The American Medical Association continues to develop reports and "ethical" guidelines that affect forensic psychiatric practice even though the origin of the concerns sometimes arise from nonpsychiatric practitioners. Three were of special interest during the interim meeting in December 1998. As with any "legislative" process we have some direct input in terms of our ability to testify at the Reference Committees and some indirect input in terms of our ability to influence the voting members (APA) in the House of Delegates. Also as AMA members, we can communicate with the committees and the staff that drafts the reports between meetings. In spite of this, reports and guidelines get passed that we would disagree with or prefer to see rewritten. Motions for reports to be reexamined can be made but, as with any political process, this is not easy.
A particular problem, said a representative from Florida, involves physicians who cross state lines, deliver egregiously inaccurate "expert" testimony, then return home, highly paid and unscathed - with no accountability to anyone. At the Annual Meeting last June, the delegates adopted the policy that physician expert witness testimony was considered the practice of medicine, opening the door to peer review - and, if warranted, discipline -of the witnesses. Florida, in fact, had moved forward and established such peer review panels. A number of other physicians suggested there should be some mechanism for temporarily licensing out-of-state witnesses, at a nominal fee or no cost, so they could be held accountable in the states in which they testify. The complaints came predominantly from non-psychiatrists.
The AMA Board of Trustees issued an extensive report on the topic in December 1998, affirming the AMA s commitment to work with the appropriate entities to solve problems regarding out-of-state expert witnesses. It also mentioned, however, difficulties involved with assembling appropriate peer review panels, including the possibility of subjecting those conducting the "peer review" to legal risk. On the whole, I thought the report was well balanced and is worthy of your review. It can be found on the web for AMA members and we have copies in our central office.