interview with a residency program; and
WHEREAS, the current economic climate does not provide adequate resources of either time or money for medical students to
incur such risk without the invitation of an interview; and
WHEREAS, fourth year undergraduate medical students are allowed four elective (“audition”) rotation months during the fall
semester of the fourth year of school before residency application deadline…
38
http://www.hsc.unt.edu/departments/ClinicEd/YearFour.htm; and
WHEREAS certain specialty rotations require that students pay a fee in order to rotate at that particular site which students may
not be able to afford, eliminating the possibility of the residency program considering those students for acceptance; and
WHEREAS, the time invested in traveling out-of-state requires the sacrifice both of academic time and time invested in
additional interviews, to the degree that the certainty afforded against acceptance if the student has not completed an away
rotation immediately devalues that sacrifice; and.
WHEREAS, TCOM students are only given seven elective months during their clerkship years; now therefore
BE IT RESOLVED, that the Texas Osteopathic Medical Association House of Delegates encourages American Association of
Colleges of Osteopathic Medicine to research the medical student assumption that specialty residency programs emphasize
“away rotations” before extending an interview opportunity for acceptance.
RESOLUTION 11-12
STATE JURISDICTION OVER ERISA PLANS
WHEREAS, over two dozen state medical and osteopathic associations are pursuing state legislation that would impose
proportionate liability on managed care organizations when their medical necessity decisions negligently injure a patient; and
WHEREAS, Texas has enacted such a statute; and
WHEREAS, Aetna Insurance Company of Texas challenged the legality of the Texas statute in court, alleging federal preemption
under the Employee Retirement Income Security Act (ERISA) of 1974 as amended and challenges of similar statutes passed by
other states are inevitable; and
WHEREAS, case law from federal court decisions has recognized the traditional authority of states to regulate the quality of
medical care services provided to their respective citizens; and
WHEREAS, the original authors of ERISA never intended to preempt state laws, nor could they have anticipated, in 1974, the
emergence of managed care as a predominant mode of health care delivery in the private sector; and
WHEREAS, federal legislation has been filed by several members of Congress which would clarify emerging case law to assure
that states retain jurisdiction over the quality of medical care provided to their citizens; and
WHEREAS, federal legislation would have rendered the Texas vs. Aetna challenge moot, as well as subsequent litigation in the
many other states pursuing similar state legislation; therefore
BE IT RESOLVED, that the Texas Osteopathic Medical Association House of Delegates formally supports federal legislation to
accomplish changes to the Employee Retirement Income Security Act (ERISA) of 1974, as amended, providing that ERISA does
not preempt a state’s jurisdiction over the quality of medical services delivered to its citizens when the state regulates managed
care organizations making medical necessity decisions for covered medical services.
RESOLUTION 04-18 reaffirmed 09
STATE OF TEXAS EDUCATION CODE PROHIBITING THE UNIVERSITY OF NORTH TEXAS FROM
GRANTING AN MD DEGREE
Whereas the following is a preamble:
Preamble
A review of the events at the UNTHSC-Ft. Worth/Texas College of Osteopathic Medicine since December of 2008 has caused
much confusion as osteopathic physicians contemplate the past 34 years of their medical career and the future at hand. This
contemplation has taken many turns that will be shared in the hopes that should allow some clarity of thought. First, one should
review the history of the state of the osteopathic profession, the Texas College of Osteopathic Medicine and the current state of
affairs.
In 1899, A. T. Still, MD/DO published The Philosophy of Osteopathy where he discussed his rationale for creating a school of
medicine that was distinctive, complete and superior to the currently accepted standards of medical practice. He based his
philosophy on self evident truths and laws of nature:
TRUTHS OF NATURE
“We often speak of truth. We say great truths, and use many other qualifying expressions. But no one truth is greater than any
other truth. Each has a sphere of usefulness peculiar to itself. Thus we should treat with respect and reverence all truths, great
and small. A truth is the complete work of nature, which can only be demonstrated by the vital principle belonging to that class
of truths. Each truth or division as we see it, can only be made known to us by the self evident fact, which this truth is able to
demonstrate by its action.
If we take man as our object to base the beginning of our reason, we find the association of many elements, which differ in
kind to suit the purpose for which they were designed. To us they act, to us they are wisely formed and located for the purpose
for which they were designed. Through our five senses we deal with the material body. It has action. That we observe by vision
which connects the mind to reason. High above the five senses on the subject of cause or causes of this, is motion. By the
testimony of the witness the mind is connected in a manner by which it can reason on solidity and size. By smell, taste and
sound, we make other connections between the chambers of reason and the object we desire to reason upon; and thus our
foundation on which all five witnesses are arrayed to the superior principle which is mind.
After seeing a human being complete in form, self moving, with power to stop or go on at will, to us he seems to obey some
commander. He seems to go so far and stop; he lies down and gets up; he turns round and faces the objects that are traveling in
the same direction he does. Possibly he faces the object by his own action. Then by about facing, he sees one coming with
greater velocity, sees he cannot escape by his own speed, so he steps aside and lets that body pass on, as though he moved in
obedience to some order. The bystander would ask the question, "How did he know such a dangerous body was approaching?"
He finds on the most crucial examination, that the sense of hearing is wholly without reason. The same is true with all the five
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senses pertaining to man, beast, or bird. This being the condition of the five physical senses, we are forced by reason to conclude
there is a superior being who conducts the material man, sustains, supports and guards against danger; and after all our
explorations, we have to decide that man is triune when complete.
BODY, MOTION AND MIND.
First the material body, second the spiritual being, third a being of mind which is far superior to all vital motions and material
forms, whose duty is to wisely manage this great engine of life. This great principle known as mind, must depend for all
evidences on the five senses, and on this testimony, all mental conclusions are bad, and all orders from this mental court are
issued to move to any point or stop at any place. Thus to obtain good results, we must blend ourselves with, and travel in
harmony with nature's truths. When this great machine man, ceases to move in all its parts, which we call death, the explorer’s
knife discovers no mind, no motion. He simply finds formulated matter with no motor to move it, with no mind to direct it. He
can trace the channels through which the fluids have circulated, he can find the relation of parts to other parts; in fact by the
knife, he can expose to view the whole machinery that once was wisely active. Suppose the explorer is able to add the one
principle motion, at once we would see an action but it would be a confused action. Still he is not the man desired to be
produced. There is one addition that is indispensable to control this active body, or machine, and that is mind. With that added
the whole machinery then works as man. The three when united in full action are able to exhibit the thing desired -- complete.
A.T Still, M.D. /D.O.
THE TEXAS COLLEGE OF OSTEOPATHIC MEDICINE
Founded in 1970, the Texas College of Osteopathic Medicine (TCOM) has emerged as one of the nation's leading osteopathic
medical schools. During this time, it has received both state and national recognition for its efforts to meet the demands of
underserved populations and excellence in education.
Quality Education, Research, Patient Care and Service
As the sole source of an osteopathic medical education for aspiring physicians and surgeons in Texas, the Texas College of
Osteopathic Medicine is unique among the state's nine medical schools. In its commitment to lead in training and service, the
Texas College of Osteopathic Medicine excels through its applications-based medical school curriculum, cutting-edge research,
quality patient care and outstanding student performance in both the classroom and in clinics.
From 2007-2008, the Texas College of Osteopathic Medicine’s students have posted the best performance record among all
osteopathic medical schools on their required physician licensure examinations.
Through UNT Health clinics, faculty members handle approximately 500,000 patient visits annually in area hospitals and
clinics.
The Texas College of Osteopathic Medicine is also home to the Osteopathic Research Center, a national research program
designed to study the clinical effectiveness of osteopathic manipulative medicine.
A Record of Service
Whether they are the only doctor serving a rural community or a specialist at a major medical center, the Texas College of
Osteopathic Medicine’s graduates distinguish themselves as leaders, teachers and scholars. With over 2,800 alumni to date,
approximately sixty-five percent of them practice primary care medicine (family practice, general internal medicine, pediatrics,
obstetrics and gynecology), helping reduce the shortage of physicians in Texas communities. In addition to primary care, alumni
also practice in over fifty specialties such as aerospace medicine and vascular medicine. Recent alumni have excelled in some of
the nation's most demanding residency training programs by earning the position of chief resident.
History
The Texas College of Osteopathic Medicine reflects the traditions, philosophy and commitment to education excellence
perpetuated in all programs at the UNT Health Science Center.
The Texas College of Osteopathic Medicine accepted its first students in 1970. In 1972, a relationship was forged that laid the
foundation for the medical school's eventual evolution into a health science center. The Texas College of Osteopathic Medicine,
then a privately funded school, contracted with North Texas State University (now the University of North Texas) in nearby
Denton to teach basic science courses to first- and second-year medical students. The Texas College of Osteopathic Medicine’s
first graduating class of 18 received their doctor of osteopathy (D.O.) degrees in 1974.
The successful collaboration between the two schools combined with the Texas College of Osteopathic Medicine’s
commitment to 'specializing' in the education of primary care physicians earned the confidence of state government leaders. In
1975, the Texas College of Osteopathic Medicine became a state-supported medical school (separate from the university) under
the jurisdiction of the University of North Texas Board of Regents.
In response to the Texas College of Osteopathic Medicine’s remarkable growth and its achievements in health care and
science, the Texas Legislature redesignated the medical school as a health science center in 1993. The Texas College of
Osteopathic Medicine became the cornerstone component, retaining its osteopathic identity and focus.
Since its founding, the Texas College of Osteopathic Medicine faculty have explored and taught the promotion of good health,
not just the treatment of disease, in the practice of medicine. Our students are encouraged to become family medicine or primary
care physicians (now in critical demand across America), although they are also trained in every specialty area. They practice in
communities where medical care is needed most, bring to their patients the unique benefits of osteopathic diagnosis and
treatment, and emphasize patient education, disease prevention, good nutrition and fitness. These are all ideals of the century-old
osteopathic tradition upon which the institution was founded.
So with this rich heritage, how does a profession arrive on the road to educational extinction in Texas? In the 1920’s the Texas
Medical Association vociferously attempted to kill osteopathy legislatively. The next 60 years were spent defending and
40
promoting osteopathic medicine so that 3 mandated osteopathic seats were ordered by the Texas legislature on the Texas Medical
Board (then known as the Texas State Board of Medical Examiners). This was done in recognition of the distinct and unique
aspects of practice of osteopathic medicine.
Since that time, many of the battles faced by the family of medicine in Texas were enjoined, side by side, by osteopaths and
allopaths culminating in the amending of the Texas Constitution changing the torts and awards process in the state judiciary.
This history may explain the changes that have taken place at the Texas College of Osteopathic Medicine as a reflection of
changing attitudes and loss of cultural identity. During its inception, the Texas College of Osteopathic Medicine positioned itself
as a premier institution creating family physicians for rural Texas. The curriculum was designed in that direction and rural
clinics were operated by the medical school to address immediate needs of the surrounding communities. This exposed students
to rural family practice, and many discovered joy in practicing in that environment. Rural family practice presents its own sets of
challenges that are unique and require special training in the judicious use of technology and the financial realities of rural Texas.
Starting in the mid-1980’s, some intrinsic and some extrinsic changes took place in the medical environment in Texas. The
advent of the Health Science Center was heralded by the legislature as an efficient mechanism of providing financing and
direction connecting medical schools with multidisciplinary institutions of higher education. The Texas College of Osteopathic
Medicine became part of the University of North Texas System as a Health Science Center. Importantly, the legislature sought to
insure the continuance of the unique training of osteopathic physicians by prohibiting the Regents from conferring an M.D.
degree to graduates. Founders Dr. Carl Everett, Dr. George Luibel and Dr. D.D. “Danny” Beyer started Texas College of
Osteopathic Medicine in 1966 during off-hours from their professional practices. In 1970, the first students joined the Texas
College of Osteopathic Medicine, which rented space in the hospital — known as the Fort Worth Osteopathic Hospital.
The Texas College of Osteopathic Medicine only held classes in the Fort Worth Osteopathic Hospital for a year, but students
and residents from the college continued to rotate through the hospital. The hospital itself had its beginnings in a mansion off
Summit Avenue and was originally called the Fisher Hospital, named after Dr. Roy Fisher, whose family lived on the second
floor. As the hospital grew, it was incorporated as the Fort Worth Osteopathic Hospital in 1946 and moved to an area off Camp
Bowie Boulevard. The Osteopathic Medical Center of Texas closed its doors in October 2004, and the Health Science Center
purchased the property from the group.
The growth of the medical school and its educational success blossomed in the late 1980’s. Numerous specialties represented
by osteopathic physicians from all over the country migrated to Fort Worth creating a multidisciplinary practice group that
potentially could have served an a reference resource for osteopathic physicians all over Texas.
It was during this time that the Texas College of Osteopathic Medicine broadened its primary focus outside of family practice
into virtually every field of specialty. The last decades of the 20th century showed unprecedented growth not only of the
osteopathic profession not only in Texas but nationally. An explosion of medical schools caused the profession to become a
victim of its own success. The postgraduate training opportunities in Texas dwindled with the closure of the hospital in Fort
Worth and graduate medical education sites declined dramatically statewide. Along with this developed a curious phenomenon.
While the Texas College of Osteopathic Medicine had been a stalwart supplier of rural family physicians, more students began to
enter specialty care. The term “primary care” was used to define the graduates, but it was clear that specialty and sub-specialties
were being included in that number. Rural Texans saw a vanishing of the “town doctor”. The healthcare access demon became a
true enemy of the populace.
It was in this environment, the UNT Board of Regents sanctioned a study group to determine the feasibility of granting an
allopathic degree at their Health Science Center. The reasons given for this were manifold, including expansion of undergraduate
clinical sites, opening of more local hospitals to postgraduate opportunities, and increase in research funding which ostensibly
would be unavailable to non-allopathic medical schools.
It would be a reasonable assumption that a new business plan for education of osteopathic students must be considered. The
Texas College of Osteopathic Medicine has a unique claim as a provider of family physicians for rural Texas. The focus of the
schools postgraduate programs remain firmly seated in Ft. Worth, Texas which is becoming a more competitive environment for
DO’s to train in.
The Texas College of Osteopathic Medicine must reclaim and re-identify its uniqueness as an osteopathic training site and
resist the me-too mentality of absorption into the allopathic mainstream. Finally, the Texas College of Osteopathic Medicine
must recognize that it is not Ft. Worth’s medical school – but rather it is Texas’ Osteopathic Medical School: a premier
institution of higher learning with a bright and vibrant future ahead of her, and
WHEREAS, the Texas legislature has recognized the unique aspects of an osteopathic institution by incorporating language into
the education code prohibiting the Board of Reagents of the University of North Texas from awarding an MD degree; and
WHEREAS, this stipulation has been in place since the inception of the Health Science Center, most recently re-confirmed in
2001; now therefore be it
RESOLVED, the Texas Osteopathic Medical Association goes on record to fully and unequivocally support the Texas Education
Code (Subchapter) 105.402 that prohibits the awarding of an M.D. degree by the Board of Reagents of the University of North
Texas; and be it further
RESOLVED, the Texas Osteopathic Medical Association opposed the use of any University of North Texas Health Science
Center facility, faculty, funds, or real property for the development or institution of an M.D. program.
RESOLUTION 09-11
STATE VACCINATION PROGRAM
WHEREAS, infections such as Pertussis can cause death in children, especially infants under six months of age; and
WHEREAS, infections such as Pertussis can be financially devastating for families; and
WHEREAS, infants may be infected by contact with adolescents and adults who have subclinical Pertussis because they are not
immune; now therefore be it
41
RESOLVED:that the Texas Osteopathic Medical Association requests that the American Osteopathic Association recommend
that the states make their vaccination programs available to all in close proximity to those at high risk for Pertussis and other
costly, devastating and communicable diseases.
RESOLUTION 09-10
STEROIDS
WHEREAS, Texas osteopathic physicians are very concerned over the health care risks of using anabolic steroids to enhance
athletic ability, and
WHEREAS, studies show that prolonged use of anabolic steroids could result in liver damage, impotence, sterility, virilism in
women, and premature bone maturation in juveniles, therefore
BE IT RESOLVED, that the TOMA House of Delegates censures the use of anabolic steroids, human chorionic gonadotropin,
and other hormones in athletes for non-medical purposes.
RESOLUTION 04-27 reaffirmed 09
STREAMLINING DUAL ACCREDITATION OF OSTEOPATHIC
AND ACGME INTERNSHIPS AND RESIDENCIES
WHEREAS, there are not enough osteopathic internships or residencies regionally or in total for training all the graduates of
osteopathic medical schools; and
WHEREAS, the AOA, though its Unity Campaign, has already expressed its intent to increase D. O. membership and
involvement within its various organizations by D. O.'s trained outside the osteopathic community; and
WHEREAS, the AOA has expressed its intent to increase residency slots, both by dual accreditation of ACGME residency
programs and the establishment of new accredited post-graduate training programs; and
WHEREAS, multiple fee and inspections are currently levied upon programs by various AOA approval agencies in order to
review the requesting program desiring osteopathic accreditation, therefore
BE IT RESOLVED, that the TOMA House of Delegates supports efforts to streamline the accreditation process and to remove
administrative and financial roadblocks to AOA approval of internship and residency programs, whether new or within existing
ACGME approved programs;
BE IT FURTHER RESOLVED, that the TOMA House of Delegates forward this resolution to the AOA House of Delegates for
its consideration and adoption.
RESOLUTION 01-27 reaffirmed 06; reaffirmed 11
SUPPORT FOR AN INCREASE IN OSTEOPATHIC RESIDENCY PROGRAMS IN TEXAS
WHEREAS, there is a large shortage of Graduate Medical Education (GME) slots in Texas forcing medical students to leave the
state after graduation, Why Texas Needs More Physicians”, http://www.texmed.org/template.aspx?id=5427; and
WHEREAS, there is a strong relationship between location of GME training and location of practice; and
WHEREAS, Texas ranks 45th in the nation in the number of physicians per population from the lack of an adequate number of
physicians as well as the needed types of specialists; and
WHEREAS, according to the AOA website there are only 23 Osteopathic residency programs in the state of Texas. If this
number were increased there would be more osteopathic physicians persuaded to practice in and thus help to better the state’s
physician deficit; and
WHEREAS, there are only 4 specialty osteopathic residency programs in Texas, http://opportunities.osteopathic.org/index.htm;
and;
WHEREAS, the most recent match data confirms that while osteopathic applicants have historically matched to Family Medicine
and Internal Medicine residency programs, there has been a statistically significant increase in interest in Obstetrics-Gynecology,
Pediatrics, Emergency Medicine, Anesthesiology, and Psychiatry. http://www.nrmp.org/data/resultsanddata2010.pdf; and
WHEREAS, according to a TMA study Texas will lose $200,000 of investment in each medical student who will move out of
state for residency training. http://www.texmed.org/template.aspx?id=17267; and
WHEREAS, according to a TMA and medical school survey 38 percent of Texas graduates who completed residencies outside
the state would have preferred to do that training in Texas if there had been slots in their specialty.
http://www.texmed.org/template.aspx?id=17267; and
WHEREAS, osteopathic programs such as those at Michigan State and Des Moines far surpass the number of opportunities for
D.O. residencies in specialties such as orthopedics, pediatrics, general surgery, etc. This discrepancy drives the necessity for
TCOM to augment the emphasis and number of specialty residencies it provides to its graduates
http://www.dmu.edu/com/do/strengths/resmatch_list/2008specialty.cfm; and
WHEREAS, there are 12 specialty residency programs in Texas as compared to 28 in New York, 16 in California, 18 in Illinois,
30 in Florida, and 43 in Pennsylvania… http://www.opportunities.osteopathic.org/search/search.cfm; and
WHEREAS, the single most important factor determining where a physician starts a practice is where they do their residency
because, doctors become familiar with the community where they train and
WHEREAS, physicians learn about the health care needs of that area, and, through networking, often find opportunities to
practice there; and
WHEREAS, the number of acceptances of osteopathic medical graduates to allopathic specialty residency positions have
increased nationwide from 1,024 to 1,444 within the past four years1, there are still only 11 osteopathic specialty residency
programs in Texas2. http://www.nrmp.org/data/resultsanddata2010.pdf,
http://opportunities.osteopathic.org/search/search_results.cfm?CFID=1732999&CFTOKEN=889d0d89a6666f51-9A911202E04C-9EE9-F9B129B3A19A897B&jsessionid=f0308af9066ce60ee5c183b2b221124664f1; and
42
WHEREAS, the current total of 66 approved residency positions in specialty areas (i.e excluding Family Medicine, Internal
Medicine, Pediatrics & OB/GYN) as recognized by the AOA fails to adequately match in proportion the current enrollment of
osteopathic students in the state of Texas; and;
WHEREAS, the State of Texas currently only offers four AOA specialty residency programs
http://www.opportunities.osteopathic.org/search/search_results.cfm?CFID=1719223&CFTOKEN=75ccf2a90adcb4b37D22307D-EB82-8241-100A265DC643BAB0&jsessionid=f030ca4e609daf5bdb1a7434571528592f57; now therefore
BE IT RESOLVED, that the Texas Osteopathic Medical Association House of Delegates encourages the Texas College of
Osteopathic Medicine to work diligently to increase the number of osteopathic residency positions in Texas.
RESOLUTION 11-11
SUPPORT FOR A PROPOSED NATIONAL RESIDENT MATCHING PROGRAM (NRMP) POLICY CHANGE
PREVENTING RESIDENCY TRAINING PROGRAMS TO FILL POSITIONS OUTSIDE THE MATCH FOR
GRADUATES OF OSTEOPATHIC MEDICAL SCHOOLS
WHEREAS, the current AOA Intern/Resident Registration Program requires that all participating programs not require
applicants to sign contracts, or require letters of commitment, or require applicants to submit ranking information to the
institution before the Match process; and
WHEREAS, Allopathic residency programs participating in the National Resident Matching Program may offer positions outside
of the Match to independent applicants (including graduates of osteopathic medical schools); and
WHEREAS, this practice by the NRMP places AOA programs at a significant disadvantage because top osteopathic applicants
are being offered pre-Match contracts by premier allopathic programs; now therefore
BE IT RESOLVED, that the Texas Osteopathic Medical Association House of Delegates encourages the American Osteopathic
Association to strongly support the proposed NRMP policy change removing the ability of participating NRMP programs to offer
pre-Match contracts to independent applicants (including graduates of osteopathic medical schools), thereby guaranteeing AOA
Residency programs a “level playing field”; and
BE IT FURTHER RESOLVED, that this be forwarded to the American Osteopathic Association for consideration.
RESOLUTION 11-07
SUPPORT FOR ALL EFFORTS TO INCREASE STATE FUNDING FOR GRADUATE MEDICAL EDUCDATION
WHEREAS, Texas has a shortage of physicians, ranking 43rd in a state comparison of physician to population ratios; and
WHEREAS, this shortage is expected to grow worse over the next decade; and
WHEREAS, Graduate Medical Education pipelines need to be expanded to better position the state for steep increases in
physician demand and adequate funding is needed to grow this pipeline; and
WHEREAS, Graduate Medical Education is growing more slowly than medical school enrollments which will force medical
school graduates to leave the state for GME; and
WHEREAS, Texas has 8% of the US population but only 6% of US physicians; and
WHEREAS, combined growth in the number of Texas residents as well as greater longevity of Texans is creating an everincreasing demand for physician services; and
WHEREAS, Texas medical school enrollments are projected to grow 30% by 2015 and GME is expanding at a much slower rate
than medical school enrollment; and
WHEREAS, losing medical students to other states has economic consequences, with a net loss to the state of more than
$200,000 in state funding for each graduate who leaves and does not return to practice in Texas; and
WHEREAS, Texas needs to expand the physician workforce and GME to improve access to care and to better position the state
for steep increases in physician demand; and
WHEREAS, ederal matching funds for programs such as Medicaid GME funding (a 40/60 state/federal match) have not been
maximized for Texas; and, in fact, the current state budget does not provide funding for the teaching hospital costs related to
GME; now therefore be it
RESOLVED, that the Texas Osteopathic Medical Association supports all efforts to restore and increase State of Texas funding
for all approved Graduate Medical Education programs including maximizing the Medicaid GME funding.
Data extracted from the 2009 Medical Education and Physician Workforce Consensus Statement for the 81 st State Legislature
RESOLUTION 09-01
SUPPORT FOR THE FORMATION OF HEALTH INSTITUTES OF TEXAS AT THE UNIVERSITY OF NORTH
TEXAS HEALTH SCIENCE CENTER
WHEREAS, good physical and mental health of the citizens of Texas is vital to their quality of life; and,
WHEREAS, the economic, educational, cultural and social success of the state of Texas depends upon the health and wellbeing
of its citizens; and,
WHEREAS, battling the current most important health issues negatively affecting the health of Texans requires a unique,
comprehensive approach through a combination of public health information and basic research, and using that information to
build new models of provider training and care delivery; and,
WHEREAS, promoting health care excellence for the people of Texas and advancing the philosophy and principles of
osteopathic medicine are two of the core missions of the Texas Osteopathic Medical Association; and,
WHEREAS, the Texas College of Osteopathic Medicine at the University of North Texas Health Science Center is ranked 28
among 145 medical schools in the nation for its innovative programs in primary care and rural medicine, thus promoting superior
health care suited to fit the unique needs of Texans; and,
43
WHEREAS, the University of North Texas Health Science Center combines highly regarded public health programs in health
surveillance, epidemiology, and health disparities with a research core that has the highest return on investment in the state of
Texas with a federal-to-state expenditure of 73 to 1; and,
WHEREAS, the University of North Texas Health Science Center practices an integrative model of research which preceded the
National Institutes of Health “roadmap” initiative mandating collaborative, interdisciplinary research; now therefore
BE IT RESOLVED, that the Texas Osteopathic Medical Association supports the concept of The Health Institutes of Texas, a
blending of three centers — The Texas Center for Health Outcomes, The Texas Center for Translational Research and The Texas
Center for Primary and Rural Care — which will combine the University of North Texas Health Science Center’s expertise in
public health, research, and primary care and rural medicine; and
BE IT FURTHER RESOLVED, that the Texas Osteopathic Medical Association supports the University of North Texas Health
Science Center’s efforts to form The Health Institutes of Texas and respectfully supports Texas Senate Bill 1248 to implement
The Health Institutes of Texas plan to provide the much-needed solutions for the health issues Texans face.
RESOLUTION 07-12
TAKE BACK LAWS
WHEREAS, Texas osteopathic physicians believe in a level playing field between physicians and insurers, and
WHEREAS, an insurer can request or demand money back from physicians for overpayment of a claim for an indefinite period
of time, therefore
BE IT RESOLVED, that Texas Osteopathic Medical Association House of Delegates calls upon the Texas Legislature to pass
legislation with wording stipulating that the insurance carrier’s appeal period that is applicable to the physician is also applicable
to the insurance carrier
RESOLUTION 02-08 revised & reaffirmed 07
TAX INCENTIVES FOR LONG TERM CARE COVERAGE
WHEREAS, Texas osteopathic physicians are very concerned over the financial burden facing millions of older Americans who
lack insurance protection for long-term care, and
WHEREAS, long-term care has become a key concern because nursing home costs are rising at a time when people are living
longer, often with chronic, debilitating diseases, and
WHEREAS, experts estimate that more than 20 percent of Americans older than 65 will spend some time in a nursing home,
therefore
BE IT RESOLVED, that the TOMA House of Delegates supports the concept of giving tax breaks to consumers who buy long
term care insurance.
RESOLUTION 03-35 reaffirmed 08
TELEPHONE PRESCRIPTIONS FOR CONTROLLED DRUGS
WHEREAS, Texas Osteopathic physicians are very concerned about abuse of controlled drugs; and
WHEREAS, people can acquire the DEA number of a physician and call in fraudulent prescriptions for controlled drugs; and
WHEREAS, sometimes the pharmacist cannot verify the controlled drug prescription; therefore
BE IT RESOLVED, that the TOMA House of Delegates encourages the State of Texas and local government agencies to
promote increased efforts by law enforcement agencies in curtaining the fraudulent telephone prescribing of controlled drugs.
RESOLUTION 04-01 reaffirmed 09
TERRY R. BOUCHER, M.P.H.
BE IT RESOLVED, that the TOMA House of Delegates goes on record thanking Terry R. Boucher, M.P.H., for his devotion and
selfless service to TOMA over the past thirteen years; and
BE IT FURTHER RESOLVED, that the TOMA House of Delegates takes great pride in bestowing the gift of TOMA Honorary
Life Membership to Terry R. Boucher, MPH, and wishes him continued success within the osteopathic family.
RESOLUTION 04-11 revised & reaffirmed 09
TEXAS ADOPTION OF FEDERATION OF STATE BOARDS REGULATION ON APPROPRIATE TREATMENT OF
PAIN
WHEREAS, the American Osteopathic Association has published a White Paper on the Federation of State Boards regulation on
appropriate treatment of pain; now therefore
BE IT RESOLVED, that the Texas Osteopathic Medical Association supports that White Paper and urges the Texas State Board
of Medical Examiners to adopt a similar regulation.
RESOLUTION 05-06, reaffirmed 10
TEXAS COLLEGE OF OSTEOPATHIC MEDICINE STUDENT POSITION REGARDING THE ADDITION OF AN
MD DEGREE TO UNTHSC
WHEREAS, the Medical Student Government Association (MSGA) Council of the Texas College of Osteopathic Medicine
(TCOM) is composed of elected representatives of each class of the TCOM; and
WHEREAS, the MSGA Council serves to represent the student body of TCOM; and
WHEREAS, the MSGA Council has made efforts to gather information from members of all classes at TCOM regarding the
issue of potentially adding an MD Degree to the degree offerings at the University of North Texas Health Science Center
(UNTHSC) via email communications, personal conversations with members of our individual classes and student town-hall
meetings as well as via review of the online survey results; and
44
WHEREAS, the majority of students state that there is no anticipated benefit to the TCOM, the community or the UNTHSC, but
there are multiple risks that outweigh any purported benefits from adding an MD degree to the UNTHSC; and
WHEREAS, the process of evaluating the feasibility of adding an MD degree to UNTHSC has been complicated by a sense of
distrust, secrecy and a lack of transparency surrounding the process of the study; now therefore, be it
RESOLVED, that the Medical Student Government Association (MSGA) Council of the Texas College of Osteopathic Medicine
(TCOM), in its capacity as the official representative body of all TCOM students, does hereby declare its opposition to any effort
by the University of North Texas Board of Regents, its Chancellor or the President of University of North Texas Health Science
Center (UNTHSC) to begin to offer the MD degree at the UNTHSC; and be it further,
RESOLVED, that the MSGA Council does hereby urge the UNT Board of Regents, the Chancellor of UNT and the President of
the UNTHSC to stop using the limited resources of the UNTHSC to study the feasibility of adding the MD degree to UNTHSC
and to use those resources to assure the future stability and continued success of TCOM as one of the nation’s top ten medical
schools by improving the quality of teaching staff at UNTHSC, improving its curriculum, securing 250 clinical rotation slots for
third and fourth year osteopathic medical students and using its political and financial influence to establish a relationship with an
area hospital as the primary teaching hospital for the TCOM; and be it further
RESOLVED, that the Medical Student Government Association (MSGA) Council does hereby urge the Board of Regents of the
University of North Texas (UNT), the Chancellor of UNT, and the President of the UNT Health Science Center to embrace the
osteopathic heritage of the UNTHSC and the Texas College of Osteopathic Medicine and to use the strengths of the school and
its strong record of academic excellence to promote its unique product to the community at large in order to better serve the
community, area hospitals, alumni and current and future students.
RESOLUTION 09-03
TEXAS DATABASE FOR PHYSICIANS
WHEREAS, the Texas Medical Board (TMB) is compiling a database on Texas physicians, and
WHEREAS, it is important that the citizens of Texas have information regarding the quality of medical care provided by
physicians in Texas, and
WHEREAS, the public’s right to know must be balanced with privacy issues, therefore
BE IT RESOLVED, that the TOMA House of Delegates goes on record urging the TMB to limit database access of confidential
information, only allowing the release of biographical and contact data, TMB actions taken against a physician, and the status of
the physician’s license
RESOLUTION 03-24 revised and reaffirmed 08
TEXAS-MEXICO PHARMACEUTICAL DRUG TRADE
WHEREAS, Texas osteopathic physicians are concerned about the Texas-Mexico pharmaceutical drug trade, and
WHEREAS, FDA regulations, enforced by Customs Service officers, allows United States residents to bring back over-thecounter purchases from Mexico as long as the drugs are for personal use, in their original packaging and in "reasonable
quantities", and
WHEREAS, drugs that do not have FDA approval for use in the United States or drugs that the FDA has deemed "fraudulent",
technically cannot be brought into this country, therefore
BE IT RESOLVED, that the TOMA House of Delegates calls on the DEA to automatically classify all drugs of abuse, that are
not FDA approved for use in the United States, as Schedule I drugs until such time that they have obtained FDA approval for use
in this country.
RESOLUTION 01-29 reaffirmed 06; reaffirmed 11
TEXAS OSTEOPATHIC MEDICAL ASSOCIATION HOUSE OF DELEGATES FORUM
WHEREAS, the delegates and alternates to the Texas Osteopathic Medical Association House of Delegates have issues that they
would like to discuss and debate with their fellow delegates and alternates, and
WHEREAS, the opportunity for informal group discussion of issues is limited by the formal proceedings of the Texas
Osteopathic Medical Association House of Delegates with its fixed agenda, and
WHEREAS, the lack of discussion of issues of concern to individual delegates and alternates to the Texas Osteopathic Medical
Association House of Delegates often results in frustration and apathy on the part of some participants, and
BE IT RESOLVED, that the Texas Osteopathic Medical Association House of Delegates directs the Texas Osteopathic Medical
Association Board of Trustees to establish a forum prior to each House of Delegates meeting where delegates and alternates can
meet, discuss, and debate issues of particular concern to individual osteopathic physicians in Texas.
RESOLUTION 04-16 reaffirmed 09
TEXAS OSTEOPATHIC MEDICAL ASSOCIATION OPPOSITION TO TEXAS COLLEGE OF OSTEOPATHIC
MEDICINE MD OPTION
WHEREAS, under the tenure of President Ronald Blanck, D.O. and Dean Marc Hahn, D.O. the quality of the academic program
at the Texas College of Osteopathic Medicine (TCOM) rose to the top of the profession by board scores alone, the class size
increased by 50 percent, and the number of applicants doubled; all signs that TCOM is an academic institution in great standing
and in alignment with the rest of the osteopathic profession; and
WHEREAS, over the years TCOM and the University of North Texas Health Science Center (UNTHSC) have enjoyed huge
growth in research funding, a fact corroborated by the current UNTHSC provost himself; and
WHEREAS, the acceptance of students and graduates of TCOM into area hospitals such as John Peter Smith, Plaza, Harris, and
Cook Children’s continues to improve; and
45
WHEREAS, during the short tenure of the current President of UNTHSC, TCOM has lost many excellent faculty members
including a number of recipients of the prestigious “Golden Apple” teaching award; and
WHEREAS, the University of North Texas and the President of UNTHSC/TCOM have initiated a study of the feasibility of
offering an MD degree at the school; and
WHEREAS, a study group organized by the Chancellor and the President of the UNTHSC has recommended further study and
development of details in a business plan for further consideration of this option, which has been directed by the Board of
Regents to be accomplished; and
WHEREAS, any need for such an MD degree in the UNT System remains undefined and of questionable validity; and
WHEREAS, many of the discussions concerning this proposal appear to be centered on: 1) a ‘need’ of Fort Worth to have such a
program; and 2) the desire of the UNT System to generate additional research dollars, both of which remain unsubstantiated; and
WHEREAS, State of Texas statutes prohibiting the UNT Board of Regents from awarding an MD degree are still in effect; and
WHEREAS, the creation of an MD degree at the UNTHSC would be detrimental to the growth and levels of excellence being
obtained by TCOM; and
WHEREAS, the creation of an MD degree at the UNTHSC would have a negative impact on TCOM’s ability to continue
providing a disproportionately higher share of well-trained primary care physicians for the State of Texas; and
WHEREAS, the rationale for creating the MD degree at the UNTHSC gives credence to those who believe only an MD degree
can be first-rate, despite all the evidence to the contrary; and
WHEREAS, the Board of Trustees of the TCOM Alumni Association has voted unanimously to issue a “Vote of No Confidence”
regarding the current president of the UNTHSC; and
WHEREAS, the storm of controversy created by the idea of creating the MD degree at UNTHSC has had a disruptive effect by
promoting:

concern, confusion, and low morale among students, faculty and staff at the institution

strained relations between the HSC and the alumni and osteopathic professional organizations

perceived or potential strained relations between and among allopathic and osteopathic physicians and organizations,
citizens of Fort Worth, and the UNT Chancellor and Board of Regents

a risk of TCOM not being able to fulfill its original mission; and
WHEREAS, the state and national osteopathic professional associations and their supporters are in agreement that such a concept
is ill-formed, untimely, and without demonstrated need; now therefore be it
RESOLVED, that the Texas Osteopathic Medical Association re-affirms its opposition to the development of an MD degree
program at the University of North Texas Health Science Center (UNTHSC) and its opposition to any change in the state statute
prohibiting the University of North Texas (UNT) Board of Regents from awarding an MD degree; and be it further
RESOLVED, that the Texas Osteopathic Medical Association states its strongest opposition to any effort
that would or could undermine the integrity, strength, and proven success of the Texas College of Osteopathic Medicine and its
proven track record in producing highly qualified primary care physicians for the entire State of Texas; and be it further
RESOLVED, that the Texas Osteopathic Medical Association calls upon all osteopathic physicians, supporters, patients, and the
public to join in this effort to oppose this proposal by every legitimate means possible; and be it further
RESOLVED, that the Texas Osteopathic Medical Association goes on record with a vote of “No Confidence” in the current
president of the University of North Texas Health Science Center and his efforts that threaten the mission of the Texas College of
Osteopathic Medicine and the contributions it makes to the osteopathic profession in the State of Texas.
For Reference:
Wording of the three resolutions passed by the TOMA Board in Dec. 2008:
XIV.
Proposals from Executive Session
MOTION
That the Texas Osteopathic Medical Association opposes the granting of an MD Degree by the University of North
Texas Board of Regents
SECONDED
APPROVED
MOTION
That the Texas Osteopathic Medical Association supports and re-affirms Texas statutes that prohibit the University of
North Texas System from awarding the MD Degree
SECONDED
APPROVED
MOTION
That the TOMA Board of Trustees appoint a task force to formulate an immediate course of action to address issues
affecting the osteopathic integrity of UNTHSC/TCOM including, but not limited to, the concept of granting the MD
degree by any entity of the University of North Texas System
SECONDED
APPROVED
RESOLUTION 09-16
TEXAS’ OSTEOPATHIC MEDICAL SCHOOL
WHEREAS, the Texas College of Osteopathic Medicine is the state’s only college of osteopathic medicine providing osteopathic
medical education; and
WHEREAS, graduates of the Texas College of Osteopathic Medicine have located throughout Texas, including rural and
underserved areas; now therefore be it
46
RESOLVED, that the Texas College of Osteopathic Medicine is Texas’ Osteopathic Medical School with a statewide reach and
statewide effect on the access to healthcare for all Texans.
RESOLUTION 09-12
TEXAS OSTEOPATHIC POSTDOCTORAL TRAINING INSTITUTION (OPTI)
WHEREAS, the Texas Osteopathic Postdoctoral Training Institution (OPTI) has not adequately provide sufficient post-graduate
slots within the state for its osteopathic post-graduates; and
WHEREAS, the OPTI has attempted to create dually accredited (AOA/ACGME) programs; and,
WHEREAS, osteopathic medical students do not occupy all available post-graduate slots, opting for allopathic training sites that
do not foster or recognize the unique aspects of osteopathic medical training; now therefore be it
RESOLVED, that the Texas Osteopathic Medical Association serve as a nationwide conduit for all Osteopathic Postgraduate
Training Institutions (OPTI’s) to enter Texas and develop osteopathic post-graduate opportunities; and be it further
RESOLVED,that the Texas Osteopathic Medical Association request placement on the agenda at the next National OPTI
Conference in San Antonio, Texas in 2010 for this purpose; and be it further
RESOLVED, that the Texas Osteopathic Medical Association help all OPTI’s in identifying potential new sites for education that
are solely accredited by the American Osteopathic Association.
RESOLUTION 09-13
TEXAS PHARMACISTS ELECTING TO REFUSE TO FILL CERTAIN PRESCRIPTIONS
WHEREAS, there is a debate among Texas pharmacists that weighs on personal morals against professional responsibility. It
pits pharmacists’ religious beliefs against patients’ needs and desires; and
WHEREAS, these two objectives may not be mutually exclusive. When a pharmacist has a moral or ethical dilemma with
dispensing any product, another pharmacist on duty can fill the prescription, the patient can be sent to a pharmacy that will
provide the therapy, or other mechanisms can be established; and
WHEREAS, the American Pharmacists Association adopted a policy calling for conscience protections, as long as the pharmacy
had an alternative system in place – another pharmacist on duty, for instance, or an agreement with a neighboring pharmacy; and
WHEREAS, in spite of the position of their own professional association, some pharmacists have refused to hand the prescription
to another druggist to fill; and
WHEREAS, in a conflict, the patient’ rights should receive great consideration; and
WHEREAS, the Texas Legislature has considered legislation which relates to the right to object to participation in an abortion
procedure or to the dispensing of an emergency contraceptive which uses language that would allow pharmacists to model their
relationship with the patient on the physician-patient relationship, which is not really professionally the same or appropriate; and
WHEREAS, the Texas Osteopathic Medical Association is concerned about proposed laws that give too much weight to either
the pharmacists’ concerns or the patients’ concerns, instead of creating a balance between both parties; now therefore
BE IT RESOLVED, that the TOMA House of Delegates supports patients’ access to their legally prescribed medications and also
supports the pharmacists’ right of conscience. That right of conscience comes with responsibility to assure patient access to the
legally prescribed therapy; and
BE IT FURTHER RESOLVED, that TOMA strongly urges pharmacists to comply with the policies established by their
professional association, and
BE IT STILL FURTHER RESOLVED, that TOMA believes that the pharmacy industry and applicable state laws should require
pharmacies to offer a timely, practical alternative, clearly post circumstances under which they make moral refusals, and that
licensed pharmacists should not be allowed to summarily deny customers access to legally prescribed medication solely on moral
grounds, in order that the health and safety of the patient may be assured and the physician-patient relationship be respected.
RESOLUTION 05-19, reaffirmed 10
TEXAS PHYSICIAN HEALTH PROGRAM
WHEREAS, the Texas Osteopathic Medical Association, working in conjunction with the Texas Medical Association, is
exploring the possibility of creating a statewide diversion program for Texas Physicians; and
WHEREAS, Texas Osteopathic Physicians could be referred for monitoring and rehabilitation, for either chemical or mental
impairment; and
WHEREAS, this proposed program, which would also be offered to those physicians who request advocacy on their own
initiative, should be able to offer a more standardized, and effective advocacy for Texas Osteopathic Physicians; and
WHEREAS, physicians in rural practice settings, where there is no active physician health program, would now have an effective
voluntary and confidential program available to them; and
WHEREAS, under this program, physicians would have a unique opportunity to come forward, and to obtain assistance for their
individual disabilities, without the stigma of a public disciplinary order by their licensing board; now therefore be it
RESOLVED, that the Texas Osteopathic Medical Association (TOMA) supports the formation of the Texas Physician Health
Program (working title)
Motion TOMA Board of Trustees meeting 9-13-2008.
RESOLUTION 09-15
THE IMPORTANCE OF OSTEOPATHIC MANIPULATIVE MEDICINE AND OTHER PREVENTIVE OPTIONS IN
THE TREATMENT OF FLU AND OTHER INFECTIONS
WHEREAS, Osteopathic Manipulative Medicine is a proven technique in the treatment of flu symptoms; and
47
WHEREAS, preventive measures (including but not limited to proper hygiene, eating fresh fruits and vegetables, taking vitamins,
and exercising regularly) that augment the immune system help the body fight off infections; and
WHEREAS, Osteopathic Physicians practice a “whole person” approach to health care including preventive care and treating the
body as an integrated whole; now therefore
BE IT RESOLVED, that the Texas Osteopathic Medical Association House of Delegates encourages all Texas Osteopathic
Physicians continue to incorporate Osteopathic Manipulative Medicine and preventive treatment options in the treatment of flu
and other infections in providing the best possible healthcare to their patients.
RESOLUTION 11-06
THIRD PARTY PAYORS CHANGING CLASSES OF MEDICATIONS
WHEREAS, many third party payors have a very restrictive formulary; and
WHEREAS, there are an increasing number of medications requiring prior authorization; and
WHEREAS, this takes an inordinate amount of time from the physician’s office to obtain prior authorizations; and
WHEREAS, many third party payors not only require switching of brands but of classes of medications; and
WHEREAS, changing of medications may be detrimental to the health of the patient; now therefore
BE IT RESOLVED, that the TOMA House of Delegates request TOMA to work with legislators to eliminate the practice of
insurance companies of requiring a change in class of medication, and decrease the “hassle factor” of prior authorization; and
BE IT FURTHER RESOLVED, that this resolution be forwarded to the AOA House of Delegates.
RESOLUTION 06-21; reaffirmed 11
TOBACCO-FREE COLLEGES OF OSTEOPATHIC MEDICINE
WHEREAS, tobacco is the leading cause of preventable illness and death in the United States, with cigarette smoking causing an
estimated 443,000 deaths each year, including approximately 49,400 deaths due to exposure to secondhand smoke; and
WHEREAS, lung cancer is the leading cause of cancer death among both men and women in the United States, and ninety
percent of lung cancer deaths among men and approximately eighty percent of lung cancer deaths among women are due to
smoking; and
WHEREAS, smoking causes numerous other types of cancer, including cancers of the throat, mouth, nasal cavity, esophagus,
stomach, pancreas, kidney, bladder, and cervix, and acute myeloid leukemia; and
WHEREAS, people who smoke are up to six times more likely to suffer a heart attack than nonsmokers, and the risk increases
with the number of cigarettes smoked; and
WHEREAS, smoking is the greatest risk factor for chronic obstructive pulmonary disease (COPD), with COPD being the fourth
leading cause of death in the United States. Twelve million U.S. adults are diagnosed with COPD, an additional twelve million
likely have the disease and do not know it, it is the only syndrome among the top 10 causes of death projected to increase in the
next decade, is expected to be the third leading cause of death by 2020, and there is no known cure for COPD: it is progressive
and irreversible; and
WHEREAS, every day in the United States, approximately 1,200 current and former smokers die prematurely from tobaccorelated diseases, almost 4,000 adolescents start smoking, $260 million is spent in direct medical costs related to smoking, the
nation experiences nearly $270 million in lost productivity due to premature deaths from tobacco-related diseases, and the
tobacco industry spends over $34 million to market and promote its products; and
WHEREAS, since 1964, more than thirty reports from the United States Surgeon General have outlined the harmful effects of
tobacco smoke, including the 2010 Report of the Surgeon General: How Tobacco Smoke Causes Disease concluding:
1. There is no safe level of exposure to tobacco smoke. Any exposure to tobacco smoke – even an occasional
cigarette or exposure to secondhand smoke – is harmful.
2. Damage from tobacco smoke is immediate.
3. Tobacco smoke contains more than 7,000 chemicals and chemical compounds, which reach your lungs every
time you inhale. Your blood then carries the poisons to all parts of your body. These poisons damage DNA,
which can lead to cancer; damage blood vessels and cause clotting, which can cause heart attacks and strokes;
and damage the lungs, which can cause asthma attacks, emphysema, and chronic bronchitis.
4. Smoking longer means more damage. Both the risk and the severity of many diseases caused by smoking are
directly related to how long the smoker has smoked and the number of cigarettes smoked per day.
5. Cigarettes are designed for addiction. Even low levels of exposure, including exposure to secondhand
tobacco smoke, are dangerous. There is no safe cigarette; and
WHEREAS, smoking cessation lowers the risk for lung and other types of cancer, reduces the risk for coronary heart disease,
stroke, peripheral vascular disease, COPD, respiratory symptoms, such as coughing, wheezing, and shortness of breath, the risk
for infertility in women during their reproductive years, and reduces the risk of having a low birth weight baby; and
WHEREAS, by establishing tobacco-free polices, colleges and businesses can reduce the health risks for all their employees,
including those who smoke. Both the elimination of second-hand smoke and the reduction in the amount of cigarettes consumed
by students and staff creates a healthier student body and workforce, which in turn can result in college’s paying less in workers’
compensation premiums, insurance payments, and health-related expenses; and
WHEREAS, passage of strong smoke-free policies can produce rapid and substantial benefits, such reduced acute myocardial
infarctions, and these benefits grow with time; and
WHEREAS, public appeal for osteopathic physicians is that DOs offer something special—their unique approach to patient care.
Osteopathic physicians are trained to teach patients how to prevent illness and injury by maintaining a healthy lifestyle; and
WHEREAS, smoking among osteopathic physicians limits their interventions with smokers and their involvement in tobacco
control. Smoking by osteopathic physicians poses a barrier to interventions with patients; and
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WHEREAS, each osteopathic physician sworn to the osteopathic oath pledges his/her commitment “To my college I will be loyal
and strive always for its best interests and for the interests of the students who will come after me. I will be ever alert to further
the application of basic biologic truths to the healing arts and to develop the principles of osteopathy that were first enunciated
by Andrew Taylor Still”. and
WHEREAS, today’s osteopathic medical students are tomorrow’s physicians, in which smoke-free colleges of osteopathic
medicine will support a smoke-free medical profession and workforce; and
WHEREAS, as the National Prevention Council discusses with the nation the important role of tobacco-free living in the firstever National Prevention Strategy An Unprecedented Opportunity to Improve the Nation’s Health through Prevention,1 the
osteopathic medical profession has both the opportunity and responsibility to serve as leaders and advocates of sound public
health policy on a national level; now, therefore,
BE IT RESOLVED, that the Texas Osteopathic Medical Association House of Delegates goes on record as supporting tobaccofree colleges of osteopathic medicine; and
BE IT FURTHER RESOLVED, that this be forwarded to the American Osteopathic Association for consideration.
RESOLUTION 11-04
TOBACCO SETTLEMENT FUNDS
WHEREAS, In January 1999, Texas received the first of its settlement payments from the attorney general’s successful lawsuit
against the tobacco industry, and
WHEREAS, Texas had approximately $1.8 billion in tobacco proceeds to allocate for the 2000-2001 biennium, and
WHEREAS, some $475 million was placed in five permanent funds created as repositories for current and future tobacco
settlement lawsuit dollars, and
WHEREAS, the settlement funds should go toward creating solutions for healthcare problems, therefore,
BE IT RESOLVED, that the TOMA House of Delegates supports the proposition that the next biennium’s tobacco dollars should
be placed in permanent funds allocated to health care and not be diverted to meet other state fiscal needs.
RESOLUTION 01-04 reaffirmed 06; reaffirmed 11
TOMA APPRECIATION FOR AOA SUPPORT
WHEREAS, the Osteopathic Profession in the State of Texas currently faces a challenge of an historic nature; and
WHEREAS, the Texas Osteopathic Medical Association (TOMA) was formed in 1900 for the purpose of defending the rights of
osteopathic physicians in Texas; and
WHEREAS, the American Osteopathic Association (AOA) has for more than one hundred years supported TOMA; and
WHEREAS, in 1970 the Texas College of Osteopathic Medicine (TCOM) became the sixth osteopathic medical school in the
US when a few visionary Texas osteopathic physicians, supported by TOMA and the AOA, founded the College to expand
osteopathic medicine in Texas, secured funding for the fledgling school from private donations, and in 1974 celebrated the first
graduating class of osteopathic physicians; and
WHEREAS, in 1975, with the full support of the AOA and after obtaining licensure and certification as a privately funded
osteopathic medical school, TCOM joined North Texas State University, later the University of North Texas (UNT), and became
a state institution; and
WHEREAS, in 2008 UNT and the University of North Texas Health Science Center (UNTHSC) announced their intent to
“study” the placement of an allopathic (MD) medical school on the campus of UNTHSC/TCOM; and
WHEREAS, the TOMA Board of Trustees met in December, 2008 and unanimously approved resolutions opposing that “study”
and the development of another medical school on the campus of UNTHSC/TCOM; and
WHEREAS, the AOA Board of Trustees also voted to oppose the development of an MD medical school on the
UNTHSC/TCOM campus and has been an invaluable ally to TOMA in facing this challenge in numerous ways including; AOA
Executive Committee guidance, assistance from the Executive Director and other staff members, the personal dedication of three
AOA Presidents, and disbursement of much needed funds; now therefore
BE IT RESOLVED, that the Texas Osteopathic Medical Association Board of Trustees, the TOMA House of Delegates, the
TOMA membership and DO’s across Texas humbly thank the AOA for their support of time, effort and funds that bolstered
TOMA activities to fight this important battle; and
BE IT FURTHER RESOLVED, that this resolution be forwarded to the Speaker of the AOA House of Delegates with the request
that it be read into the minutes of that body.
RESOLUTION 11-27
TOMA AWARDS AND SCHOLARSHIP COMMITTEE TO MAKE NOMINATIONS
WHEREAS, the Texas Osteopathic Medical Association has six awards that may be presented each year; and
WHEREAS, these awards are very prestigious; and
WHEREAS, there are a number of TOMA members who have made outstanding contributions to their profession, association,
district, and/or community; and
WHEREAS, these individuals deserve to be recognized for their contributions; and
WHEREAS, the members of the TOMA Awards and Scholarship Committee are in a unique position to know which individuals
are deserving of such recognition; now therefore be it
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RESOLVED, that the Texas Osteopathic Medical Association House of Delegates allow members of the TOMA Awards and
Scholarship Committee to make nominations for TOMA awards, and that the nominating person recuse himself/herself from the
vote.
RESOLUTION 08-07
TOMA BOARD OF TRUSTEES HONORS THE TEXAS COLLEGE OF OSTEOPATHIC MEDICINE (TCOM)
WHEREAS, the House of Delegates of the Texas Osteopathic Medical Association honors the historic achievements of the Texas
College of Osteopathic Medicine in 2010, as recognized in US News and World Report.
WHEREAS, this represents long standing exemplary efforts by the students, faculty and administration of Texas College of
Osteopathic Medicine, therefore be it
RESOLVED, that the House of Delegates of the Texas Osteopathic Medical Association honors the following historic
achievements of the students, faculty and administration of Texas College of Osteopathic Medicine including:
o Being ranked nineteenth in the United States in training primary care physicians.
o Being ranked in the top fifty medical schools in the United States for nine consecutive years.
o Having the third highest percentage of graduates in the United States entering primary care residencies.
o Being ranked eleventh in training family medicine physicians, fifteenth in training geriatric medicine
physicians, and twenty second in training physicians to practice in rural areas.
RESOLUTION 10-25
TOMA HEADQUARTERS BUILDING
WHEREAS, the TOMA headquarters building in Austin, Texas, is a one of a kind asset for the osteopathic medical profession in
Texas, and
WHEREAS, the physical site of the TOMA headquarters building with its close proximity to the Capitol building and its inherent
historical value to the City of Austin cannot be duplicated now or in the future, therefore
BE IT RESOLVED, that the TOMA headquarters building at 1415 Lavaca Street, Austin, Texas, cannot be sold or otherwise
bartered without a two-thirds consent of the TOMA House of Delegates.
RESOLUTION 03-23 reaffirmed 08
TOMA POSITION PAPER ON HEALTHCARE REFORM
WHEREAS, The Texas Osteopathic Medical Association (TOMA) is dedicated to putting patients first and protecting the
patient-physician relationship, and as such strives to improve the quality and accessibility of healthcare services delivered to all
patients, and
WHEREAS, we believe that reform of the delivery model to provide incentives for prevention, consumer education, healthy
lifestyles, and accountability are essential first steps; and any health system reform must include our goal as physicians to make
patient care better, and
WHEREAS, The Texas Osteopathic Medical Association opposes HR 3200 in its current form; however, TOMA endorses the
concept of health care reform and pledges to work with the Obama Administration and the Congress to develop a comprehensive
plan for health care reform that is affordable, protects the sanctity of the patient/doctor relationship, and provides quality health
care for the people of the US, and
WHEREAS, TOMA specifically opposes certain inclusions in the bill and is concerned about certain issues that are not included
in the bill such as tort reform, therefore be it
RESOLVED, that Texas Osteopathic Medical Association has established a white paper that provides the guiding principles that
would allow effective, cost protected healthcare delivery by osteopathic physicians: (adopted from American Osteopathic
Association Policy Compendium)
TOMA POSITION PAPER ON HEALTHCARE REFORM
The Texas Osteopathic Medical Association (TOMA) is dedicated to putting patients first and protecting the patient-physician
relationship, and as such strives to improve the quality and accessibility of healthcare services delivered to all patients. We
believe that reform of the delivery model to provide incentives for prevention, consumer education, healthy lifestyles, and
accountability are essential first steps; and any health system reform must include our goal as physicians to make patient care
better. TOMA provides the following guiding principles that would allow effective, cost protected healthcare delivery by
osteopathic physicians: (adopted from American Osteopathic Association Policy Compendium)
1.
2.
3.
4.
5.
The need for any new regulation must demonstrate that access to or the quality of healthcare will be improved by the
proposed regulatory action, and that the claimed improvement can be accomplished at an acceptable cost to the public.
In all matters where the health profession has demonstrated its capacity for self-regulation, government at all levels
should not impose additional or preemptive regulation.
Where the need for regulation has been demonstrated, it should emanate from the lowest level of government.
Where there is a demonstrated necessity for regulation of healthcare, such regulation must be drawn and implemented
in such a way as to promote pluralism and preserve the free enterprise system in healthcare.
These guiding principles further include but are not limited to the following:
a.
Promote portable and continuous health care coverage for all Americans using an affordable mix of public
and private payer systems that also includes preventative and primary care services.
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b.
6.
7.
8.
9.
10.
11.
12.
13.
14.
15.
16.
17.
18.
19.
20.
21.
22.
23.
24.
25.
26.
27.
Promote patient safety as a top priority for reform, recognizing an effective mix of initiatives that combine
evidence-based accountability standards, committed financial resources, and rewards for performance that
ensure patient safety by allowing tax and financial incentives versus punitive measures.
c.
Adopt physician-developed, evidence-based tools for use in scientifically valid quality/patient safety
initiatives that reward the physician-led health care delivery team, and include comparative effectiveness
research used only to help patient-physician relationships choose the best care for patients.
Preserve patient and physician choice and the integrity of the patient-physician relationship. Foster better communication
between patients and physicians.
TOMA also strongly endorses the sanctity of the patient-physician relationship when making individual treatment
decisions.
Incorporate physician-developed comparative effectiveness research, evidence-based measures and preventive health and
wellness initiatives into any new or expanded health benefit package as a means to promote healthy lifestyles.
Recognize and support the role of safety net and public health systems in delivering essential health care services within
our communities, to include essential prevention and health promotion public health services. Put patient safety first and
work to reduce preventable injuries.
Support the development of a well-funded, nationwide emergency and trauma care system that provides appropriate
emergency and trauma care for all Americans.
Support public policy that fosters ethical and effective end-of-life care decisions, to include encouraging all Medicare
patients to have an advance directive that a Medicare enrollee can discuss as part of a covered Medicare visit with a
physician, and should be available at least every three years and when any significant new diagnosis or change in
prognosis appears.
Provide sustainable financing mechanisms that ensure the aforementioned affordable mix of services and create personal
responsibility among all stakeholders for financing and appropriate utilization of the system.
Invest needed resources to expand the physician-led workforce to meet the health care needs of a growing and
increasingly diverse and aging population.
TOMA will continue to observe patient-centered medical home demonstration projects, and encourages and supports
increased funding and compensation for services provided by primary care physicians and the services provided by nonprimary care, specialist physicians as part of the patient-centered medical home continuum.
Through public policy enactments, require accountability and transparency among health insurers to disclose how their
premium dollars are spent, eliminate pre-existing condition exclusions, simplify administrative processes, and observe fair
and competitive market practices.
Reform the national tort system to prevent non-meritorious lawsuits, keeping Texas reforms in place as enacted by the
Texas Legislature and Constitutionally affirmed by Texas voters. This reform plan should include limits on contingency
fees, and encourage establishment of non-biased panels to judge the merits of lawsuits before they proceed.
Abolish the Medicare Sustainable Growth Rate annual update system and initiate a true cost of practice methodology that
provides for annual updates in the Medicare Fee Schedule as determined by a credible, practice expense-based, medical
economic index.
Support the implementation of an inter-operable National Electronic Medical Records System, financed and implemented
through federal funding.
Require payers to have a standard, transparent contract with providers that cannot be sold or leased for any other payer
purposes without the express, written consent of the contracted physician.
Support efforts to make health care financing and delivery decision-making more of a professionally advised function,
with appropriate standard-setting through clinical efficacy, payment policy, and delivery system decisions fashioned by
physician-led deliberative bodies as authorized legislatively.
Increase primary care physician workforce through increased funded primary care residency programs, decreasing student
debt through increased loan forgiveness and increasing funding and establishment of Community Based Health Care
Centers and the National Health Service Corps.
Maintain employer based coverage. TOMA is against a public option plan and such a plan should not be allowed to enter
the market under rules not applicable to the plans it will compete against. Competition must be on a level and equitable
playing field. TOMA is opposed to any public option plan based on the Medicare program, and any provisions that would
mandate physician participation in the program.
Continue preservation of physicians-owned hospitals as viable options to expanded access to healthcare. These facilities
provide high quality medical care, have high levels of patient satisfaction, provide access to diverse populations, and
contribute to the economic health of the communities they serve, and need to be able to expand and meet the changing
medical needs of the community.
Promote individual investment in health through prevention, wellness and public health, and not impose untested and
arbitrary treatment standards that do not improve the quality of patient care.
Create an equitable healthcare financing infrastructure that promotes quality and reduces impact of current tort laws.
Support reduction of federal government and bureaucracy red tape for patients and physicians.
Reform should be comprehensive and simultaneously increase access to care, reduce cost, and improve quality. This
includes a health care system that should be revisable and responsive to changing circumstances. The system should
encourage physicians, patients, and communities to engage as partners in health care, and it should encourage mutual
respect, healthy lifestyles, adherence to treatment plans, active self-management, and effective communication for better
health.
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28. Excluding individuals or populations from access to health care benefits should not be used to restrain cost. Reform
should encourage efficient use of health care resources by all stakeholders, and should promote quality health care that
provides incentives to carefully monitor and improve quality.
29. Reform must be equitable, consistent, transparent, sensitive to value, and be accompanied by a set of consensus
recommendations from well-accepted methods for generating measurable clinical practice guidelines for policies and
actions to ensure fairness in health care coverage decisions.
RESOLUTION 10-22
TOMA RESOLUTION ACTION PLAN
WHEREAS, many Texas osteopathic physicians donate their time to represent the profession at the TOMA House of Delegates,
and
WHEREAS, their actions represent the policies of the membership for this organization, therefore
BE IT RESOLVED, that the TOMA House of Delegates directs the TOMA Executive Director, in the annual report to the
TOMA House of Delegates, report all actions and on-going activities reflecting the due diligence of the TOMA Board of Trustees
in accomplishing the approved resolutions. This report shall include information pertaining to each and all resolutions passed by
the TOMA House of Delegates until it reaches final disposition, including actions taken by agencies and/or committees to whom
any resolutions may have been referred.
RESOLUTION 00-25 revised & reaffirmed 05, reaffirmed 10
TOMA SUPPORTS EARLY VOTING DAY POLICY
WHEREAS, voter apathy is epidemic in Texas, and
WHEREAS, Texas osteopathic physicians do not believe that a minority of the total electorate should be making government
policies concerning issues such as health care and education, and
WHEREAS, early voting is now the law in Texas and voters no longer have to wait until election day to cast their ballots, and
WHEREAS, if every health care provider and health care facility in Texas would initiate a policy to allow their employees time-off
during working hours to participate in early voting, the political clout of organized medicine would be substantially enhanced in
Austin, Texas and Washington, D.C., therefore
BE IT RESOLVED, the TOMA House of Delegates encourages all Texas osteopathic physicians to adopt early voting policies in
their work places that would allow their employees time-off during working hours to participate in early voting for local, state, and
national elections, and
BE IT FURTHER RESOLVED, that the TOMA House of Delegates encourage other medical and health care organizations in Texas
and throughout the United States to follow our example.
RESOLUTION 04-28 reaffirmed 09
TOMA/TCOM TOMA STUDENT ORGANIZATION (TOMA SO)
WHEREAS, the student members of the Texas Osteopathic Medical Association have expressed a desire to become more
involved in policy and position development within the Texas Osteopathic Medical Association; and
WHEREAS, the membership of the Texas Osteopathic Medical Association wishes to hear the voice of the student body of the
Texas College of Osteopathic Medicine; and
WHEREAS, the student members of the Texas College of Osteopathic Medicine bring a unique perspective to the policies and
positions of the Texas Osteopathic Medical Association; therefore
BE IT RESOLVED, that the House of Delegates of the Texas Osteopathic Medical Association endorse and recognize the Texas
Osteopathic Medical Association Student Organization (TOMA SO); and
BE IT FURTHER RESOLVED, that the Texas Osteopathic Medical Association Student Organization (TOMS SO) be
empowered to present resolutions to the House of Delegates for thoughtful consideration and action; and
BE IT FURTHER RESOLVED, that the Speaker of the TOMA House of Delegates direct the President of the Texas Osteopathic
Medical Association to appoint a liaison to the Texas Osteopathic Medical Association Student Organization (TOMA SO) and
that such liaison present a report to the House of Delegates annually.
RESOLUTION 04-09 revised & reaffirmed 09
TRANSPORTATION AT SPONSORED OSTEOPATHIC MEETINGS AND CONVENTIONS
WHEREAS, some active, productive members of our state and national osteopathic associations are aging and may have
difficulties including mobility, and
WHEREAS, these same members have been vital in making osteopathic medicine the extraordinary profession that it is today,
and
WHEREAS, hotels at state and national conventions may be of substantial distance from the meeting areas, and
WHEREAS, the osteopathic medical associations should support the intent and purpose of the Americans with Disabilities Act,
therefore
BE IT RESOLVED, that the Texas Osteopathic Medical Association House of Delegates recommends that appropriate
transportation for disabled and elderly members be provided at TOMA meetings and conventions.
RESOLUTION 01-41 reaffirmed 06; reaffirmed 11
UNEQUAL MEDICAID & CHIP REIMBURSEMENT
WHEREAS, the Texas Medicaid program has different reimbursement rates for physicians depending on where their practices
are located, and
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WHEREAS, physicians in South Texas have been receiving 16% less Medicaid reimbursement than similar physicians in other
geographical areas of Texas, and
WHEREAS, the Children’s Health Insurance Plan (CHIP) parallels Medicaid as far as reimbursement rates are concerned, and
WHEREAS, low reimbursements rates along with high medical liability insurance rates make South Texas a less desirable
location to start a new medical practice, therefore
BE IT RESOLVED, that the TOMA House of Delegates call upon the Texas Legislature to increase the current Medicaid &
CHIP reimbursement so that all physicians will receive equal reimbursement for services rendered, regardless of their geographic
location in Texas.
RESOLUTION 01-09 reaffirmed 06; reaffirmed 11
UNITED STATES / MEXICO BORDER HEALTH ASSOCIATION
WHEREAS, the United States / Mexico border region needs the support of the federal and state governments to address the use
of drugs and prevention of drug abuse, and
WHEREAS, the Center for the Application of Prevention Technologies (CAPT) projects are at the risk of being cut or partially
funded at the national and regional levels, and
WHEREAS, the Border CAPT is in need of capacity building and technical assistance to help with their prevention program
designs, therefore
BE IT RESOLVED, that the Texas Osteopathic Medical Association House of Delegates calls upon the federal and state
governments along the United States / Mexico border to keep in place the drug abuse prevention programs and drug formularies
supported through the Border Center for the Application of Prevention Technologies (CAPT) project, and
BE IT FURTHER RESOLVED, that the Texas Osteopathic Medical Association House of Delegates goes on record supporting a
formal liaison between the Texas Osteopathic Medical Association and the United States / Mexico Border Health Association.
RESOLUTION 00-07 revised & reaffirmed 05, reaffirmed 10
UNIVERSAL IMMUNIZATION PLAN
BE IT RESOLVED, that TOMA support a law authorizing a Universal Immunization Plan (The Plan) for the State of Texas.
shall buy all the immunizations recommended by the American Academy of Pediatrics (AAP) Committee on Infectious Diseases
and distribute them at no cost to all physicians in the state. Reimbursement to the physicians shall be for administration and
supplies at $20.00 for the first immunization and $15.00 for each subsequent injection. Costs for the vaccine shall be offset by:
1.
All commercial insurance companies will be required to reimburse the state
(at the state vaccine cost) for children (birth-20 yrs.) who are enrolled in each plan
2.
Funds appropriated by the state for Medicaid and Children’s Health Insurance Program (CHIP) are matched with
Federal dollars at a rate of 1.5 or 2 to one.
3.
Buying in "bulk" (purchasing for the entire state at one time) will enable the
state to negotiate significant reductions in vaccine costs.
RESOLUTION 06-01; reaffirmed 11
UNIVERSAL PURCHASE OF VACCINES
WHEREAS, states with universal purchase (UP) vaccine programs have higher immunization rates, and
WHEREAS, under a UP program, the state buys the vaccine, pays all excise taxes, and supplies free vaccines to health care
providers, who in return charge patients only the administration fee set by the state, and
WHEREAS, families without insurance coverage for immunizations who have previously been paying out of pocket for privatesector immunizations are the specific target of the UP plan, therefore
BE IT RESOLVED, that the TOMA House of Delegates goes on record supporting a Texas Universal Purchase of Vaccines
Program.
RESOLUTION 00-19 revised & reaffirmed 05, reaffirmed 10
UNT BOARD OF REGENTS
WHEREAS, Texas osteopathic physicians are confronted by serious issues as they enter the new millennium, and
WHEREAS, the TOMA Long Range Planning Committee met for the purpose of establishing goals for TOMA, therefore,
BE IT RESOLVED, that TOMA continue to vigorously pursue the goal of osteopathic physician representation on the Board of
Regents of the University of North Texas.
RESOLUTION 00-34 reaffirmed 05, reaffirmed 10
USE OF ANIMALS IN MEDICAL RESEARCH
WHEREAS, Texas osteopathic physicians support humane handling and treatment of all animals, and
WHEREAS, one of the basic tenants of osteopathic medicine is disease prevention, and
WHEREAS, the osteopathic profession has always been on the "leading edge" of medical research, and
WHEREAS, laboratory animals are needed to conduct much of this medical research, and
WHEREAS, past achievements in both preventive and therapeutic care would not have been discovered, and
WHEREAS, future advances in preventive and therapeutic care would be dramatically hampered, therefore
BE IT RESOLVED, that the Texas Osteopathic Medical Association's House of Delegates supports the use of animals for valid
medical research projects, and
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BE IT FURTHER RESOLVED, that the TOMA House of Delegates supports the humane handling and treatment of such animals
and their ready availability from legitimate, federally licensed sources at nominal cost.
RESOLUTION 00-20 revised & reaffirmed 05, reaffirmed 10
USE OF LASERS
WHEREAS, when tissue is altered or changed in any way, by the use of instrumentation, such as
a needle, scalpel, or laser, the Texas State Board Of Medical Examiners (TSBME) considers this to be surgery, and
WHEREAS, the use of lasers for any indication would be considered surgery by the TSBME, and
WHEREAS, the Texas Department of Health, Bureau of Radiation Control, classifies medical devices including but not limited
to lasers and other Class IV medical devices, and
WHEREAS, the TSBME requires a physician to be on-site before he or she can delegate a surgical procedure to a non-physician,
therefore
BE IT RESOLVED, that the Texas Osteopathic Medical Association House of Delegates supports a policy that the use of a Class
IV medical device to alter or change tissue constitutes surgery, and
BE IT FURTHER RESOLVED, that the Texas Osteopathic Medical Association House of Delegates supports the policy that a
physician must be on site in order to delegate a procedure with a Class IV medical device by a non-physician.
RESOLUTION 02-10 reaffirmed 07
USE OF OMT BY OSTEOPATHIC PRECEPTORS
WHEREAS, Osteopathic Manipulative Therapy (OMT) is a distinguishing characteristic of the osteopathic medical profession;
and
WHEREAS, OMT is helpful in both the diagnosis and treatment of disease; and
WHEREAS, practical OMT techniques are best taught by the “hands on” approach; therefore
BE IT RESOLVED, that the TOMA House of Delegates encourages the teaching of OMT by Texas osteopathic preceptors
during all rotations of osteopathic student doctors.
RESOLUTION 04-03 reaffirmed 09
WHITE COAT CEREMONY AT TCOM
WHEREAS, the first major event in the life of a new osteopathic medical student at the Texas College of Osteopathic Medicine
(TCOM) is the “White Coat Ceremony”; and
WHEREAS, a few years ago TOMA volunteered to purchase the white coats to be given to the incoming students; and
WHEREAS, the “White Coat Ceremony” is something TOMA should continue to participate in, and funds should be made
available to purchase the white coats; therefore,
BE IT RESOLVED, that the TOMA House of Delegates support the “White Coat Ceremony” at TCOM and that TOMA
purchase the white coats each year.
RESOLUTION 04-02 reaffirmed 09
WHO SPEAKS FOR OSTEOPATHIC PHYSICIANS?
WHEREAS, Texas osteopathic physicians are very aware of the importance of good public relations, and
WHEREAS, physicians throughout Texas and the United States are constantly being asked to comment on health care and other
issues of the day, and
WHEREAS, such comments on the part of some physicians and medical groups are often controversial and do not represent the
opinion of the vast majority of physicians, and
WHEREAS, there is a lot of wisdom in that old adage "shoemaker stick to your last", and
WHEREAS, many physicians are reluctant to support financially that which they condemn verbally and feel no legal, moral, or
financial obligation to support medical organizations that do not represent the will of the majority of their membership, and
WHEREAS, the public should know who speaks for osteopathic physicians in Texas and throughout the United States, therefore
BE IT RESOLVED, that the TOMA House of Delegates makes it clear that major health care policy decisions pertaining to
osteopathic physicians in Texas will be debated and decided in the TOMA House of Delegates, and
BE IT FURTHER RESOLVED, that the TOMA House of Delegates encourages the American Osteopathic Association (A.O.A.) to
make it clear that major health care policy decisions pertaining to osteopathic physicians in the United States will be debated and
decided in the A.O.A. House of Delegates.
RESOLUTION 04-29 revised & reaffirmed 09
YELLOW PAGES LISTING
WHEREAS, Texas osteopathic physicians are very concerned about where and how they are listed in the yellow pages of telephone
books, and
WHEREAS, Texas osteopathic physicians feel that inaccuracies in yellow pages listings can have a negative impact on their
individual medical practices, therefore
BE IT RESOLVED, that the TOMA House of Delegates goes on record supporting the listing of D.O.'s and M.D.'s names and/or
clinics in alphabetical order in Texas yellow pages under a single heading, "Physicians and Surgeons - D.O./M.D." and under the
medical specialty guide listing.
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RESOLUTION 01-38 reaffirmed 06; reaffirmed 11
RESOLUTION COMMITTEE'S PROCEDURE FOR SUNSET REVIEW
All resolutions will be reviewed on a yearly basis. After one year, resolutions pertaining to other than Texas Osteopathic Medical
Association policy issues such as host district, honorary membership, etc. will be automatically deleted. Resolutions, which have
been on the books for five years, will be up for sunset review.
The Resolutions Committee will make recommendations each year to the TOMA House of Delegates regarding TOMA resolutions.
The recommendations will take three forms of action: 1) to delete resolutions that have been accomplished or are obsolete; 2) to
revise resolutions that have been partially accomplished before the end of five years; or 3) to reaffirm parts of or entire resolutions
that are still viable and needed at the end of five years.
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