t the 2003 Legislative Conference, Senator Hillary Clinton (D-NY) made a presentation that, among other issues, recognized the contributions of anesthesiology to patient safety, specifically describing pin-indexing and key-indexing of anesthetic gasses and agents. In fact her reference was as specific as referring to an oxygen “E” cylinder. A member of the Committee on Governmental Affairs was surprised at the depth of her knowledge, even to the level of using the correct technical language. He also noticed that there was a neurosurgeon in the senator’s accompanying group. Apparently this neurosurgeon was serving a sabbatical year as a “fellow” to the senator.¹

In August 2003, the Committee on Governmental Affairs submitted a recommendation to the Board of Directors that ASA create and support an ASA public policy fellowship modeled on that of the American Academy of Neurology (AAN). The AAN policy was to encourage younger members, such as individuals who had just completed their residency, to serve in these positions. The recommendation was approved with an $80,000 stipend for a fellow to serve every other year. The first (2005-06) ASA Lansdale Public Policy Fellow was William G. Horton, M.D., who is from the Virginia Mason Clinic in the Washington State (the other Washington!), but is a retired member. The second (2007-08) ASA Lansdale Fellow is Joshua L. Lumbley, M.D., an anesthesiology resident from Texas who is sandwiching the fellowship between his CA-2 and CA-3 years. He is presently doing his residency training at the Brigham and Women’s Hospital in Boston.

There are several hundred congressional fellows — usually individuals with established careers and areas of expertise — who observe and learn about the congressional processes in Washington. They cover a wide range of subjects and also may serve the uniform services, federal agencies and national laboratories. Fellows seek assignments in the offices of members or committees of either the House of Representatives or the Senate, where they may work either within or outside their area of expertise. Dr. Horton has likened the environment as very much akin to being a student at one of the nation’s largest graduate schools.² At this “school,” however, you are playing for real as opposed to undertaking some theoretical or academic exercise.

ASA’s public policy fellowship was named after Jack Lansdale, an attorney from Squires, Sanders & Dempsey in Chicago who was instrumental in protecting the practice of anesthesiology as we know it now.³ Mr. Lansdale (1912 -2003) was appointed as ASA legal counsel in the late 1940s by Leroy D. Vandam, M.D. (also from Brigham and Women’s). Anesthesiology was in its infancy and, together with radiology and pathology, was considered to be a hospital service. His work, together with ASA leadership in 1961,⁴ succeeded in battling hospitals and insurers to obtain recognition that the practice of anesthesiology is the independent practice of medicine. In 1965, with the passage of the Medicare bill, early legislation contemplated placing anesthesia again under the control of the hospitals, with reimbursement coming from Medicare Part A, effectively killing anesthesiology as an independent practice of medicine. Despite vigorous opposition from the American Medical Association, ASA refused to oppose the Medicare program itself. That action would have lost any chance that anesthesiology could remain independent. Mr. Lansdale and 1965 ASA President, Perry P. Volpitto, M.D., testified before the Senate Finance Committee and were successful in maintaining the independent practice of anesthesiology.⁴ Ironically Medicare A is playing an increasing role for reimbursement for resident training programs and possibly Rural Access, but for reasons that few could have predicted in the 1960s. The third political battle in which Jack Lansdale was directly involved was the challenge by the Federal Trade Commission that the Relative Value Guide was antitrust. When other societies were signing consent decrees with the Department of Justice and in the face of strong skepticism by AMA, ASA stayed the course and prevailed in 1979. If there were ever an individual who was prepared to take on political and other organizations, it was Jack Lansdale. The fellowship is aptly named.

One of the conditions of the fellowship is an annual report to the ASA NEWSLETTER. Dr. Horton (also from Brigham and Women’s!) has submitted three reports^2,5,6 that describe some of the depth and breadth of his experience. Initially he was on staff of the House Policy Committee, chaired by Rep. John B. Shadegg (R-AZ). This committee considered Medicare physician payment, health care information technology development and avian influenza with its associated vaccine and antiviral issues. In summer 2005, Hurricane Katrina struck. September 2005 was occupied with evaluating the federal response to that disaster and also preparation for a pandemic influenza outbreak. An interesting observation made by Dr. Horton was the challenge to reduce an extremely complex scientific field into language that individuals with a limited science backing are able to understand.

The second session of the 109th Congress brought a change in leadership of the House occasioned by Tom Delay’s resignation. Dr. Horton joined Rep. Shadegg’s (now no longer House Policy Committee chair) personal staff to work on the Health Care Choice Act (H.R. 2355 and S.R. 1015), which would allow interstate commerce in health insurance plans. Unfortunately they were only able to muster 210 votes, eight short of the magic number of 218 to ensure passage. Dr. Horton’s second article⁶ describes much more of the ins and outs of the political process and the forces surrounding any particular issue as well as some of the other more human issues. He ends his piece with the comment that “we are a nation closely divided on many philosophical issues,” which makes resolution of differences very difficult. This article, combined with a third article that describes the turmoil in August just before the recent elections, reflects some of the disquiet surrounding the political process. It is not surprising that Congress, the White House, the Administration and the political process is presently held in such low regard by the community as a whole. Many feel that Congress is unable to take any action in addressing urgent issues and is more focused on partisan issues.

This should not, however, deter ASA and its members from being involved. If anything participation should be even greater now than before. Health care is a major issue only overshadowed by the Iraq war. Many feel that the existing system is about to undergo significant and possibly radical change. Times of change both represent times of great opportunity and also great risk. We should heed Dr. Horton’s last comment in his second report. “Physicians also must understand the system if they have any interest in influencing the effect of government on their lives and their patients. The best way for each of us to begin is by learning how the government affects our daily lives and our practices at the local level."⁵

The Committee for Governmental Affairs and ASA look forward to receiving Dr. Lumbley’s reports, another perspective under a different political leadership in a changing health care environment.

For those interested in obtaining further information, the ASA Web site (Office of Governmental and Legal Affairs) has a synopsis of the requirements and conditions.

References:
1. Goudine Scott. Personal communication.
2. Horton WG. The first semester of a congressional fellowship. ASA Newsl. 2006; 70(8):22-23.
3. Scott M. Jack Lansdale (1912 -2003), Remembered with awe and affection. ASA Newsl. 2003; 67(10):3-4.
4. Bacon DR. Henry Kissinger and P4P. ASA Newsl. 2006; 70(8):1-2.
5. Horton WG. Tuesdays at the White House: My second semester as a congressional fellow. ASA Newsl. 2006; 70(9):19-21.
6 Horton WG. Epilogue: A time for sowing grassroots. ASA Newsl. 2007; 71(1):24-25.

Richard M. Flowerdew, M.D., is an attending anesthesiologist, Spectrum Medical Group, Portland, Maine.