adam Speaker, President-Elect Sinclair, officers, members of the House of Delegates, and guests:

This morning, I want to begin by making a few comments about the state of ASA from my perspective as its President. This will be easy because I am pleased to tell you that today the ASA is strong!

The strength of a professional society is in its membership. Each year ASA membership sets new records. Our 39,336 members include 5,912 residents. As I have visited with them, I have found them to be well-trained young physicians who are bright, articulate and passionate about our specialty. ASA is strong, and our future is bright!

The strength of a professional society is related to its financial resources. ASA has very adequate financial reserves and will again this year finish with a healthy, black bottom line. ASA is financially strong.

The strength of a professional society depends on its governance. The new structure of governance which became effective at the close of the 2003 House of Delegates is working well. The addition of a 12th officer, the Vice-President for Professional Affairs Alexander A. Hannenberg, M.D., has filled a void that existed on the Administrative Council. ASA’s governance is strong.

The strength of a professional society depends on the staff in its offices. Executive Director Ronald A. Bruns has efficiently and effectively led ASA through a year where new directors of three divisions have been named. ASA’s staff is strong.

I want to introduce the three new directors to this House.

Gina A. Steiner is the new Director of Communications, and this is her first ASA Annual Meeting.

Richard E. Barwacz is the new Director of Finance, and while this is not his first ASA Annual Meeting, it is his first in this position.

Ronald Szabat is the new Director of the Washington ASA Office of Governmental Affairs. This is his first ASA Annual Meeting. He will succeed Michael Scott who has led the Washington office for 11 years and who will retire at year end.

Please join me in welcoming these new directors to the ASA family.

Also please join me in thanking Mr. Scott for his years of service to ASA and all anesthesiologists.

Yes, today ASA is strong

In my President-Elect address to this House of Delegates a year ago, I defined the essence of a physician in three words: compassion, science and involvement. Further, I laid out my vision for ASA — that ASA would be a Society that is driven by compassion, guided by science and involved in the political process.

A year has passed. I want to share with you what I have observed and learned this past year as your President about compassion, science and involvement.

This morning you will hear a recurring theme. It is my hope that it will resonate with you, as it is important.

In a small rural hospital, a lady had just given birth, and she suffered the complication of amniotic fluid embolism. Her condition was critical. The call went out to a regional referral center for help. The evacuation team knew that a member of the anesthesiology staff had expertise in this problem. The anesthesiologist was not on call but responded to the call for help, rode the helicopter to the small rural hospital, stabilized the mother and returned to the referral center with her. Over the next 24 hours, the anesthesiologist stayed by her side eventually using ECMO [extracorporeal membrane oxygenation] to stabilize the mother, who survived. Compassion and science at work. WHY?

It’s all about the patient because we have no other reason to exist.

The patient had a complex pain problem and was referred to a pain center a significant distance from home. Because of the distance involved, the patient’s family also made the trip. The problem was complex and required a number of days to be evaluated and a new treatment plan put in place. During this time, the families’ funds were exhausted. The pain physician, an anesthesiologist, invited the family into his home and provided for them until they were ready to return to their home. Compassion and science at work. WHY?

It’s all about the patient because we have no other reason to exist.

One of our academic anesthesiology departments I visited this past year is involved in significant research in the area of shock and trauma. They realized that there was no research center that was devoted to improving combat casualty care through research and development. Operation Purple Heart was born. This anesthesiology department is taking the lead in developing the funding, $100 million, to make this center a reality and to improve the chances of survival of the brave men and women who are wounded defending our great land. Compassion and science at work. WHY?

It’s all about the patient because we have no other reason to exist.

The anesthesiologist arrived at a hospital where the anesthesiology department was a division of the surgical department. With hard work over a number of years, the anesthesiology department attained the status of an independent department. In the meantime, the anesthesiologist became a member of the hospital board of directors, and the surgery department sought his advice as they addressed problems facing them.

This is involvement in the process that defines how we practice. WHY?

It’s all about the patient because we have no other reason to exist.

Four ASA members are members of their state legislatures:

Maryland State Senator Andrew P. Harris, M.D.

Michigan State Senator Tom M. George, M.D.

Texas State Senator Kyle L. Janek, M.D.

Missouri State Representative Sam L. Page, M.D.

In addition, Montana anesthesiologist Gregar H. Lind, M.D., is a candidate for the Montana state senate [Dr. Lind was eventually elected.]

Please join me in recognizing these involved anesthesiologists.

WHY DO THEY DO IT?

These anesthesiologists understand the link between medicine and politics.

It’s all about the patient because we have no other reason to exist.

But what about the rest of us? Do we understand the link?

There are two issues that are tightly linked to our future, and they are political in nature.

The first issue involves the unfair payment treatment of our teaching anesthesiologists by Medicare. This issue is crucial to our future because if our training programs fail, there will be no more anesthesiologists. Medicare must treat us fairly! In July, ASA learned that the Centers for Medicare & Medicaid Services (CMS) would not change this rule.

Today I need to tell you that ASA is pursuing the change in this rule with additional lobbying help and with the help of an additional lobbying firm and all the resources available to us in Congress and at the White House.

The second issue is equally as crucial. If our newly trained anesthesiologists are unable to find affordable medical liability insurance, even though well-trained, they will be unable to practice anesthesiology. We must have tort reform!

What is the solution?

Involvement in the political process, which defines the practice of medicine today. WHY?

It’s all about the patient because we have no other reason to exist.

Three words define the essence of a physician: compassion, science, involvement. WHY?

It’s all about the patient because we have no other reason to exist.

The author of the Old Testament book of Joel wrote:

“…your old men shall dream dreams…”

I thought this qualified me, so I want to share three dreams I have about the second century of ASA.

I dream that ASA will have a theme to lead it into its second century. Here is one worth considering! You have already heard it several times this morning!

It’s all about the patient because we have no other reason to exist.

I dream that one day there will be an Institute of Perioperative Medicine at the National Institutes of Health. As medicine becomes more specialized, anesthesiologists are the physicians who should care for the patient throughout the entirety of the surgical experience — preoperatively, intraoperatively and postoperatively. We need to be there. In addition, pain control and critical care are areas that belong to us. WHY?

It’s all about the patient because we have no other reason to exist.

I have a dream that, one day, anesthesiologists, certified registered nurse anesthetists and anesthesiologist assistants will share training and education so that the best parts of all the disciplines can be brought to the bedside of our patients. That one day, a single organization will represent all the anesthesiologists, nurse anesthetists and anesthesiologist assistants because our resources are limited, but the need for the care we provide is not limited. Only when we are united in purpose will we be able to devote our limited resources to the unlimited anesthesia needs of our patients.

The anesthesia needs of all the patients in this great land, the United States of America demand no less! WHY?

It’s all about the patient because we have no other reason to exist.

Beginning at 12:30 today, this House will discuss many issues of importance to ASA and every anesthesiologist. I ask each of you to bring an open mind to those discussions.

Debate the issues freely and fully.

A principle that always needs to be remembered is this: People of goodwill can disagree on issues, even contentious issues, without becoming disagreeable!

On July 4, 1939, Lou Gehrig stood before a microphone in a packed Yankee Stadium and called himself “the luckiest man on the face of the earth.”

I stand before this microphone today to echo his words.

You have given me the greatest honor an ASA member can receive. That honor is to be your President and represent every anesthesiologist for a year. I am humbled by this honor.

No one can do the work of the ASA President without help.

Last year I asked for your prayers, and you have given them to me. They have sustained us. Our travel has been safe.

I have been supported by an excellent staff in Park Ridge, Illinois, and Washington, D.C.

I have been supported by an Administrative Council that is fiercely loyal to our specialty.

I have been supported by President-Elect Eugene P. Sinclair, M.D., and First Vice-President Orin F. Guidry, M.D., as members of the Executive Committee. They have given me immeasurable help this year.

There is one unsung hero in the audience today. She is my beautiful wife, Ona, the first lady of ASA. I am asking her to join me here on the podium.

As the first lady of ASA, she has traveled by my side throughout this year and represented you with dignity, charm and grace.

Many times this year we would return to the Roanoke Valley and our home after dark. As we approached our landing at Roanoke Regional Airport, this would be the view we would see. The illuminated star atop Roanoke Mountain was a sign we were home in Roanoke, Virginia — the star city of the South!

We shall never forget this year! We thank you for the memories! I pray that God will continue to bless ASA and our great land, the United States of America.

I close this, my final address to the ASA House of Delegates, with this old Irish blessing:

May the road rise up to meet you.
May the wind always be at your back.
May the sun shine warm upon your face
and rains fall soft upon your fields.
And until we meet again,
May God hold you in the palm of His hand.

The following are my closing comments to the House of Delegates:

This morning I want to leave you with a challenge, an opportunity, for the ASA centennial year.

Our Rovenstine Lecturer, Jerome H. Modell, M.D., spoke passionately about the past, present and future of our specialty. He told us what we could accomplish if each anesthesiologist was willing to donate only 0.8 of 1 percent of our annual income to our specialty, we would raise more money for anesthesiology than we presently receive from the National Institutes of Health!

The U.S. Marines have a saying: “When the going gets tough, the tough get going!” The financial times in our specialty are tough, and so it is time, no, past time, for us to get going! CMS MAY or MAY NOT change the teaching rule. We cannot wait for CMS to save our specialty. We MUST do it ourselves! OPERATION RESCUE is long overdue!

We can leave no greater legacy to the future generation of anesthesiologists who will follow us than the fact that in its centennial year, ASA and the anesthesiologists of America accepted the challenge, no, the opportunity, and began to save our specialty.

President Ronald W. Reagan often spoke of America becoming a shining city on a hill for all the rest of the world to see.

ASA has a unique opportunity, in its centennial year, to become a shining specialty Society on a hill for all the rest of medicine to see as we begin to save our own specialty! Today let us commit to launching OPERATION RESCUE!

Roger W. Litwiller, M.D., is Chief of Anesthesia Services, Chief of Special Medical Services, Member of the Executive Committee of the Professional Staff and staff anesthesiologist, Carilion Roanoke Memorial Hospital, Roanoke, Virginia.