The DJP Update

DJP 5-11-2004 AMA Update: Liability vote in House and JAMA article on uninsured

ITEM ONE:  Medical Liability Vote in House of Representatives

http://www.ama-assn.org/ama/pub/article/9255-8560.html

The U.S. House of Representatives will vote on a comprehensive medical liability reform bill (H.R. 4280) on May 12.  H.R. 4280 is essentially identical to H.R. 5 (minor word changes).  Goal is to keep the heat up on this critical issue and it is hoped that the Senate will realize that action is needed become more states go in to crisis.

ITEM TWO:  AMA proposal to cover the uninsured published in JAMA

http://www.ama-assn.org/ama/pub/article/1615-8565.html

In JAMA: AMA’s proposal to expand health coverage

An article in the May 12 issue of The Journal of the American Medical Association outlines the American Medical Association’s plan to increase health insurance coverage.

“Expanding Insurance Coverage Through Tax Credits, Consumer Choice, and Market Enhancements,” by AMA President Donald J. Palmisano, MD, and two authors from the AMA’s Center for Policy and Research – David W. Emmons, PhD, and Gregory D. Wozniak, PhD – describes a three-pronged approach for covering more of the nation’s 44 million uninsured.

Under America’s current employer-based system, much of the $188 billion federal tax subsidy favors relatively wealthy employed people and their families, but does little for those without employer-based coverage and those in the lowest-income tax brackets.

The centerpiece of the AMA proposal is a federal tax credit system that would replace the current federal tax exclusion of employer-based health insurance. The credits would be inversely related to income, refundable and advanceable – and large enough for most individuals and families to be able to afford insurance. Employers’ spending on employee health benefits would remain fully deductible as a business expense, but employer-based plans would no longer be the only group coverage option. A health insurance market with a variety of choices would increase satisfaction and access to care. The AMA plan would reform the health insurance market with incentives to offer a wider range of new, affordable and permanent insurance options.
Press release follows:

EMBARGOED FOR RELEASE: 3 P.M. (CT) TUESDAY, May 11, 2004

AMA DETAILS PLAN TO COVER THE UNINSURED

BY STRENGTHENING CURRENT SYSTEM

Proposal featured in Special Communication in this week’s JAMA

CHICAGO – The American Medical Association outlines its plan for expanding insurance coverage to approximately 95 percent of Americans in a “Special Communication,” published in this week’s Journal of the American Medical Association.

“There is no question that we must find a solution to the problem of the more than 43.6 million people who are uninsured in this country,” said AMA President Donald J. Palmisano, M.D.  “Research shows that the health consequences for Americans without insurance can be devastating.  The AMA advocates a solution to the uninsured crisis that builds on the strengths of our current system.  We believe that a health care system based on a mix of private and public sector financing will best benefit the uninsured, improve quality, restrain costs, and expand patient choice and individual purchasing power.”

The plan detailed by the nation’s largest physician organization, representing more than 250,000 doctors nationwide, calls for a comprehensive three-pronged program to include:

• Tax credits for the purchase of insurance:

The current federal income tax exclusion system provides the greatest benefits to the wealthiest employed persons and their families.  Those that do not have employer-based coverage and those in the lowest tax brackets receive little or no tax benefit.  The AMA plan would replace the current tax exclusion of employer-based health insurance with tax credits that are inversely related to income (and large enough to ensure that health insurance is affordable for most people), refundable and advanceable.  Advanceable credits would mean that people do not need to wait until their federal income taxes are filed to use the credits to purchase insurance.  Employers’ spending on employee health benefits would remain fully deductible as a business expense.

• Individually selected and owned health insurance:

Under the AMA proposal, an employer’s option of health plans would no longer be the only   group coverage option for people.  Individuals would be able to choose coverage that reflects their personal health care preferences and needs.  In the current system, employees often cannot change insurance carriers if they are unhappy with their service or coverage.  Providing a choice of plans will allow individuals to be more satisfied and increase access to care.

• Expansion and formation of new insurance markets:

The AMA plan would increase choice in the individual and group health insurance markets by implementing insurance market reforms and incentives to offer a wider range of new, affordable and permanent insurance options.  The expansion of managed care has led to the current system, which has limited individual choice and damaged the patient-physician relationship often resulting in patients deferring care.

“The AMA’s proposal would give people the power to choose their health plan and give patients and their physicians what they want and deserve — more control over their health care decisions,”  Palmisano said.

The Special Communication, authored by Dr. Palmisano and David Emmons, Ph.D. and Greg Wozniak, Ph.D., AMA’s Center for Health Policy Research, also warns against the dangers of implementing a single-payer, government-run system.  The AMA previously has noted that by implementing a single-payer system, the U.S. would be trading the uninsured problem for an entire new set of other problems that may be much worse.  Long waits for health care services, a slowness to adopt new technologies and maintain facilities, and development of a large bureaucracy that can cause a decline in the authority of patients and their physicians over clinical decision-making are all hallmarks of the single-payer system.

“The AMA has learned from countries that have a single-payer system, that the solution to the health care problem is a mix of private and public sector financing, with coverage and care remaining in the private sector,” said Palmisano.

In an accompanying editorial, Mark V. Pauly, Ph.D., Department of Health Care Systems, The Wharton School, University of Pennsylvania, writes that “the logic behind the [AMA] proposal is economically attractive.” Pauly further notes that “The AMA proposal is not only to help the uninsured ….  In proposing replacement of the current tax exclusion for employment-based coverage with a credit, it takes a major step toward cost containment.”

###

NOTE TO REPORTERS: The Journal of the American Medical Association (JAMA) is an editorially independent medical journal, and, as such, may publish views of others that do not always correspond with the American Medical Association’s (AMA) positions and policies.

The AMA health insurance proposal is available at: www.ama-assn.org/go/insurance-reform.

For more information, please contact:

Lori Bolas

Media Manager

(312) 464-4418

Brenda Craine,

Director, Media Relations, Washington Media Relations

(202) 789-7419

LAGNIAPPE:

Now in Divonne, France at World Medical Association meeting, but wired in by international cell phone and e-mail to AMA in Chicago and Washington, DC.  A lot is going on.  Very pleased that our AMA plan for the uninsured is in the May 12, 2004 issue of JAMA.  Also be sure to read editorial about our article by Dr. Mark Pauly of the Wharton School in Pennsylvania.

Finally, I will send another DJP update in a moment that will be a special edition on patient safety.

Donald J. Palmisano, MD, JD

AMA President

DJP 7-9-2003 AMA Update: Quick update on today’s activities and media alert

Washington, DC

5:05  p.m Eastern

DJP 7-9-2003 AMA Update: Quick update on today’s activities and media alert

National Press Club Speech and Q & A completed today.  Hope you saw it.

Then participated in Senate press conference on today’s vote in Senate.

49 votes our way and 48 votes against.

Then did CNN Fn – debated ATLA representative just after 4 PM Eastern.

Return to CNN for another debate at 6PM Eastern tonight on Lou Dobbs show.

Check AMA web for more details.

DJP

DJP AMA 7-18-2002: More on Medical Liability Reform; LAGNIAPPE

This e-mail contains two items:

ITEM ONE: MEDICAL LIABILTY REFORM; RALLY IN FLORIDA AND MORE

ITEM TWO: LAGNIAPPE: COURAGE

Hit delete if not interested.

Best regards,

Donald

Donald J. Palmisano, MD, JD

AMA President-Elect

E-mail: Donald_Palmisano@ama-assn.org

Or

DJP@donaldpalmisano.com

NOTICE: I believe the more we communicate with each other, the better is our

chance for success with AMA’s goals. I certainly learn a lot from the

feedback I get regarding these updates.  If anyone wishes to be removed from

the updates at any time, just hit the reply button and state “remove” in

subject line and you will be removed from the mailings.

Also, if you have a colleague who wishes to be added to the list, have her

or him drop me an e-mail.

ITEM ONE: MEDICAL LIABILTY REFORM; RALLY IN FLORIDA AND MORE

More than 1,000 attend Florida rally for medical liability reform

On July 17, AMA President-elect Donald J. Palmisano, MD, JD, joined more than 700 Florida physicians and hundreds of patients, nurses and physician assistants at the Palm Beach County Courthouse as they protested skyrocketing medical liability premiums. “Without reforms, patients, trauma centers, maternity wards and physician practices are at the mercy of Florida’s out-of-control liability system,” Dr. Palmisano told reporters from Reuters, Palm Beach and Ft. Lauderdale newspapers, and local TV affiliates for ABC, NBC, FOX and PBS.

Read more about the event on the AMA Web site: http://www.ama-assn.org/ama/pub/article/1616-6469.html

Read more about the AMA’s campaign for medical liability reform: http://www.ama-assn.org/ama/pub/category/7259.html

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More Than 1,000 Rally In Florida For Federal Med-Mal Bill

Best Wire

July 16, 2002

By Marie Suszynski

The American Medical Association urged legislators in Florida to reform the state’s medical-liability system and support a federal bill at a rally attended by more than 700 physicians. “The medical liability system is out of control,” Dr. Donald Palmisano, the AMA’s president-elect and a surgeon in New Orleans said.

More than 1,000 people showed up to rally July 16 at the Palm Beach County Courthouse to urge reforms in Florida’s medical malpractice industry, Palmisano said. Among them were more than 700 physicians.

The rallies were in reaction to a report that six trauma center surgeons at Delray Medical Center would lose their medical malpractice insurance on July 31, AMA said. Palmisano has since learned that the surgeons would be covered in the hospital’s policy. “But that’s a band-aid approach,” he said. “We need to have a marketplace where an individual can purchase insurance at a reasonable rate.”

The bipartisan bill, recently introduced in Congress and modeled after the successful MICRA law in California, would keep medical liability rates at a reasonable level. The bill would allow patients to recover medical expenses and lost wages in a med-mal case, but it would limit damages for pain and suffering, Palmisano said. A companion bill is about to be introduced in the Senate, he said.

The Florida legislature is feeling more and more pressure to address medical liability, said Sam Miller, spokesman for the Florida Insurance Council. Ten years ago, 35 carriers actively wrote medical malpractice insurance in Florida, but that number has dwindled to six. Most recently, First Professionals Insurance Co. of Jacksonville said it would renew existing business but wouldn’t issue new med-mal business, he said.

“What’s happening right now is that doctors are blaming lawyers and lawyers are blaming insurance companies,” Miller said. Some trial attorneys have accused insurers of making “blood-sucking” profits, he said, but in reality insurers are leaving the market because of losses.

In June, American Physicians Capital Inc. said it would stop writing medical-liability insurance in Florida, citing an underwriting loss of $18.8 million in the state in 2001 (BestWire, June 24, 2002).

The AMA wants states such as Florida to follow California’s lead when it comes to medical malpractice. In 1975, the state had the highest medical-liability rates, but now it’s in the lower third, Palmisano said. Since the law was passed 25 years ago, malpractice premiums have gone up 167% in California and 505% in the rest of the United States, he said.

Last year in Florida, insurers paid out $1.36 for every dollar of premium they collected, Miller said. And one in five doctors or surgeons will be sued over medical malpractice, compared with one in 12 in the rest of the country. Many physicians told Palmisano that med-mal premiums have tripled over the past two or three years, and one gastroenterologist and internal medicine specialist said his premium tripled at his last renewal. Obstetricians and neurosurgeons pay more than $200,000 a year in premiums, he said.

The AMA released a report in June that said medical liability has reached crisis proportions in 12 states, including Florida, and is in trouble in 30 other states. The medical-malpractice shortage became high profile in late 2001 when St. Paul Cos., the country’s largest writer of that line, said it would exit the business (BestWire, June 17, 2002).

The AMA has also held rallies in Nevada and Mississippi and has provided support for physicians in numerous other states. The top five writers of medical malpractice insurance in Florida by market share, according to A.M. Best Co.’s 2001 state/line data, were FPIC Insurance Group Inc., with 18.8%; Health Care Indemnity Inc., with 13.7%; ProAssurance Group, with 9.3%; Zurich/Farmers Group, with 8.1%, and HDI U.S. Group, with 5.2%.

——————

Trial lawyers and the terrorist threat — editorial

The Washington Times

July 17, 2002

We reported on this page last week on the crisis situation in Las Vegas, where one of the busiest Level-I trauma centers in the country – and one of the first lines of defense in the event of a terrorist attack – was forced to shut its doors July 3 due to escalating malpractice insurance costs. We recommended an exemption from existing malpractice laws for trauma centers due to the terrorist threat.

The facility, located at the University of Nevada Medical Center [UMC], closed after most of its surgeons resigned, saying they risked bankrupting their families if they continued to practice and were hit with a seven-figure lawsuit by one of the city’s increasingly aggressive malpractice lawyers. Local physicians and emergency rescue personnel said the shutdown left the Las Vegas area, home to roughly 1.5 million people and destination of 36 million tourists a year, unprepared to face a catastrophic terrorist attack. When our editorial was published last Thursday, the trauma center had been closed for more than a week, and officials were pessimistic that negotiations to reopen the facility would bear fruit any time soon. Just 24 hours later, however, local officials and some of the surgeons reached an agreement to temporarily reopen the UMC trauma center on Saturday, 10 days after the liability crisis had forced it to close. The accord limits doctors’ liability in malpractice lawsuits for at least 45 days. Meanwhile, Gov. Kenny Guinn has called on the legislature to convene in a special session July 29 to take up a reform measure that would place permanent caps on jury awards in malpractice cases despite an intense campaign against it by state trial lawyers.

In an interview yesterday with The Washington Times, Nevada Sen. John Ensign warned that seriously injured patients face “potential loss of life” if insurance problems force the facility to close once again. Asked specifically about the possibility that such a closure could hamper the Las Vegas area’s ability to respond to a terrorist attack, he responded: “Let’s hope we don’t have to find out.” Mr. Ensign said he was heartened by the fact that Nevada’s insurance crisis has drawn “national attention,” referring specifically to last Thursday’s editorial in The Times and columnist George Will’s commentary on ABC’s “This Week.”

And Nevada is just the tip of the iceberg. According to the American Medical Association [AMA], 11 other states are “in the throes of a medical liability crisis.” Aside from Nevada, the AMA lists the states in the most precarious condition as being Florida, Georgia, Mississippi, New Jersey, New York, Ohio, Oregon, Pennsylvania, Texas, Washington and West Virginia. In these states, doctors “are leaving . . . retiring early or abandoning high-risk services because they can’t afford or can’t find liability insurance,” the organization says. Another 30 states and the District of Columbia are also “seeing signs of problems,” the AMA adds.

The Level-II trauma center at Brandywine Hospital in Coatesville, Pa., closed June 10, because of rising malpractice insurance rates, the Las Vegas Sun reported last week. Area trauma patients are now being transported more than 30 miles away to hospitals in Philadelphia and Lancaster. “I believe lawyers have a better ability to lobby,” Brandywine spokeswoman Evelyn Walker told the Sun when asked about the state legislature’s failure to enact tort reform, which includes damage caps for pain and suffering. “Hospitals and doctors are not as diligent when it comes to lobbying.”

This is a situation that needs to change right away. Trauma centers are an essential component of America’s defense against terrorist attack. At a minimum, it’s time that the medical community gets serious about carving out some form of war or terrorism-related exemption, at the national, state and local levels, for doctors and other health-care facilities that will be on the front lines when terrorists strike here once again.

July 18, 2002, Thursday, BC cycle

SECTION: Domestic News; Business News

LENGTH: 1335 words

HEADLINE: Soaring malpractice insurance squeezes out doctors, clinics

BYLINE: By THERESA AGOVINO, AP Business Writer

BODY:

The shock from Jim Lawson’s July 4 death in Nevada auto accident was felt well beyond his family and friends.

The two-car crash on a busy street leading to Las Vegas airport came just one day after the nearest trauma clinic, at the University Medical Center, closed down. The 58 orthopedic surgeons who rotate through the hospital had insisted on relief from the soaring cost of medical malpractice insurance.

No one can be sure his death, confirmed at an emergency room an hour away, could have been avoided. Trauma centers generally offer more effective attention for accident victims. But it prompted a quick July 13 reopening of the university center. Some 10 to 15 of the doctors agreed to become temporary employees of the county hospital, limiting their liability to $50,000, while the governor tries to enact legislation that would restrict medical malpractice awards.

On a much broader level, it brought new attention to a national problem that doctors say is obliging many of them to flee certain states or give up certain specialties – or the entire profession – because of skyrocketing insurance premiums linked to soaring jury awards.

The impact of the trauma center’s closure in Las Vegas was summed up by its director, Dr. John Fildes: “The standard of care in our community was set back 25 years.”

The number of communities suffering similar problems is mushrooming.

This summer, two Pennsylvania hospitals, one Arizona hospital and a clinic in Oregon closed their obstetrics units.

Several counties in upstate New York have no obstetricians covering night shifts.

Soon, two counties in Pennsylvania won’t have a neurosurgeon. Seven hospitals on the Mississippi coast share 3 neurosurgeons, one of whom, Terry Smith in Biloxi, is likely to leave next month because he can’t find insurance.

Thirteen insurance companies have refused to cover Dr. Smith, who currently pays $65,000 in annual premiums. One company may agree to cover him, but it is likely to cost $100,000, an amount he says he can’t afford.

Smith said he often puts in seven-day weeks now to meet the community’s needs.

“This is an area with lots of poor and minority people, so you as a doctor feel you doing something important,” Smith said. “I feel guilty about leaving but I just don’t have a choice.

“The two guys I’m leaving behind are friends of mine and they’ll be working even harder,” he said.

Mississippi is one of 12 states where rising premiums, tied to awards by state juries in malpractice cases, are creating a crisis, according to the American Medical Association. The others are New York, Nevada, Florida, Ohio, Texas, Georgia, Pennsylvania, New Jersey, Washington, Oregon and West Virginia.

Because of risks associated with certain medical conditions and forms of treatment, some specialties pay especially high rates, and those rates are compounded by being charged in states where laws place fewer limits on jury awards.

For example, while premium increases this year average about 15 percent nationwide for all practices, rates for obstetricians and gynecologists in Pennsylvania are set to balloon by anywhere from 40 percent to even 81 percent, according to Medical Liability Monitor, a trade publication. In West Viriginia, they are catapulting anywhere from 29 percent to 36 percent.

The average jury award for medical malpractice doubled to $1 million in the six years ending in 2000, according to Jury Verdict Research, a private database used by lawyers, insurers and doctors. Lawyers who handle malpractice cases are critical of the database, pointing out that it is not comprehensive and contending that its findings are inflated.

In any event, verdicts of more than $1 million are common in states like Mississippi and Nevada. In the first six months of this year, there were five jury awards in in Mississippi and the average verdict was $5.6 million, according to the state’s medical association.

“I think juries are just frustrated with managed care and health care in general, so they take it out on doctors,” said Dr. Michael Daubs, an orthopedic surgeon who said he may leave Las Vegas if his rates keep rising.

He says he has never been sued but his insurance jumped $20,000 to $60,000 a year. He has applied for medical licenses in three other states.

Some insurance companies are leaving the medical liability business. St. Paul Cos., the second largest provider of medical malpractice insurance, announced last December it would stop writing policies, leaving 42,000 doctors searching for coverage. St. Paul said it lost close to $1 billion on its medical malpractice line last year.

Smaller insurers are also cutting back or leaving the business. Pennsylvania’s second-largest medical malpractice insurer, Phico Insurance Co., failed earlier this year and was liquidated by the state.

Legislation has been introduced in Congress that would limit the pain and suffering portion of malpractice awards to $250,000. The bill, intended to override state laws, would also curtail lawyers’ fees and allow juries to hear about the plaintiffs’ other sources of income.

“We absolutely need tort reform,” said Dr. Donald Palmisano, president elect of the AMA. “The situation has spiraled out of control.

The AMA lists six states as having their malpractice situations under control: California, Colorado, New Mexico, Wisconsin, Indiana and Louisiana. In Wisconsin, where there is a limit on awards, St. Paul did not suffer a loss.

Trial lawyers are opposed to the caps. They cite surveys showing juries rule in favor of doctors in two thirds of all malpractice lawsuits. They say doctors and hospitals should focus on reducing mistakes, not jury awards.

“If you run over someone over by accident, no one is putting a cap on what you will have to pay them. Why do we want to elevate one group in society above another?” said Leo Boyle, president of the Association of Trial Lawyers of America.

Boyle blames insurance companies for keeping rates artificially low in the 1990s to win business as they expanded wildly, a practice made possible by booming returns in the stock market. “Insurance companies were reckless in their pricing and now patients are supposed to pay for it?” he said.

Joseph Roethel, who follows the medical insurance industry as assistant vice president at A.M. Best Co., an insurance rating agency, parcels out the blame equally: Insurance companies kept rates too low in the 1990s and jury awards have gone too high.

Now, he said, “Insurance companies don’t have the reserves for these types of jury awards.”

Some doctors are resorting to working without insurance, using a credit line or their own money to cover malpractice expenses. The practice isn’t common but is done, especially in Florida. Most hospitals won’t allow that practice.

Two hospitals in West Virginia have begun directly employing more doctors and paying their insurance to alleviate the doctor shortage. Many hospitals consider such an option too expensive.

At Bluefield Regional Medical Center in West Virginia, doctors are more careful now in delivering medicine, according to hospital president Eugene Palowski. But they are also much less willing to care for high-risk patients with multiple conditions, leaving them to find physicians in surrounding states.

Many patients are confused, or just plain angry.

Marine Hawkins, 20, of Boyle, Miss., was shocked to hear from her obstetrician that he was closing his practice – just two weeks before her due date of July 21.

The nearest doctor is 30 minutes away. She doesn’t have a car, and will have to rely on relatives to get there.

“This isn’t what I needed now,” she said.

On the Net:

www.ama-assn.org

www.juryverdictresearch.com

www.MedicalLiabiltyMonitor.com

Association of Trial Lawyers of America: www.atla.org

Lisa Snedeker in Las Vegas and Brian Farkas in Charleston, W.V contributed to this report.

And many more articles; here are four more.

1. AMA to Protest Insurance Costs — Miami Herald

2. Doctors, Lawyers to Air Dispute — Palm Beach Post

3. AMA’s call to arms: $15 million campaign aims to enact tort reform –Modern Healthcare

4. Medical Malpractice Remath — Miami Daily Business Review

——————————

AMA to Congress: Patients need medical liability reforms now

Patient access to care is now seriously threatened in many states, including Florida, Mississippi, Nevada, and Pennsylvania, the AMA told the House Energy and Commerce Health Subcommittee today in a written statement. “Due to large jury awards and the burgeoning costs of defending against lawsuits (including frivolous claims), medical liability insurance premiums are skyrocketing,” the AMA said.  “As insurance becomes unaffordable or unavailable, physicians are being forced to leave their practices, stop performing high-risk procedures, or drop vital services — all of which seriously impede patient access to care.”

Read more on the AMA Web site: http://www.ama-assn.org/ama/pub/article/1616-6471.html

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ITEM TWO: SECRETARY THOMPSON AND MEDICAL LIABILITY REFORM

President’s Forum today in Chicago

Secretary Thompson’s remarks were terrific and his comments on the need for medical liability reform THIS YEAR were outstanding.

HHS secretary speaks to specialty society leaders

Health and Human Services Secretary Tommy Thompson today received a standing ovation after emphasizing his support for modernizing Medicare, regulatory relief for physicians and medical liability reform to 130 leaders of organized medicine gathered in Chicago for the AMA Presidents’ Forum.  Thompson was the keynote speaker for the meeting, which prepares specialty society presidents, presidents-elect and CEOs to critically address the challenging issues facing their organizations today.  After his remarks, Thompson answered questions from the specialty society leaders on a variety of topics, including preventive medicine, bioterrorism preparedness and mental health parity.

Next year the meeting will be in Washington, DC in March and will be held just before Leadership meeting.

In addition to specialty society presidents and president-elect, the county and state medical presidents and president-elect will be among those invited next year.

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LAGNIAPPE

QUOTES ABOUT COURAGE:

http://www.quotationspage.com/subjects/courage

Courage is the price that Life exacts for granting peace.

Amelia Earhart, Courage, 1927

Life shrinks or expands in proportion to one’s courage.

Anais Nin (1903 – 1977), The Diary of Anais Nin, volume 3, 1939-1944

Courage is the ladder on which all the other virtues mount.

Clare Booth Luce, in Reader’s Digest, 1979

The bravest thing you can do when you are not brave is to profess courage and act accordingly.

Corra Harris

I would rather be a coward than brave because people hurt you when you are brave.

E. M. Forsterbb, as a small child

Courage is doing what you’re afraid to do. There can be no courage unless you’re scared.

Eddie Rickenbacker

A coward turns away, but a brave man’s choice is danger.

Euripides (485 BC – 406 BC), Iphigenia in Tauris, circa 412 B.C.

I wanted you to see what real courage is, instead of getting the idea that courage is a man with a gun in his hand. It’s when you know you’re licked before you begin but you begin anyway and you see it through no matter what.

Harper Lee, To Kill a Mockingbird, 1960

A timid person is frightened before a danger, a coward during the time, and a courageous person afterward.

Jean Paul Richter

Courage and perseverance have a magical talisman, before which difficulties disappear and obstacles vanish into air.

John Quincy Adams

Courage is being scared to death – but saddling up anyway.

John Wayne

If courage wasn’t a standard result of aging, it meant that the young could somehow acquire it as well.

Lawana Blackwell, The Courtship of the Vicar’s Daughter, 1998

Live as brave men; and if fortune is adverse, front its blows with brave hearts.

Marcus Tullius Cicero (106 AD – 43 AD)

Courage is resistance to fear, mastery of fear – not absence of fear.

Mark Twain (1835 – 1910)

It is curious that physical courage should be so common in the world and moral courage so rare.

Mark Twain (1835 – 1910)

The only courage that matters is the kind that gets you from one moment to the next.

Mignon McLaughlin, The Second Neurotic’s Notebook, 1966

Fortune helps the brave.

Publius Terentius Afer (190 BC – 159 BC), Phormio

A hero is no braver than an ordinary man, but he is braver five minutes longer.

Ralph Waldo Emerson (1803 – 1882)

When you meet your antagonist, do everything in a mild and agreeable manner. Let your courage be as keen, but at the same time as polished, as your sword.

Richard Brinsley Sheridan (1751 – 1816)

Keep your fears to yourself, but share your courage with others.

Robert Louis Stevenson (1850 – 1895)

Fortune favors the brave.

Virgil (70 BC – 19 BC), Aeneid

DJP AMA Update 9-11-2001

This e-mail contains two items:

ITEM ONE: Terrorist attacks in America

ITEM TWO: AMA President recovering from operation of last week

Hit delete if not interested.

Best regards and be on the alert and stay safe!

Donald

Donald J. Palmisano, MD, JD

AMA Secretary-Treasurer

E-mail: Donald_Palmisano@ama-assn.org

Or

DJP@donaldpalmisano.com

ITEM ONE: Terrorist attacks in America

Former Senator Monihan once said in the United Nations “The World is a dangerous place.”  Events of today again confirm that view.

Word from AMA Headquarters is that AMA employees at all offices and board members are safe.  I hope the same is true for your loved ones.

Dr. Ron Davis was in Washington, DC on AMA business, Dr. Duane Cady was in New York City, and Dr. John Knote was traveling.  My flight to Washington, DC today – to give AMA testimony on privacy- was canceled.  Dr. Tim Flaherty is in London and is safe.  Staff and Board leadership are in communication.  The AMA Washington, DC office and the New Jersey offices are closed.  Our AMA Headquarters in Chicago is open.

Our thoughts and prayers are with those killed or injured by the acts of evil people.  We have had disasters in our history and America always has risen to the occasion with honor and bravery.  I know we will do the same as a result of the dastardly acts of today.  Today we are ONE as AMERICANS, not divided into Democrats, Republicans, or Independents.

ITEM TWO: AMA President recovering from operation of last week

Dr. Richard Corlin, AMA President, had a pulmonary lesion removed at operation last week.  It was a BENIGN carcinoid.  I talked by phone with Dr. Corlin last night at his home. He was in good spirits.  He gave me permission to notify my pen pals of his operation and diagnosis.  We expect him back soon.  He obviously is not going to let this operation slow him down.

DJP Update 2-21-2001 Happy Mardi Gras!

Happy Mardi Gras!

This e-mail has nothing to do with AMA.  It is info about Mardi Gras in New Orleans.  Hit delete if not interested.

Best regards,

Donald

Happy Mardi Gras.  Tomorrow is “Fat Tuesday” in New Orleans, sometimes known as The Crescent City or  the Big Easy or the City That Care Forgot.

Mardi Gras is billed as the greatest free show on earth.

This year CNN’s Larry King is the King of Bacchus.

Below are some web sites that contain info about Mardi Gras, photos, and live cam cameras.

Caveat: Use discretion with the live videos from Bourbon Street.  Sometimes the scenes get a little wild in the French Quarter as evidenced by the last excerpt.

Best regards,

Donald

http://www.nola.com/

http://www.mardigrasfun.com/

http://www.mardigrasneworleans.com/balls.html

http://www.insideneworleans.com/events/holidays/

http://www.insideneworleans.com/events/special/mardigras.html

for Mardi Gras photos

http://www.satchmo.com/nolavl/mardigras.html

excerpt from this site:

“Police Relax Flashing Rules! New Orleans Police say they’ll let partiers walk on the wild side in the French Quarter this Mardi Gras. Last year, officers were overwhelmed when they tried to crack down on the female flashers …., primarily women lifting their shirts for strings of beads. Police Superintendent Richard Pennington said that this year, officers are being instructed to make arrests only when bare breasts pose a threat to public safety… “Have a good time,” Pennington said, “but please don’t overdo it.” ”

End of excerpt.