minutes of the bureau of the world association of societies of pathology …€¦ · ·...

Minutes of the Bureau of 79

20. August – 21. August 2007 Petaling Yaya, Kuala Lumpur, Malaysia

MINUTES Of

The Bureau of the World Association of Societies of Pathology And

Laboratory Medicine

20. August - 21. August 2007 Petaling Yaya

Kuala Lumpur, Malaysia

Agenda of the Bureau Schedule of Events 20 August 2007 0900 – 1700 Bureau Meeting (incl. Lunch) Caribbean Level 20 August 2007 1930 – 2200 President’s Dinner (Dr. Melo) 21 August 2007 0830 – 1000 Opening Ceremony 21 August 2007 1200 – 1600 Bureau Meeting (incl. Lunch) Bermuda Level 21 August 2007 1600 – 1800 World Pathology Foundation Meeting

Bermuda Level 22 August 2007 0900 – 1300 House of Representatives (incl. Lunch) Carribean Level 22 August 2007 1400 – 1800 New Bureau Meeting Cancun Level 22 August 2007 1930 Gala Dinner – Auction 23 August 2007 1630 – 1730 Closing Ceremony



Scheduled Attendees: Dr. Marilene Melo Brazil Dr. Mário Flávio Alcântara Brazil Dr. Robby Bacchus U.K. Dr. Gonec Ciliv Turkey Dr. David Davies Australia Dr. Alfred Hartmann U.S.A Dr. Gamze Mocan Kuzey Turkey Dr. Utz Merten Germany Dr. Mikio Mori Japan Dr. Michael Oellerich Germany Dr. Paul Raslavicus U.S.A Dr. Henry Travers U.S.A.

Administrators:

Dr. Masami Murakami Japan Dr. Ikunosuke Sakurabayashi Japan Mr. Susumu Kanda Japan

XXV World Congress Progress Report: Dr. Debra Graves Australia

Ms. Eve Propper Australia Attending by Video Conferencing: Dr. Raj Dash U.S.A Apologies for Absence:

Dr. Manfred Böhm Austria Dr. Tjaart Erasmus South Africa Dr. Oh Hun Kwon Korea Dr. Barrie Murphy U.K. Dr. Marc-Andre Viollier Switzerland



WASPaLM Bureau Meeting Schedule Malaysia 2007

- August 20th – 9:00 – 17:00 08:00 – 09:00 - Continental breakfast

09:00 – 09:15 – Welcome to attendees:

a) –Apologies for absences:

b) – Attendees - Nomination

c) – Guests

d) – Administrators

09:15 – 10:00 – Review of Action Items of Bureau Meeting in Chicago (pages 6 - 8):

10:00 – 10:30 – Reports of Officers – 10 minutes each (approximately)

a) President (pages 9 - 12)

b) President-elect (pages 13 - 17)

c) Secretary Treasurer (pages 18 - 19)

10:30 – 10:45 – Break

10:45 – 11:30 - Report of Directors – at – Large - 05 minutes each (approximately)

a) Dr. Paul Raslavicus – North America (pages 20 - 22)

b) Dr. Mario Flavio – Latin America (pages 23 - 24)

c) Dr. Tjaart Erasmus – South Africa (pages 25 - 26)

d) Prof. David Davies – Australasia (pages 27 - 37)

e) Prof. Gamze Mocan Kuzey – Turkey (page 38)

f) Prof. Oh Hun Kwon – Asia (no report)

g) Dr. Manfred Böhm – Europe (no report)

11:30 – 12:15 Report of WASPaLM Tokyo Administrative Secretariat

a) Report of Executive Director - Dr. Murakami (page 39)

b) Agreement regarding organization and operation of the

Administrative Secretariat (pages 40 - 43)

c) Proposed bylaws change – Mr. Susumu Kanda (page 44)



12:15 – 12:30 Review of WASPaLM Membership (secretary-treasurer)

d) current society membership (page 45)

e) bylaws change (page 46)

12:30 – 13:30 - Working lunch – Discussion of “issues”

Director’s insurance

Structure of the secretariats

Expanded administrative office (education, fund raising)

WASPaLM’s role in SNOMED CT (Raj Dash)

13:30 – 14:00 – Report of Secretariat of Education – 10 minutes each (approximately)

a) - Robby Bacchus – Future Plans (pages 47 - 48)

b) - Mario Flavio – Future Plans (pages 49 - 51)

c) - Discussion

14:00 – 15:30 – WASPaLM and the WHO

15:30 – 16:00 – Break

16:00 – 17:00 - Web site (Informatics report, Raj Dash), (pages 52 - 56)



- August 21st - 12:00 – 16:00

12:00 – 13:00 – Reports of Secretariats and Committees

a) – COWSA – Alfred Hartman – (pages 57 - 59)

b) – SEQUA – Hans Reinauer – (pages 60 - 62)

c) – Ethics in Pathology and Laboratory Medicine –

David Davies – (pages 63 - 76)

d) - Committee on Qualification of Pathologists –

Manfred Böhm –

13:00- 14:00 – Working lunch

14:00 – 15:00 - Organizations and Affiliations

a) WHO – Utz Merten, Robby Bacchus (pages 78 - 82)

b) CLSI –

c) CIOMS – Robby Bacchus

d) ISO –

15:00 – 15:15 - a) Administrative Secretariat

b) – Corporate Sponsors

15:15 – 15:45 - Review of World Congress

Sydney 2009 – Dr. Debra Graves, Ms. Eve Propper (pages 83 – 90)

Milan / Rome 2010/2011 (page 91)

15:45 – 16:00 – Other Business

16:00 – 18:00 – World Pathology Foundation

(Separate WPF Agenda and Documents)



Review of Chicago Minutes and Review of Status of Assigned Tasks

Task Assigned Status # 1: Reconfirm that Taiwan will be an active member in the future. Bureau is open to participation of mainland China in WASPaLM.

Dr. Mori complete

# 2: Following recommendation proposed by Dr. Rodriguez (to be discussed with Constituent Societies and to be proposed and voted on in Malaysia) the text for section 3.2 (a) should be amended as follows: Section 3.2 Qualifications. (a) Membership in the Association as a Constituent Society shall be open to national or international societies whose governing body is composed of at least 50% lawfully qualified physicians specializing in the practice of pathology and/or laboratory medicine.

House of Delegates

Amendment approved by the Bureau; Dr. Merten to present to the House of Representatives

# 3: Bureau recommends to strive for CME accreditation for the World Congresses and ask the Constituent Societies to become active in this. For the upcoming Malaysia meeting, the Bureau members are encouraged to contact their societies regarding CME accreditation. For the Sydney meeting, RCPA will begin the process of investigating CME accreditation.

Organizers of World Congresses

Complete; Secretary- Treasurer to contact member societies regarding CME accreditation

# 4: A. Allocate funds for a single 2007 educational program to be directed by Dr. Bacchus in India. The budget will accommodate a cost of up to 10,000 USD for this program. 7,000 USD will be derived from the Japanese office and 3,000 USD from the US-WASPaLM account. Collaboration and sponsorship with other organisations such as IAP is encouraged. B. Allocate funds for a single 2007 educational workshop to be directed by Dr. Mario Flavio Alcantara in Latin America (Accreditation Workshop, Lima, Peru). The budget will accommodate a cost of 2,000 USD for this program to be derived from the Japanese office. C. A detailed budget for allocation of provided funds will be circulated to the bureau for review. The Bureau recommends the use of the website for the educational programs and to seek out collaboration with other organisations, such as the ASCP that already have educational programs available.

Administrative Secretariat Dr. Bacchus, Dr. Alcantara

Complete; USCAP permission granted; funds allocated (see action items).

# 5: Dr. Oellerich proposes that the President-Elect prepare a report for the Bureau detailing the risks covered by the various Directors insurance policies and associated costs of these policies

Dr. Travers Complete; director’s insurance in



to be submitted for review electronically within the next 3 months place # 6: Dr. Oellerich requests funding in the amount of US $100 per month required to offset effort required by administrative assistant over his term in office that has occurred for the past year and will continue for at least one year (two years of funding with a total budget allocation of US $2400) at which time this funding will be re-evaluated. The Japanese account will reimburse the main WASPaLM account on a semi-annual basis for this expenditure. Motion by Dr. Oellerich, seconded Dr. Davies; Dr. Oellerich excused from discussion and voting: VOTE: carried, unanimous, 0 abstentions. Discussion regarding investment strategies: Certificate of Deposit or US Treasury Bonds can provide guaranteed return on investment. Dr. Raslavicus: who has check writing authority for Japanese and / or US accounts? Is a 2nd signature required above a certain amount (e.g. $50,000 maximum)?

Administrative Secretariat

Complete

# 7: Dr. Raslavicus proposes that Dr. Oellerich and Pete Travers draft a policy regarding the disbursement of funds from accounts and recommends that a single individual be granted the authority for control all WASPaLM funds. Motion: Dr. Raslavicus, seconded by Dr. Hartmann; VOTE: 1 against, 0 abstentions, motion carries. Dr. Oellerich further recommends that we establish a mechanism for permitting an internal audit as part of the above-mentioned policy. The selection of an internal auditor should follow establishment of the Director’s insurance.

Dr. Raslavicus, Dr. Travers, Dr. Oellerich

incomplete

# 8: Chair of the ethics committee of WASPaLM and the President will provide a statement for South American countries addressing the issue of A. illegal honorary splitting and B. securing and protecting potentially dangerous biohazardous materials that could be misued.

Dr. Davies Incomplete;

# 9: Dr. Oellerich asks that Dr. Davies provides a condensed version to the President for use as an article in Bulletin directing readers to sources of information. Dr. Oellerich requests approval from the RCPA via Dr. Davies for permission to publish certain aspects of the “pathology update 2006” CD onto the website (copy provided to the Bureau members).

Dr. Davies Complete

# 10: On site visit and the evaluation by the President for the upcoming Congress in Malaysia 2007 is desireable with a report back to the Bureau

Dr. Melo Complete

# 11: Dr. Davies recommends that Bureau should agree in principle to extend invitation to Dr. Vercauteren to Bureau meeting in Malaysia, explore political and administrative ramifications, and to engage in contingency planning if costs of travel must be covered by Bureau. Dr. Bacchus will organize. Dr. Melo will extend letter of invitation.

Dr. Melo Complete; Dr. Vercaut-eren could not attend

# 12: A. Dr. Hartmann will provide a written outline highlighting Dr. Hartmann, incomplete



WASPaLM’s involvement in standard setting activities. B. Dr. Dash will post this document on the WASPaLM website. C. Dr. Hartmann will inquire whether draft documents may be disseminated to constituent societies for review and what type of information may be posted to the WASPaLM website (with registration level security if requested). Dr. Hartmann will identify what authority and responsibilities WASPaLM, as a liason member, has in regards to ISO generated information. D. Dr. Hartmann will report back to the Secretary who will distribute to the Bureau.

Dr. Dash

# 13: Dr. Davies will draft a position statement in regards to WASPaLM ethics as proposed above for review by the Bureau.

Dr. Davies Complete

Action Items Regarding the Review of Assigned Tasks: ACTION ITEM #1: Dr Merten to draft amendment to be presented at House of Representatives. ACTION ITEM #21: Secretary/treasurer to correspond with representatives in Australia, Japan, Europe, the USA, and the UK to contact organizations for CME accreditation in their regions. Program from Sydney required for this. ACTION ITEM #3: The Secretary-treasurer will communicate with USCAP for permission to place a link to USCAP on WASPaLM website. ACTION ITEM #4: Re-authorize funding for an administrative assistant for Secretary-treasurer at $100 per month for period of 12 months beginning September 2007. ACTION ITEM #5: Authorize Secretary-treasurer to request a local certified accountant to audit WASPaLM accounts in the United States annually. Bureau authorizes up to US$300 for this audit. Initial audit to be completed for calendar year 2007.

1Motion by Dr. Bacchus and Dr. Alcantara, seconded by Dr. Davies, past unanimously without abstentions.



Report of WASPaLM Officers

President’s Report Dear colleagues and friends, When I was invited to be President-elect I was proud to be the first woman of the history of WASPaLM to assume this position. Today I am pleased to report that we reached many important goals. Communication - Communication among us Bureau Members and with Constituent Societies gained quite an improvement with the new web site, supported for free by Control-Lab, which made it more attractive and functional. We had good feedback from the Constituent Societies, which sent me their logos, summaries of their activities as well as their congresses calendar. I received many invitations to attend to their National Congresses. Corporate Sponsors also corresponded to our requests providing information about them to be post in our site. This quick exchange of communication and the possibility to use the web site has generated an appropriate environment for communication such as Elections 2007, which is happening now electronically for the first time. Thanks to Bureau members we could create the “Gallery of Presidents” to honor our colleagues who worked for WASPaLM collecting photos of these great and unforgetable doctors.

Considering job activities I have exchanged about 4800 e-mails during my first term among the Bureau members and Directory and approximately 3600 e-mails during my second term. What touches our Constituent Societies I sent over 960 e-mails in my first term and 1440 e-mails in my second term considering the large use of the web site. What a number!! This was possible thanks to Suely, my secretary, who helped me out for three hours in this task everyday.

This dynamic attitude of all of us and presidents of Constituent Societies motivated us to work as we were together.

Ethics - After being invited to give a lecture on Laboratory Ethics in Marmaris – Turkey during their National Congress in 2004, I was touched with this matter and decided to fight for it worldwide. And this was exactly what I did: giving lectures in several



congresses and insisting with the Constituent Societies to include this important matter in their agenda.

Thus I created a questionnaire with the help of David Davies and we researched about Ethics among our Constituent Societies.

Constituent Societies - Old Constituent Societies that had quitted us answered positively to our request and now are coming back to WASPaLM: Israel, Ireland, Mexico, Cuba and Bolivia, France and Singapore.

New Societies showed interest in belonging to WASPaLM such as: Romania, China, Peru, Brazilian Society of Pathology, and Ecuador.

Societies 2003 2005 2006 2007 Constituent Societies 22 26 28 29 (French) Associate Societies 03 07 06 06 Corresponding. Societies 02 02 02 02 T O T A L 27 35 36 37 Total of countries = 28 We are getting bigger and more important. We are accomplishing our mission Education Programs - In ‘The Program of Education in Countries in Need’ there were 2 workshops in Asia, conducted successfully by Robby Bacchus one in New Delhi between 17th – 21st January 2005 gathering 340 attendees, another in Bangalore on February 1st – 3rd 2006 gathering 426 participants as well as WASPaLM Workshop Accreditation Programs In Latin America. The first one was held in Uruguay in on 24th-26th of October 2006 gathering 100 attendees and the second one in Peru - Lima held on 25-27 April 2007 with 510 attendees conducted by Mario Flávio and Brazilian Society of Clinical Pathology. International Congress – Fortunately we have scheduled up to 2011.

One year before the 23rd World Congress, which was held in Turkey – Istanbul in 2005

and 24th World Congress now in Malaysia – Kuala Lumpur, I travelled to these two countries to prepare the Congress, meeting the Organizing Committee as well as their Presidents to discuss relevant issues for the congresses. This was very productive, and I suggest doing the same for the future ones.



Finance - Mikio Mori as Chair of Corporate Sponsors Committee with the help of our Japanese Colleagues are providing financial support to WASPaLM. Since Bureau Meeting in 2006 of Chicago we decided to invest our money in Japan in safe investments. The result is bringing positive earnings.

Bulletin - After several years in silence we again have our Bulletin published since 2006 under Pete Travers responsibility.

Bylaws – Substantial changes to the Bylaws have been intensively discussed since 2006 and will be approved, I hope so, in this House of Delegates. Incorporation – WASPaLM is now incorporated under the laws of the State of Illinois in the United States as a not-for-profit corporation.

WHO – WASPaLM had an active participation as a NGO in the World Health Organization in important meetings. We could involve WHO through Dr. Vercauteren (our direct contact in WHO) for our Educational activities.

Utz Merten, Mario Flávio and Robby Bacchus represented WASPaLM at 57th WHO Assembly in May 2004 and since then Utz Merten and Robby Bacchus are representing WASPaLM at WHO meetings and assemblies. This year they have attended Executive Board 120th Session, Geneva, January 22nd to 31st, 2007 and the 121 Session of the Executive Board Meeting which was held in 24 to 26 May, 2007. Our representatives also met with Mr. P. Cerf, Counsellor Federal Foreign Office, Berlin, member of the German delegation regarding the establishment of a common Health Terminology based on SNOMED CT. CIOMS – WASPaLM had strong participation at CIOMS in the International Bioethics Colloquium and did as well a very good job performed by Secretariat on Medical Ethics in Pathology and Laboratory Medicine by David Davies contributing with comments on ‘Special Ethical Consideration for Epidemiological Research”.

WPF – I have been motivating applicants for WPF scholarships throughout Brazilian and Latin America Societies resulting in 11 candidates for the fellowship this year. Consequently we had to vote on three of them.

I can proudly state that our current Directory accomplished the entire five important goals and the noble mission of WASPaLM.



Thank you all,

Marilene Melo

Report of the President-Elect

Introduction As President Marilene Melo noted in her report, the leadership of WASPaLM and the World Pathology Foundation, with the able assistance of our Administrative Secretariat, has worked very hard over the last year to expand the membership and influence of WASPaLM worldwide. Modifications to our bylaws that we expect to be adopted at the 24th World Congress, will permit societies formerly excluded from membership to become part our Association. Unchanged from my previous report to the Bureau, however, are most of the significant challenges I had discussed with you. While cooperating with member societies in the conduct of biannual World Congresses, our expanded work with the WHO and COIMS, and our outstanding educational programs effectively promote pathology, we wtill have no secure and sufficient mechanism for funding even our basic structure, while at the same time adding ongoing operating expenses (funding Bureau meeting attendance, the Administrative Office and the office of the President as well as funding WHO meeting attendance; insurance expense; expenses related to incorporation). We continue to lack the financial base to indefinitely extend one of our most successful programs, education for pathologists in countries with limited resources. In spite of our connection to ISO through COWSA, we receive no input or help from either member societies or individuals when ISO laboratory standards are proposed, discussed and adopted. Changes in laboratory practice throughout the world – including the United States – have included (1) increasing market share for large national laboratories; (2) decreasing influence of pathologists in the clinical laboratory; (3) increasing influence of instrument and reagent manufacturers in test menus and laboratory instrumentation; (4) technologic advances in anatomic pathology that will ultimately lead to digital and molecular solutions to diagnosis formerly provided by morphology. International societies are currently polarized between anatomic and clinical pathology, and WASPaLM rides on a middle road between them: our By-laws insist on our influence on both pathology and laboratory medicine, yet both the International Academy of Pathology and the International Federation for Clinical Chemistry are the organizations to which pathologists and laboratory specialists turn for technical support, standards guidance and practice models. Our national societies, some of them member societies in WASPaLM,



handle local political, economic and practice issues nearly always without turning to WASPaLM for advice. It is in this environment of challenge that the Bureau, the central leadership of WASPaLM, must develop fiscal and operational strategies that further the interests of our membership.

Significant Challenges for 2007 to 2007: Proposals to the Bureau

Our primary challenge is to secure on-going funds to support the organization. This year we experienced a substantial reduction in contributions from corporate sponsors. We have previously identified the need to expand these sponsorships, but have found little support in Europe, the US, Australasia and Africa. While we should continue and expand our efforts with corporations, we need to seek other sources including World Congresses, philanthropic organizations, member societies and the development of services which create income. Our current resources cannot sustain the Association. Our annual budget approaches US$ 90,000:

Bureau Travel US$ 40,000 WHO/Other meeting travel US$ 6,000 Educational Programs US$ 25,000 Administrative Expenses US$ 12,000 Miscellaneous Expenses US$ 5,000

We cannot develop income sources to meet this need without staff support; thus an important strategic plan continues to be the expansion of a corporate office with a staff dedicated to developing funding sources as well support for World Congresses and education.

Advantages of an increased number of staff with specific skills include (1) full time efforts at fund raising; (2) central planning for World Congresses, such “last minute” items as the Gala Auction and educational programs; and (3) a decreased aministrative burden for officers. Risks of increasing the number of staff include (1) loss of funds from our treasury should the effort fail; (2) legal issues with employees related to their employment; and (3) new personnel management requirements for our existing part-time staff.

I propose the Bureau consider hiring two new full time employees for a period of two years in the Administrative Office. Salaries for each of these individuals will be approximately US$ 50,000 with 18% additional in benefits. Thus the two employees would cost WASPaLM US$ 118,000 or US$ 236,000 for the two year period. Requirements for these people would include fluency in English and training or experience in fund raising, marketing or meeting planning. In the worst case, WASPaLM



will lose $236,000; in the best case, we will raise sufficient funds to support these positions and more. Of the opportunities for funding, I consider philanthropic support and greater contributions from our member societies to be the most likely to provide what we will need. At the present time, except for a possible opportunity related to SNOMED about which you will hear from Raj Dash, I do not see WASPaLM in a position of providing any services other than those that may be incident to the web site. In keeping with an action of the Bureau last summer, we need to maximize the value of our existing treasury by investing monies at interest. Because of differences in banking laws, funds in Japan do not earn us as much as we would like. We need to take steps to place funds in banks outside of Japan to increase our return. World Congresses continue to be an important focus for WASPaLM. World Congresses planned through 2011, but attendance is based upon the member society’s local meeting, including companion meetings. WASPaLM can assist in strengthening the value and attendance by taking a number of steps:

• Require organizing societies to pay an up-front fee to WASPaLM to conduct a World Congress

• Work 3-4 years in advance with the WHO, commercial corporations and local governments to support World Congresses offering short and long courses that will assist local and regional pathologists and laboratory scientists in their practices; this support would include travel stipends, speakers and so forth

• Utilize the new employees in the Administrative office work with member societies, WHO, other international societies, and industry to coordinate World Congresses.

• Provide the opportunity for sites with high-speed internet access to participate in webcasts of the program for a fee

• Direct that the WPF Dinner be planned and conducted by WASPaLM rather than the organizing society, but with specific financial support from member societies and industry for its conduct

Educational programs need to be continued. Dr. Bacchus’s efforts have increased the respect WASPaLM enjoys in the international pathology community. In order to further this effort, new Adminstrative Office employees coud

• Solicit funds as well as assisting Dr. Bacchus in travel and coordination • Ask the WPF for a change in its by-laws to permit, if not used in any given year,

money from the Gordon-Signy fellowship to be used in support of an educational program

• Format the educational programs for our web site, including streaming video Participation by individual members of our member societies and by the member societies themselves needs to be developed immediately. Through the efforts of Dr. Melo and Dr. Oellerich in particular, but certainly not limited to those two officers, our membership is broad and strong. Nonetheless, we still have poor attendance at the House of Representatives, little or no participation in COWSA activities, no sponsorship



support for existing WASPaLM activities, little individual member interest in Bureau participation. There are several initiatives we can take to improve this situation.

o Ask Constituent Societies to assume responsibility for a specific part of World Congresses. This could be sponsorship of a short or long course, a specific lecture, a social event. It will require the society to assume the expense for the support including travel.

o Ask COWSA to take the initiative in communicating with those individuals from our Constituent Societies who are working on the same thing through their own National Standards Organizations.

o Solicit membership in a broad committee to support SNOMED o Provide regular information to societies through their presidents. This will

require our Secretary-treasurer to maintain an up to date list, the “official” copy of which would be on our web site.

More material needs to be provided for the Bulletin. I have found it difficult to put together material for the Bulletin when already written articles are not submitted. Except for paraphrased reports from WHO, the President’s Column, and my own material, I receive no articles, although many ideas. Bureau members and member societies need to be encouraged to provide written material as well as images for this publication. This year, we will be fortunate to have two issues. Hopefully, one issue will be in your hands before we meet in Malaysia. Our Secretariat and Committee structure needs to be updated. I propose that we discontinue the Secretariat on Quality Assurance for three reasons. WASPaLM receives no benefit from this secretariat; the secretariat has not been active in the service of WASPaLM; and there is no member interest in its continuation. Further, I propose that we delete the Committee on Qualification of Pathologists. Certain committees should have established memberships. For example, the secretary-treasurer should chair the Finance Committee, the immediate past president should chair the Nominating Committee and the president-elect should chair the Constitution and Bylaws Committee. I would propose limiting committee membership to four to facilitate communication. I would also extend this membership limitation to secretariats.

Director’s Insurance

We have found a new company (The Cincinnati Insurance Company) that will provide director’s insurance for $1,200 per year, considerably less than the Chubb Group. The application will be completed by the time of the Bureau meeting in August. The maximum amount of coverage is US$ 1,000,000. Henry Travers, M.D., President-Elect ACTION ITEM #6: Authorize the President to develop an agreement with CAP foundation or another appropriate organization for fundraising for WASPaLM.



ACTION ITEM #7: Authorize the President-Elect to contact the CAP foundation to establish whether it would be willing to fund certain WASPaLM educational programs. ACTION ITEM #8: The Bureau requires that formal preparations for World Congresses begin no later than 4 years prior to the Congress. This preparation would include development of relationships with WHO, commercial corporations and constituent societies. This requirement will be immediately conveyed to all constituent societies.2 Report of the Secretary-Treasurer

FINANCIAL REPORTS FOR THE BUREAU

ASSETS AND LIABILITIES

MAY 31, 2007

Item Category Amount Comments

Assets Cash on Hand $852,069 General + Cash Account Accts Receivable (includes Japan and General

US-account) - Constituent societies dues $4,800 TOTAL $856,869

Liabilities Accounts Payable $3,555 Travel expenses incl. Bureau $33,000 Estimated Meeting Kuala Lumpur

Room rental (Bureau/House of Representatives meetings)

$2,410

TOTAL $38,965 Net Worth $817,904* * incl. Certificate of deposit: 300,000 $ Japan account; 30,000 $ US account.

2 This is part of a formal policy on World Congresses that is being updated by Drs. Raslavicus, Oellerich and Travers for presentation to the Bureau later this year and subsequent dissemination to Constituent Societies and publication on the WASPaLM web site.



INCOME-EXPENSE STATEMENT 1 June 2006 – 31 May 2007

Item Category Amount Comments 2007 Budget

Income Dues $12,796 $12,000 Corporate Sponsorships $18,000 $18,000 Interest $2,638 $9,856 Other $0 $0 TOTAL $33,434 $39,856

Expenses Travel Bureau $32,171 $33,000 Bureau: Room Charges,

Food $3120 $2,410

Bureau: Miscellaneous (Dinner Cruise)

$5282 $0

Legal/Accounting $939 $950 Bank Fees $303 $303 Dues/Membership (CIOMS) $375 $375 Web site $724 $800 Education workshop

(countries in need) $3,030 $10,000

Administrative Office (Japan) $10,000 $13,913 Golden headed canes $ $5,566 Treasurer's Office (Secretary) $2,200 $1,200 TOTAL $58,144 $68,517 EXCESS INCOME $(24,710) $(28,661)

Notes: Return of Organization Exempt from Income Tax, form 990, 2006 was sent to the Internal Revenue Service Center, Ogden, UT, USA on March 29, 2007.

Prof. Dr. med. Dr. h.c. M. Oellerich, FFPath (RCPI), FRCPath Secretary-Treasurer

ACTION ITEM #9: Based upon the 2008 budget to be discussed at the New Bureau meeting on 22 August 2007, the bulk of all current WASPaLM funds will be invested in higher interest bearing insured bank accounts. The US account will be composed of $100,000 operational expenses and $60,000 in one certificate of deposit. The Japanese Administration Office will put the remaining money up to $300,000 in one or two certificates of deposit. ACTION ITEM #10:



Dr Merten is assigned the task of updating the WASPaLM history from 1975 to the present. The Japanese Administrative Office is requested to provide an electronic copy of the book in PDF format for the Bureau and to appear on the website.

Report of Directors To: WASPaLM BUREAU From: Paul A. Raslavicus, MD, Director for North America Subject: REPORT FOR 2006-2007 Date: July 12, 2007 I submit herewith my report for 2006-2007. I am grateful for the opportunity to comment. Health care—especially its costs—continues to be a major focus of public and media attention. By now 16% of the entire United States workforce is involved in the delivery of care, and expansion continues unabated. This overarching fact is reflected in the continuing expansion of our specialized area of medicine, and is well demonstrated by the robust growth of our Societies of pathology and laboratory medicine in North America. The Societies are continuing to expand their membership. There is a continuing and increasing demand for physicians trained in pathology and laboratory medicine. To supplement the output of American and Canadian medical schools a significant influx of trainees and graduate physicians from abroad is continuing. Meanwhile, there is an increasing shortage of medical laboratory technologists, particularly of those with university degrees—fueled by the fact that the salary levels are not keeping up with opportunities available in other sectors of the economy. Our societies are seeing their national meetings reach record attendance numbers. The American Association for Clinical Chemistry has a huge attendance of nearly 20,000 individuals from within the country and abroad and presents terrific programs in the field of laboratory medicine. The United States-Canadian Academy of Pathology, focusing exclusively on anatomic pathology, sees the largest attendance of pathologists specializing in this field (approximately 6000). Their educational efforts are of very high quality and are now available free on the web for those who do not come to the meetings (see www.Uscap.org.) The College of American Pathologists annual meeting draws over a thousand pathologists-generalists as does the meeting presented by the American Society for Clinical Pathology. The newest and fast growing annual convention is that of the Association for Molecular Pathology that has its focus on the entire field of molecular and genetic diagnostics. Because of the accelerated growth of the field of knowledge and concerns about keeping up the quality of the work performed by laboratory physicians in the field, the American Board of Pathology has promulgated new educational requirements. All new Board certificates are limited to ten years and not for the lifetime of the physician, as



before. Likewise formalized required education tracks have been established which all pathologists are likely to pursue. These Maintenance of Competence areas include:

♦ Patient Care: diagnostic competence and ability to provide appropriate consultation

♦ Medical Knowledge: familiarity with old and evolving fields of medical science and the application of it in pathology and laboratory medicine

♦ Practice Based Learning and Improvement: assimilation into one’s practice of scientific advances and improvement in patient care practices

♦ Interpersonal and Communication skills: effective information exchange with colleagues and patients.

♦ Professionalism: adherence to ethical principles, effective performance of professional responsibilities

♦ Systems-Based Practice: awareness of the larger context of system of health care, and ability to call on system resources to optimize the value of services performed.

With this type of mandate for continuous improvement, continuing growth of organized societies and their offerings in continuing education is assured. As health care expands, so do the expenses to society and to those who directly pay for it. Likewise the business community sees opportunities for expansion of their role with an eye towards profits through the development of better ways of service and new technologists.

♦ The US government, which now directly or indirectly pays about half of the health care costs, is intent on cost containment. It is developing policies that it hopes will inhibit laboratory expansion.

o It is stepping into regulating laboratory developed procedures, which would require formal demonstration of efficacy

o It is proposing to regulate diagnostic computer algorithms that utilize inherent biomedical databases and result in prediction of a diagnosis or therapeutic benefit of a particular approach in an individual patient

o It is developing criteria for rejection of payment requests for rendered services that they believe are duplicative or not necessary (the so called “Medically Unlikely Edits.”

♦ The business community continues to show significant interest in the pathology

market place o The commercial independent medical laboratory market continues to

expand and consolidate. There are two mega labs in the US: Quest Diagnostics and LabCorp, which dominate the industry and provide both primary and reference testing capabilities. In recent years they have increased their focus on the anatomic pathology market, developing their own capabilities or acquiring independent pathology laboratories such Ameripath. Hundreds of pathologists are either direct employees or are contracted with them. International corporations, such as Siemens and General Electric, have broadened their involvement in diagnostic



medicine from their established positions in medical imaging to the medical laboratory by purchasing specialized corporations (such as companies specializing in bedside testing modalities) of having unique capabilities in molecular testing.

o The potential for profits have not escaped the practitioners of other specialties. For example, we have seen the development of specialized anatomic pathology laboratories owned by groups of urologists or gastroenterologists. These efforts have been vigorously opposed by organized pathology, and it appears likely that the government will step in to significantly control these activities on the basis of self-referral and inappropriate costs.

This report has emphasized that the growth of the health care “industry” in North America is continuing, as is the growth in our specialty. There is a lot of action on all fronts. These are exciting times full of opportunity and of uncertain future. With new fields of endeavor or new modes of delivery of services opportunity has come with dangers to the continuing professionalism of pathology and laboratory medicine.

Report from Latin America Kuala Lumpur, August 2007 A – The 40th Brazilian Congress of Clinical Pathology / Laboratory Medicine was held in the city of Curitiba, in September 2006, and had a total of 5.000 participants. In comply with WASPaLM solicitation the organizers have agreed to offer free registration to pathologists who live in the Latin American countries. Thanks to this gesture there were some attendees from neighboring countries. As to the 41st Brazilian Congress, to be held in the city of Salvador, on September 4th-7th 2007, the organizers are now offering a low-priced-packet to the pathologists from Latin American countries, that include transport, hotel and registration. Furthermore, there will be simultaneous translation from Portuguese to Spanish on the expectation of attracting a greater number of colleges from the neighboring countries. B- The II WASPaLM workshop on Accreditation in Latin America was hosted in Peru at the city of Lima, during the ALAPAC/ML Congress, according to the WASPaLM decision taken in Chicago. This WASPaLM sponsored workshop was originally scheduled to November 2006, was actually held from April 25th to 26th, 2007. The course was a great success. Initially, 80 participants were expected, but 510 persons attended to it, 450 from Peru and 60 from other countries (Mexico, Ecuador, Cuba, Chile, Uruguay, Bolivia and Colombia). This course had the support from the Brazilian Society for Clinical Pathology through their president Dr. Wilson Scholnick and also from the ALAPAC organizing committee through their president Dr. Jose Leon. The entire course was lectured on Spanish by the



Brazilian Society members Dr Luisane Vieira and Dr.Derliane Oliveira and having the WASPaLM president Dr.Marilene Melo delivering the closing remarks. This workshop was very important to raise WASPaLM image in Latin America. C- The XVII Latin American Congress of Clinical Pathology/Laboratory Medicine (ALAPAC/ML) was held on 23rd – 24th April 2007, in Lima Peru. During the opening ceremony it was presented the Golden Book of ALAPAC/ML 1974-2007, written by Dr. Jose Carreon Moldiz, from La Paz, Bolivia, the ALAPAC/ML permanent secretary. This particular book is a written testimony of the history of ALPAC/ML from it’s beginning until now. It describes every single Congress Meeting, Reunion and specifies its founders and members. A copy of this biography work was presented to Dr. Marilene Melo and another copy, at this very moment, is handed to the WASPaLM Board of Directors. Dr. Jose Carreon Moldiz, gladly let us know that:

1-The ALAPAC/ML flag has been created 2-The schematic and ALAPAC/ML Board of Directors policies has been created and approved. 3-ALAPAC/ML has an agreement with the Revista Mexicana de Patologia Clinica for written publications and virtual diffusion through www.medigraphic.com 4- ALAPAC/ML has an associated website with the Uruguayan Society of Clinical Pathology: www.supac.org.uy 5- ALAPAC/ML has increased the number of its membership with the inclusion of: Medical Society of Clinical Laboratory of Chile and Cuban Society of Clinical Pathology. 6- The city of La Habana, in Cuba, has been chosen to hold the XIX Latin American Congress of Clinical Pathology / Laboratory Medicine on September 10th-13th 2009. 7- A “Proposed Strategic Plan of Education ALAPAC/ML-WASPaLM 2007”, written by Dr. José Carreon Moldiz is attached to this report to be analyzed by WASPaLM. This proposal is focused in the increase of professors and specialist exchange, for professional training, educational cooperation and spread of information.

D- on going project Due to the warmly welcome in Uruguay and the amazing success in Peru, we are already making arrangements to provide, at least, one more WASPaLM Workshop on Accreditation, whether in Cuba or in Ecuador, in the next coming years. I strongly believe that these courses are very helpful to Latin America people and to Latin American pathologists. Dr. Mario Flavio Paes Alcantara WASPaLM Director at Large for Latin America ACTION ITEM #11:



WASPaLM recommends to support the upcoming ALAPAC Workshop on Accreditation to be held in Cuba in March 2009. The organizers are kindly asked to reschedule the meeting so that an overlap with the 25th Congress can be avoided (before 8 March or after 20 March). Report of the Director at Large for Africa Subject: REPORT FOR 2006-2007 Date: July 30, 2007

I apologise for the late submission of my report for the Kuala Lumpur meeting in Malaysia. I would also like to apologise for the fact that I will not be able to attend this meeting, as I will unfortunately be recuperating from knee replacement surgery scheduled for the 31st July. This has disrupted my travel plans, as I had originally intended to attend the meeting, and I am very disappointed not to be able to do so. The National Pathology Group continues to function in South Africa as the official subgroup of the South African Medical Association representing pathology. We had our biannual general meeting on the 30th August 2006 and the following members were elected to our Executive Committee:

Drs A Bramdev; P Cole; P Davies; B Dietrich; M Gritzman; N Lazarus; N Miller; J van Rooyen; J Senekal; Prof M Hale.

Dr T Erasmus was re-appointed as President.

The Executive Committee meets quarterly and has been dealing with a number of issues which, on careful reading of my report from last year, seem to have carried over and continue to demand our attention. The most important medical issue for South Africa is the prevalence of HIV in the population. It does, however, appear as though the curve is flattening with the national average of infections for 2006 recorded as 29.1%. This varies significantly throughout the country with the highest prevalence in Kwa-Zulu Natal at 39% and the lowest prevalence in the Western Cape at 15.2% The prevalence in individuals younger than 20 has dropped from 15.9% in 2005 to 13.7% in 2006. This is a statistically significant decline. A similar decline has also occurred in the age group between 20 & 30, but not in the older age groups, which has shown a tendency to increase, albeit not at a statistically significant level. The result of the epidemic is that the life expectancy for females is currently 50.7 years and for males 45.1 years. The South African government is now pursuing its HIV prevention and treatment campaign far more vigorously than in the past. The current total health budget is approximately 10 billion dollars for a population of about than 40 million. This is clearly inadequate by Western standards, and, in all likelihood, it is also inadequate for a developing country like South Africa with its extensive health problems.



In addition, the country faces a shortage of medical professionals. Many professionals have left South Africa, and the country has a significant shortage of skilled nurses and medical practitioners. This is also manifest amongst pathologists, and it is likely that there are fewer than 450 qualified pathologists remaining in South Africa, of which 220 work in the private sector and the remainder in the State sector. The state sector is serviced by a combined body – the National Health Laboratory Service (NHLS).This group is also represented on our Executive Committee. The pathology congress was held towards the end of July and was very well organized under the auspices of Prof Raubenheimer and the Medical University of South Africa. There were more than 400 attendees and 11 international speakers. One hundred and thirty five papers were presented. The organising committee should be justifiably proud of their endeavours. Our Executive Committee meets regularly, at least once a quarter, and has dealt with a number of issues, which were also reported on in 2006. We continue to be challenged by the ICD10 implementation and the difficulties of obtaining ICD10 diagnosis from referring clinicians. The process continues. Another challenge is to ensure that patient confidentiality is adequately dealt with and managed. We are continuing with our costing study. This is being conducted by Deloitte Actuarial Services in an attempt to create a completely transparent costing model which will be used as a reference point for paying private pathologists for services for medically insured patients. The majority of the South African private laboratories are accredited by SANAS (South African National Accreditations Systems) to ISO/IEC 17025. This is obviously very demanding on the laboratories, both in time and in resources, and the laboratories are justifiably proud of their voluntary participation in this process. We trust that you will have a successful meeting. I am very jealous that I am unable to participate, but look forward to doing so at a later occasion. Yours sincerely, Tjaart Erasmus, Director-at-Large for Africa



Report of the Director at Large of Australasia Subject: REPORT FOR 2006-2007 Date: July 23, 2007

1 Professional practice 1.1 Regulation of Pathology Practice in Australia and New Zealand My report last year provided for WASPaLM’s an outline of the complex formal arrangements in Australia and New Zealand. Since my last report there have been no fundamental change as far as these regulatory requirements are concerned but there has been a major change to the practice environment in New Zealand (see below). In both countries laboratory accreditation to the standard of ISO 15189 is now firmly in place and not producing any major difficulties. Requirements to provide “uncertainty (of) measurement” have generated some uncertainty about how to approach this but a recent publication from the National Pathology Accreditation Advisory Council (NPAAC) is useful and includes some worked examples. The chairmanship of NPAAC has changed in the past year but remains in the hands of a Fellow of the RCPA with Professor Leslie Burnett succeeding Dr David Weedon. There has been substantial activity during the past 12 months. Standards and guidelines accessible released or under development in the past 12months are listed in appendix 1 to this report and are accessible on: http://www.health.gov.au/internet/wcms/Publishing.nsf/Content/health-npaac-publication.htm No charge is made for their use but the documents are Copyright and acknowledgment in a form described in the documents is expected for their use. 1.2 Regulation of Pathologist Training Accreditation of the Royal College of Pathologists of Australasia by the Australian Medical Council (AMC) The Australian Medical Council (AMC) has been in existence for some years for the purpose of accrediting University courses for the award of medical degrees but since 2002 has now become involved also in accrediting of postgraduate medical professional qualifications. The RCPA had submitted a 150-page document with numerous attachments to the AMC for this purpose. This mainly involved detailed documentation of College processes and approaches but did not involve substantive changes. In August 2006 a member of the AMC accreditation was present as an observer at the examinations for Fellowship. This was followed in mid-September 2006 by the formal inspection during which the AMC Team traveled around Australia and New Zealand to visit facilities and meet trainees and supervisors followed by meetings at the College in Sydney with the Executive committee, the Trainees Advisory Committee, Chief Examiners and Chairs of major committees among others. The Team comprised: Professor Michael Field (convenor), Associate Dean, Northern Clinical School, Royal North Shore Hospital, Sydney, Professor Roger Allison, Dean, Faculty of Radiation Oncology, Royal Australian and New Zealand College of Radiologists, Dr John Collins Dean of Education, Royal Australasian College of Surgeons, Dr Nada Mikhael Director of Education, The Royal College of Physicians and Surgeons of Canada



Professor Sir John Lilleyman Medical Advisory Panel, National Patient Safety Agency, UK, Dr Claire Blizard Chief Executive Officer, Greater Western Area Health Service NSW, Dr Kumanan Rasanathan, Senior Trainee in the Public Health Medicine Specialist Training Programme, Australasian Faculty of Public Health Medicine, New Zealand, and Ms Roslyn Lawson Consumers’ Health forum nominee. From the affiliations of its members this team was both expert and broad-based with substantial international representation. A draft report for consultation was received in December 2006 and a revised version considered by the AMC Specialist Education Accreditation Committee on 16 January 2007. After some further iteration the College received formal advice in May 2007 that its education, training and continuing professional development programs had been approved to December 2010 when the AMC will review progress in relation to key recommendations, with a view to extending the period of accreditation to the maximum of six years. Annual reports are required commenting on the response to recommendations and their implementation. The first report will concentrate on: • greater use of audiovisual and information technologies to improve equity of access by all trainees to training courses and materials; • improvements in planning and implementation of a coherent assessment plan; • progress on systematic accreditation of laboratories for training, including regular visits; • strategies to increase supervisor participation in the supervisor training; and strategies to improve participation in CPDP. The College Council had already identified these as important measures with steps already being taken to address a number of these points. 1.3 Workforce The Impact of the Pathology Workforce Crisis on Acute Healthcare My previous report advised that there is a serious global problem with the pathologist workforce affecting Australia New Zealand, Hong Kong, Singapore and Malaysia.. The situation was summarized in February 2007 in the RCPA Newsletter “Pathology Today”. At the beginning of 2007 there were 1290 pathologists in active practice in Australia; of these 20% of these are over the age of 60 with almost half over the age of 65 years. In addition there were already 70 unfilled vacancies for qualified pathologists. In Australia, the pathologist per head of population ratio equates to one pathologist for every 15,500 people. In 2003 the government-convened Australian Medical Workforce Advisory Committee (AMWAC), an extra 100 training positions each year for at least 5 years. Despite the fact that all State, Territory and Commonwealth Health Ministers signed off on this report there should have been 300 positions yet only 45 had been created. The situation in other countries where the RCPA provides training is even worse. In New Zealand there is one pathologist per 20,250 people. Applying the current inadequate Australian ratio of pathologists to population Zealand would require another 63 pathologists to bring it to the Australian ratio. In Hong Kong, Singapore and Malaysia, the figures are worse again. In Hong Kong, there are 260 pathologists for a population of 6.9 million a ratio of one per 26,500 per head of population, in Singapore, 92 pathologists for 4.5 million people, a ratio of one pathologist per 48,900 and in Malaysia in 2004 there were 242 pathologists in practice, for a population of 25 million; a ratio of one pathologist per 103,300.In relation to the needs of the



healthcare system the situation in Australia in early 2007 was considered to be critical. Despite the low profile of pathology in many medical courses application rates suggest there are sufficient recent medical graduates interested in pathology; the problem is purely one of governments not funding training positions. Because of the global shortage immigration will not met the problem. Workforce substitution advocated by some also is unlikely to be effective because the shortage of medical scientists from whose ranks pathologist replacements are to be drawn are in equally short supply. Despite the low profile of pathology in many medical courses application rates suggest there are sufficient recent medical graduates interested in pathology; the problem is purely one of governments not funding training positions. During 2007 there has been intense lobbying activity of Federal and State jurisdictions in Australia to secure funding for additional positions which has met with some success. By mid July this had resulted in a total number of new positions of 80 (Commonwealth government 30 (includes support for training in private practice) Queensland 21, New South Wales 6, Victoria 6, Australian Capital Territory 2,Tasmania 2, South Australia 2, Western Australia 1). The situation New South Wales with by far the largest population and training capacity remains a cause for concern. There has been a meeting with the new Minister in June and representatives of the College and the President of the National Coalition of Public Pathology who listened but made no promises. 1.4 Pathologists’ Workload While of continuing concern this is related to and overshadowed by problems related to the size of the workforce though compounded by continuing growth in the number and complexity of pathology services. This applies across all disciplines: the situation is difficult for Anatomical Pathologists and Cancer Services groups are now becoming aware of the problem but the same applies for haematology and microbiology with the latter disciplines also being affected by increased demand in clinical haematology and clinical infectious diseases services. 2 Government relations 2.1 New Zealand In the past 12 months a complex and critical situation has developed. Since the 1950s, diagnostic laboratory testing for eligible New Zealand patients (citizens and some others) had been fully funded by the National Government with no charge to the patient. In community practice, laboratory tests were divided into two categories: “schedule tests,” a list of about 80 specific tests listed in the Diagnostic Laboratory Schedule, and “non-schedule tests”—the remaining ever-expanding list of investigations. Schedule tests were funded fee-for-service in most community laboratories for which payment was made from a central government agency of different types and names but with a period of funding by Regional Health Authorities. Nonscheduled test specimens are commonly collected by those laboratories and transferred to a public hospital where the analyses are performed and were funded by the administration responsible for the hospital as a whole which again had been subject to multiple changes especially in recent times. The requirement for funding has been that the test is requested by a doctor (or in some circumstances a dentist or midwife), that the patient is not an inpatient in a public hospital, and that the test is for diagnosis and not for immigration, industrial, research, or



insurance purposes. There had emerged a dual system of private pathology providers some of which were corporations which covered the entire country together with the laboratories of the public hospital system. In 2003 however responsibility for funding was de-centralised to one of the 21 health boards which separately administer health services in this country with a population of approximately 2.7 million people. In 2002, the incorporated society of District Health Boards (DHBs), known as DHBNZ, commissioned a paper on Options for Reform of Diagnostic Laboratory Services Markets; concerns over rising costs uncontrollable in a fee for service system may have been a major factor motivating this. Each of the DHBs have now implemented schemes for pathology funding based on block contracts for which tenders are required for an unspecified number of services at a fixed price. Although all appear to have this feature in common there are major differences in the way arrangement have been implemented across the 21 DHBs. To date the outcome has been mixed and unpredictable. Some districts have maintained the status quo. In others private companies have merged but some mergers have been blocked by the national competition policy regulator, the Commerce Commission, presumably as anticompetitive. In some hospital and community pathology has merged while in others they have remained separate. There is substantial variation in the duration of contracts.There does not seem to have been any direction of the process by the National Governement which nevertheless seems content with what has developed. The impact has been destabilising in the extreme for private and public pathology alike but the real surprise to pathologists, and to administrators and boards, has been the unexpectedly high level of spontaneous public support and protest, exceptional for a clinical service with a normally low profile. The fall out has included intervention by the national competition policy regulator the Commerce Commission and litigation with one case estimated to have cost approx $NZ 2 culminating in March 2007in a judgment in the New Zealand High Court ruled that the contract for community laboratory services in the Auckland region that had been let was invalidated resulting in extensive staff redundancies. The changes have been controversial in the extreme; the NZ Medical Association President observing that “we’re so far steeped in the river of blood it’s too late to turn back”. At present the outcome both in both the short and long term is uncertain but to date there appears to have been much pain and little gain. The RCPA has expressed its concerns to the National Government about the implications of this state of affairs for both the safety and quality of services and also for the workforce implications referred to above but with no response to date. This account is based on: 1 “All Change For the New Zealand Laboratories by Ross Boswell, Andrew Tie Republished

by kind permission of THE NEW ZEALAND MEDICAL JOURNAL (Vol 119 No 1243 ISSN 1175 8716) URL: www.nzma.org.nz/journal/119-1243/2252/ © NZMA in the College Newsletter “Pathology Today” of February 2007.

2 “COVER STORY Blood feuds: Massive changes to New Zealand pathology services have unsettled the profession” Marilyn Head, “Pathway” Issue 12 Winter 2007 (July) PathWay is published quarterly for the Royal College of Pathologists of Australasia (ABN 52 000 173 231) by S2i Communications, Suite 1201, Level 12, 4 O’Connell St Sydney



2.1 Australia At a National level there is continuing interaction with a wide range of Australian Government Agencies separate and distinct from the standard setting body, the National Pathology Accreditation Advisory Council (NPAAC).

Foremost among these is the Department of Health and Aging in the forum of the Pathology Consultative Committee over the national pathology agreement which covers the arrangements for funding of non-public hospital funding for pathology the terms of which are set by a Memorandum of Understanding (MoU) between Government and the Pathology Profession represented by the RCPA, the Australian Association of Pathology Practices (Private Practice) recently joined by the National Coalition of Public Pathology (Public hospital practices in the states and territories).

Negotiations for funding have been were extremely disappointing principally apparently because monies had been set aside for future pathology funding based on economic analysis of growth in volume of pathology ordering alone. The profession has been unable to convince government that changes in clinical practice that improved the quality of pathology services should be funded. The argument that money spent on pathology services saved money elsewhere in the health care spend was ignored. The current MoU runs out in 2009, and it is time to prepare our case for the economic value of pathology. Many Fellows have shown interest in presenting an economic argument for the value of pathology to the various keepers of the purse – at hospital, state and federal levels. It may be time to ask a health economist to help us use the language of the country we find ourselves in so that we can talk in terms of productivity and balance sheets. Apart from negotiating funding allocation for pathology under the “capped” agreement under the MoU useful negotiations have occurred in this forum to secure funding for training positions.

The College was successful in two funding submissions to the Australian Government Quality Use of Pathology Committee (QUPC). The first was further funding for “Common Sense Pathology” is a joint initiative between the RCPA, Australian Doctor and the Department of Health and Ageing issued as “lift outs” in the publication for Australian General Practitioners, Australian Doctor. Second support was provided to a Fellow expert in laboratory genetics to support his development of a national framework for delivery of genetics services The College has been requested to make nominations to advisory panel register of experts of the Medical Services Advisory Committee (MSAC), the body which advises the Australian Health Minister on new and existing medical technologies and procedures and their safety, effectiveness, cost-effectiveness and whether they should fall under the Medicare Benefits Scheme (MBS). Currently the College is preparing a submission to MSAC on the use of synoptic reports with a view to increasing reimbursement for production of reports of this type. The College also has continuing involvement with the Pathology Services Table Committee which advises on the structure and fees pain by Medicare Australia for Pathology and has also advised on a review of the composition and terms of reference of that Committee. 3 Community Relations



3.1 Lay Advisory Committee The Council of the RCPA has established this committee and following a call of expressions of interest interviews have been conducted appointments have now been made to its four lay positions.

3.2 Medical student liaison The College booth at the meeting of The Australian Medical Students' Association (AMSA) Meeting in Perth WA had many inquiries about each of the Pathology Disciplines. Some Colleges, including the RCPA, gave brief talks about their specialties. The students' questions focussed on practical issues - how to enter a training program; the details of Joint Specialist training in both Pathology and a Specialty of internal medicine ; if specialist positions would be available; what were the emerging disciplines; how to cope with autopsies etc. Clearly many of the students have had limited previous exposure to pathology and pathologists. The phenotype of the latter was described as typically being: “A short-sighted, slightly stooped doctor of advanced years, quietly spoken (but every word a precise jewel) standing alone in a group (preferring own company).” 3.3 Media relations The College retains professional media advisers S2i Communications. Activities have included organizing a media conference on the workforce crisis. Also for the second year in succession it has made its second annual media awards for excellence in journalism relating to pathology. The New Zealand Print Media category winner was Martin Johnston, Health Writer for the New Zealand Herald, for his exposé entitled “Lab docs demand a halt to shake-up” exploring the potentially devastating ramifications of the pathology service tendering process on New Zealand’s health system. The Australian Print Media category winner was Janelle Miles, Health Writer for Brisbane’s Courier-Mail, for her review of where pathology has come in 50 years entitled “Medical science leaping ahead”. The winners were announced at the RCPA’s Annual Pathology Update Conference, and were each presented with a $2000 prize for their portrayal of issues in Pathology. 3.4 Museum exhibition: getting the message about Pathology out to the public Among the Golden Jubilee events in “Pathology Week” in March 2006 the College put on display at the Powerhouse Museum exhibition Darling harbour , Sydney an exhibition ‘Blood, Bugs and Bodies’ which was well attended. Part of the Exhibition was the Development of a DVD entitled “The Power of Pathology-Toby’s Adventures” which was developed and designed to educate people about pathology.. It has been reproduced in DVD format and is currently being distributed to laboratories throughout Australasia so that it can be shown in pathology collection centres. Over 11,000 DVDs have already been sent to schools across Australia courtesy of the Australian Science Teachers Association (ASTA). In August the RCPA had a stand at Sydney’s Science in the City, the Australian Museum’s event for Science Week. Several thousand high school children attended during the 3 days. Volunteers at the stand included one of the pathology trainee from the Royal North Shore Hospital Department of Anatomical pathology. 3.5 “PathWay”Magazine



This is a professionally produced publication which presents highly readable pathology-related information and comment, combined with aspirational lifestyle themes. It is issued quarterly in print but can also be accessed on the College website. Its objectives are to provide medical and general communities in Australasia generally with an understanding of Pathology and also to inform the broader medical profession about use of pathology. The College believes PathWay magazine, is a valuable tool, which is enhancing the position of pathology in the medical community, and attracting people into the profession. Correspondence from the Minister of Health in Western Australia indicated that an article in PathWay contributed to the Governments of that State’s decision to substantially increase its numbers of pathology trainees. 4 Member services 4.1 Continuing professional development (CPD) This is now mandatory Council’s from 2006. At the beginning of each calendar year fellows must submit a summary of CPD hours for the previous calendar year. This can be done via the College website. The website also contains the most recent information manual relating to the College’s CPDP which clearly sets out the different categories and the mandatory requirements for each of those categories. In addition to this there is a copy of the summary sheet for the return and an Excel spreadsheet for an organised record of activities for substantiation in the event of an audit. The CPDP is hours-based requiring a minimum of 500 hours of CME activities to be undertaken over a 5 year cycle, with a maximum of 125 hours to be credited in any one year. The 3 sections of the program are: A) Group Activities/Meetings B) Personal Study C) Quality Activities. A minimum participation in each of these 3 classes is now specified. 4.2 RCPA Ombudsman For Trainees Expressions of interest have been called for an Ombudsman position for Australia. A Trainee may approach the Ombudsman with matters related to their training that the Trainee in a given situation feels have not been satisfactorily resolved after initial review. The Ombudsman for Australia was appointed by the Executive Committee following receipt of the expressions of interest from Fellows. The skills and attributes to be considered in making an appointment include: • At least five years post-Fellowship status in the College • Familiarity with RCPA training programs and examination processes, but not an examiner • Demonstrated commitment to fairness, impartiality, confidentiality and integrity as well as a genuine interest in the welfare of Trainees • Considerable diplomacy • Willingness to listen to trainees in difficulties. An appointment has now been made. This complements a similar pre-existing position in New Zealand. 4.3 RCPA access to “Pathology” online Fellows now have on line access to the RCPA journal Pathology access contents pages and articles from the current issue dating back to 1994. 4.4 Email for fellows The College can now provide an email address for use by each individual fellow. 4.5 Travel agent



A contract has been let to an agency which can provide services at an advantageous rate. They will be represented at the RCPA booth at this Congress to provide information about travel options for the 2009 Congress in Sydney. 5 Pathology Update 2007 This was an overwhelming success as 922 delegates filled the Sydney Convention and Exhibition Centre over the weekend of 2-4 March. Of these 810 were from Australia, 80 from New Zealand and the remainder from other countries mostly in South East Asia. Professional Day speakers included Dr David Burnett who presented the Inaugural David Rothfield Memorial Oration on Quality Assurance, Lord Patrick Carter of Coles (chair of the Review of NHS Pathology Services in England) and Dr Larry Kricka on Technology Solutions for the Analytical Demands of Pathology and Laboratory Medicine. Professional Day had over 450 delegates, and included special sessions for Trainees and a focus on Innovation. With over 120 local speakers and 7 international speakers across the 8 disciplines, the scientific program included 5 combined sessions:

• Genetics and Haematology, • Anatomical pathology and Genetics, • Haematology and Microbiology, • Genetics and Immunopathology, • and an off-site session of Forensics and Paediatrics at the NSW Department of

Forensic Medicine. The scientific program highlights included Anatomical Pathologist Dr Robert Petras on “everything I think I know about inflammatory bowel disease” who was described as an excellent invited speaker, informative, practical, may there be more like him, outstanding! The combined Anatomical and Genetics session with Dr Huntsman was seen as “cutting edge”. 6 WASPaLM Congress 2009 A comprehensive report by Ms Eve Propper, Events Coordinator, The Royal College of Pathologists of Australasia is provided as a separate document accompanying this report. DJ Davies 23rd July 2007



Appendix 1

Publications by the National Pathology Accreditation Advisory Council

2006- 2007

Published 2006 Requirements for Gynaecological (Cervical) Cytology Guidelines for the use of Liquid Based Collection Systems and Semi-Automated Screening Devices in the Practice of Gynaecological (Cervical Cytology) Performance Measures for Australian Laboratories reporting Cervical Cytology Requirements for the Supervision of Pathology Laboratories Guidelines for Approved Pathology Collection Centres Laboratory Accreditation Standards and Guidelines for Nucleic Acid Detection and Analysis Guidelines for the performance of the Pathology Surgical Cut-up Standards and Guidelines for Laboratory Testing of Antibodies to the Human Immunodeficiency Virus (HIV) and Hepatitis C Virus (HCV)

Published 2007 These documents have a proposed date of effect of 1 July 2007: Requirements for the Estimation of Measurement Uncertainty (New document) Requirements for Pathology Laboratories (Revised document) Requirements for In-house In Vitro Diagnostic Devices (Revised document) Requirements for Quality Management in Medical Laboratories (Revised document)

Documents awaiting Final Approval - Proposed date of effect 1 January 2008 The following documents were endorsed at the 48th meeting of NPAAC. The material is awaiting approval from the Minister/Delegate. As soon as the material has received final approval, it will be forwarded to laboratories. Requirements for Packaging and Transport of Pathology Specimens and Associated Material - 2007 (PDF 845 KB) (revised document) Requirements for the Retention of Laboratories and Diagnostic Materials - 2007 (PDF 104 KB) (revised document) Requirements for Cytogenetic Laboratories - 2007 (PDF 84 KB) (revised document) Classification of Human Genetic Testing - 2007 (PDF 40 KB) (New document - supplement to Laboratory Accreditation Standards and Guidelines for Nucleic Acid Detection and Analysis)

Draft NPAAC Documents for public consultation closes on 27 October 2006 Draft publication title Requirements for Procedures Related to the Collection, Processing, Storage and Issue of Haemopoietic Progenitor cells (PDF 215 KB)

Draft NPAAC Documents for public consultation closes on 10 November 2006 Draft publication title

Requirements for Information Communication (PDF 133 KB)



Director at Large Gamze Mocan Kuzey Subject: REPORT FOR 2006-2007 Date: August 20, 2007

I am glad to inform you that, on March 16, 2006, Turkish Federation of Societies of Pathology was established. According to the Turkish Laws, at least five scientific societies, representing the same branch ( eg., medicine, engineering, etc.. ) are required to be a ‘federation’. Turkish Society of Pathology (1966, İstanbul) and Ankara Society of Pathology (1967, Ankara) are the two authorized anatomopathology societies. Then, Ege Society of Pathology (Izmir), Cukurova Society of Pathology (Adana) and Turkish Society of Cytopathology (Ankara) were established. Turkish Society of Cytopathology is also a member of European Federation of Societies of Cytology (EFSC). Above mentioned five societies compose the ‘federation’. The aim of the Federation is to represent all Turkish Pathologists nationally and internationally. Turkish Journal of Pathology is the official journal of the federation and I am the elected representative of this Federation at the House of Representatives of WASPaLM. Yours sincerely, Prof. Dr. Gamze Mocan Kuzey Director-at-Large of WASPaLM



Report of WASPaLM Administrative Secretariat

Report of Executive Director August 8, 2007 1. WASPaLM Administrative Office Moves:

The WASPaLM Administrative Office moved to a new office building on April 9, 2007. The Administrative Office had been located in the same room of Japanese Society of Laboratory Medicine (JSLM) since 2002 per an agreement between JSLM and WASPaLM. JSLM has decided to move to new offices and agreed to support the WASPaLM as part of the move. There will be no changes for e-mail addresses and the FAX number. We have agreed to pay a room rent of US$450 per month, while we did not pay any rent in past 5 years thanks to a generous support of JSLM.

2. Japanese Corporate Sponsors: It has been long appreciated that almost all of our Corporate Sponsors are of Japanese and/or Japan branch of international company. WASPaLM could not have been reconstructed without their generous contributions for more than 20 years. However, the number of reagent manufacturer decreased due to merger and acquisition, and a profitability of Japanese reagent manufacturers have significantly declined due to dramatic reduction of overall health care costs. Reflecting those medical expenses constrains, many of them have now reservations to be sponsors. We had 35 sponsors who contributed US$49,000 in 2006, but we have only 19 who contributed US$29,000 as of today. We will try to convince 14 remaining sponsors who supported us in 2006. However, it will be difficult for WASPaLM to totally depend on Japanese Corporate Sponsors.

3. WPF/Gordon Signy Fellowship: As the Administrative Office has been long a window for the application of Gordon Signy Fellowship, numerous of hours were spent to response and handle inquires and applications worldwide.

4. Agreement between WASPaLM and the JSLM

WORLD ASSOCIATION OF SOCIETIES OF PATHOLOGY and LABORATORY MEDICINE (WASPaLM)

JAPANESE SOCIETY OF LABORATORY MEDICINE (JSLM)

Agreement regarding the organization and operation of

WASPaLM TOKYO ADMINISTRATIVE SECRETARIAT

1. Acting upon the resolution of JSLM Board, the JSLM continues to accept the responsibility for the operation of WASPaLM Tokyo Administrative Secretariat (WTAS).



2. The responsibility of WTAS shall be those that are approved by the WASPaLM Bureau and listed in the attachment to the agreement.

3. At the expiration of term of Executive Director of WTAS, the JSLM President shall

nominate a candidate from JSLM members and advise to the WASPaLM President, who shall appoint him/her an Executive Director of WTAS.

4. The WASPaLM Secretary-Treasurer shall be the Bureau’s liaison with WTAS.

5. The WTAS, which stays in the same office of JSLM, shall be responsible for actual

expenses of clerical works such as telephone, fax and coping that are spent for WASPaLM business. It is also agreed for WTAS to pay JSLM a rental of JPY50,000 per month inclusive of utility costs.

6. The agreement shall remain in effect until the JSLM or the WASPaLM files a letter of

intent to terminate the agreement to the other party at least six months before the first day of the following World Congress. In the instance of the termination, the agreement shall be terminated on the first day of the following World Congress.

7. Upon termination of the agreement the JSLM shall transfer WTAS files to an

organization or individual designated by the WASPaLM President.

8. This agreement becomes effective and binding on the date it is signed by the Presidents of the WASPaLM and the JSLM.

9. This agreement and the attachment shall be reviewed by both parties three years after its

initiation. This agreement between the Japanese Scoietey of Laboratory Medicine and World Association of Societies of Pathology and Laboratory Medicine was initially signed on May 28, 1992, renewed on May 28, 1995, and second renewed on May 28, 1998, third renewed on May 28, 2001, fourth renewed on May 28, 2004 and 5th renewed on May 28, 2007. Marilene Melo , M.D. Kiyoaki Watanabe, M.D. President President World Association of Societies of Japanese Society of Pathology and Laboratory Medicine Laboratory Medicine

Agreement regarding the organization and operation of

WASPaLM Tokyo ADMINISTRATIVE SECRETARIAT

ATTACHMENT

Responsibilities of The WASPaLM Tokyo Administrative Secretariat (WTAS) are to provide the following administrative services and supports to the WASPaLM.



1. Keep and maintain the official files and/or copies of the WASPaLM publications, documents and correspondence, excluding those which are kept at the offices of the WASPaLM President, Secretary-Treasurer and respective responsible Societies.

- Constitution and Bylaws - Agreements with constituent societies and other organizations, - News Bulletins, Directories and other WASPaLM publications - Minutes - World Congress materials - Official communications of officers, Bureau members and constituent

societies - Communications with other organizations and individuals - Other materials relating to WASPaLM activities.

2. Refer inquiries and correspondence to the appropriate WASpALM officer, Bureau member,

secretariat, committee, constituent society or other individual or organization, and respond the inquiries, if possible.

3. Distribute, on request, official materials prepared or supplied by WASPaLM officers, Bureau,

House of Delegates, Constituent Societies and other individuals and organizations. All operations related to the development and maintenance of WASPaLM website shall be excluded.

4. Send the WTAS Executive Director or another responsible individual to WASPaLM Bureau

and House of Delegates meetings to provide reports on Secretariat activities. 5. Assist the Bureau (the Secretary-Treasurer or the President) to make arrangements for

WQASPaLM Bureau and House of Delegates meetings. 6. Serve as the published contact address of WASPaLM. 7. Open an account with the bank for WTAS and administer WASPaLM Tokyo funds by

following the instructions of WASPaLM Secretary-Treasurer. 8. Assist the operation of World Pathology Foundation. 9. Members of The WASPaLM Tokyo Adminsitrative Secretariat shall include a representative

and a clerical staff of JSLM. Member for the WASPaLM Tokyo Administrative Secretariat: Dr. Masami Murakami Executive Director, WTAS Dr. Mikio Mori Past President, WASPaLM Dr. Ikunosuke Sakurabayashi Secretary, WPF Dr. Kiyoaki Watanabe President, JSLM Ms. Yasuko Morito Clerical Staff, JSLM Mr. Susumu Kanda Administrative Staff, WTAS



ACTION ITEM #12: The Bureau unanimously approved the agreement between WASPaLM and JSLM for the WASPaLM Tokyo Administrative Office. 5. Proposed bylaws change - Mr. Susumu Kanda Article 5 Officers and Directors Section 5.3 (e) Election (page 25 of Directory 2005-2007) that reads: “......The ballots will be structured by geographic areas as specified in Article VII of the Constitution...........” The words of "Article VII of the Constitution" should be replaced with "Article 5 Section 5.2(b)".

ACTION ITEM #13: The Bureau agrees with this editorial change to the bylaws and will propose the change to the House of Representatives. The Bylaws Document will be editorially retitled ‘Articles of Incorporation’ and all references therein will be changed to ‘Articles of Incorporation’. 6. Review of WASPaLM Membership (see table on the next page)



Current Membership

No. Class Country Constituent Society 1 C Australia The Royal College of Pathologists of Australasia (RCPA) 2

C

Austria

Österreichische Gesellshaft für Laboratoriumsmedizin und Klinische Chemie (ÖGLMKC)

AS Bolivia Sociedad Boliviana de Patología/Medicina de Laboratorio 3 C Brasil Sociedade Brasileira de Patologia Clinica / Medicina Laboratorial 4 C Brazil Sociedade Brasileira de Patologia

AS Cuba Ciban Society of Clinical Pathology (Associate Society) AS Ecuador Sociedad Ecuatoriana de Patología/ Medicina Laboratorial (Associate Society)

5 C Germany Deutsche Vereinte Gesellshaft für Klinische Chemie und Laboratoriumsmedizin 6

C

Germany

Institut für Standardisierung und Dokumentation in Medizinischen Laboratorium e.V. (Instand e.V)

7

C

Germany

Deutsche Gesellschaft für Qualitätssicherung im Medizinischen Laboratorium e. V. (DGQML)

8 C Germany Berufsverband Deutscher Laborärzte e. V. 9 C Hong Kong THZ Hong Kong

AS Indonesia Indonesian Association of Pathologists (Associate Society) AS Indonesia Indonesian Association of Clinical Pathologists (Associate Society) 10 C Irland Faculty of Pathology of the Royal College of Physicians of Ireland 11 C Israel Israel Association of Pathologists 12 C Italy Società Italiana di Medicina di Laboratorio (SIMeL) 13 C Itay Associazione Italiana Patologi Clinici (AIPAC) 14 C Japan Japanese Society of Laboratory Medicine 15 C Japan Japanese Association of Clinical Laboratory Physicians 16 C Korea The Korean Society for Laboratory Medicine 17 C Malaysia College of Pathologists, Academy of Medicine of Malaysia 18 C Mexico Federación Mexicana de Patologia Clinica

CPS Mongolia Mongolian Association of Laboratory Medicine (Corresponding Society) AS Peru Sociedad Peruana de Patología Clinica (Associate Society) 19 C Romania Romanian Society for Laboratory Medicine 20 C S. Africa National Pathology Group 21 C Switzerland Foederatio Analyticorum Medicinalium Helveticorum (FAMH) 22 C Taiwan Taiwan Society of Clinical Pathologists

AS Thailand The Royal College of Pathologists of Thailand (Associate Society) 23 C Turkey Ankara Society of Pathology 24 C Turkey Turkish Society of Clinical Biochemistry 25 C Turkey Turkish Microbiological Society 26 C UK Royal College of Pathologists 27 C UK Association of Clinical Pathologists 28 C Uruguay Sociedad Uruguaya de Patologia Clinica (SUPAC) 29 C USA College of American Pathologists

CPS USA American Society of Clinical Pathology (Corresponding Society)

C: Constituent Societies AS: Associate Societies CPS: Corresponding Societies



ACTION ITEM #14: The dues statement directed to the larger, more financial countries should request donations or payment for dues for a less financially able country. ACTION ITEM #15: Bureau members are encouraged to talk to potential member societies in their region with the goal of incorporating their societies in WASPaLM.

By-laws change

At the House of Representatives Meeting in Kuala Lumpur the Bureau of WASPaLM will propose to vote on the following bylaw change for section 3.2.(a):

Section 3.2 Qualifications. (a) Membership in the Association as a Constituent Society shall be open to national or international societies whose governing body is composed of at least 50% lawfully qualified physicians specializing in the practice of pathology and/or laboratory medicine.

This formulation will replace the current section 3.2. (a):

Membership in the Association as a Constituent Society shall be open to national and international societies, at least a majority of whose voting members are lawfully qualified physicians specializing in the practice of pathology and/or laboratory medicine. The remainder of Section 3.2. remains unchanged. Explanation: The practice of pathology at the beginning of the 21st century is a team activity involving both medical specialists and specialized non-medical scientists. This is being reflected in changes in membership of many current and potential future Constituent Societies of WASPaLM. Pathology with Laboratory Medicine however is an aspect of specialist medical practice recognized when the organization was first established. The amendment to the bylaws increases flexibility in eligibility for an organization to become a Constituent Society without departing from the fundamental purposes for which WASPaLM was established. ACTION ITEM #16: The Bureau will introduce for discussion a proposal to modify article 4.1 of the Articles of Incorporation to add new section (c) ‘Representatives to the meetings of the House of Representatives should only be qualified physicians’ and renumber current section (c) as 4.1 (d).”



Reports of Secretariats and Committees

Secretariat for Pathology Education for Countries in Need (SPECN) Subject: REPORT FOR 2006-2007 Date: March 26, 2007

The sixth WASPaLM sponsored workshop was conducted at the Indraprashta Apollo Hospital New Delhi between 2nd – 4th February 2007. The meeting was jointly sponsored by the British Division of the International Academy of Pathology (BDIAP), and the Indian College of Pathologists. Consistent with our philosophy on the promotion of Postgraduate Education the programme was arranged to meet specific needs and requirements of the participants. The programme consisted of a very wide range of topics. These included: - Pathology Without The Diagnostics Of Lymphoma, New Horizons In Cytological Diagnosis Changing Concepts In Lung Tumours, Traditional Prognostic Factors In Breast Cancer, Preinvasive Lesions And DCIS, Mesothelioma, Diagnosis And Management Of Small Round Cell Tumours Of Childhood, Dysplasia In GI Endoscopic Biopsy – Current Guidelines For Reporting And Clinical Relevance, Inflammatory Bowel Disease And Its mimics Use Of Molecular Pathology Techniques, Tumours Of The Kidney – PIN And Prostate Cancer, Everything You Always Wanted To Know About Endocrine Pathology But Were Afraid To Ask, Thyroid Neoplasoms, Synchronous And Metachronus Tumours Of The Female Genital Tract, Current Guidelines In The Diagnosis And Management Of Endometrial Hyperplasia. Interspersed between the lecturers were clinico pathological symposia on Molecular Target therapy in Cancer Care, Molecular Markers in Breast Cancer, Expectations from Pathologists in the Management of Carcinoma of the Oesophagus the Role of Gleeson Grading in the clinical management of prostate cancer, several organ specific slide seminars, and a debate on the role of cytology in gynaecological carcinoma. The clinico pathological symposia and slide seminars were very lively and attracted clinicians. In general audience participation was good and interaction with the faculty was very intensive during lunch breaks. As on previous occasions the involvement of appropriate clinical departments was encouraged. Several heads of clinical departments participated in the clinico pathological symposia thus bridging the divide between the laboratory bench and the bedside. The slide seminars were also very lively and provoked robust discussions. The meeting was attended by 216 participants with the predominant numbers from Delhi (46%). Other states represented at the meeting included Gugrat (5%) Chandigarh and Aligrah (14% repectively). The remainder were from Amritsar, Arungzabad and Dehradan approximately 7% respectively. The evaluation revealed satisfaction and appropriateness of the programme for the participants. During the workshop we attended a reception hosted by the British High Commissioner Sir Michael Arthur. The visibility of WASPaLM has been considerably enhanced by the educational workshops which have been conducted over the past three years. Six workshops have now been completed 2 in Sri Lanka, and 4 in India. The feedback from participants and local educators in these countries point to the need for the provision of more learning opportunities for pathologists in the debeloping world. Globalisation is acceleration and forces us to realise that we cannot isolate ourselves. In the modern world bacteria and viruses travel as fast as money. The importance of learning about the determinants of health; in the document “Tomorrow´s Doctors”, the General Medical Council in the UK stated that a priority is “the undertaking of the manifold issues that increasingly impinge on health. “educational opportunities for pathologists in developing countries must be sustained and augmented especially in the light of changed inmigration rules in the UK and the high costs if sending trainees to the developed world. There is a clear signal and



need that investment in learning is an integral part of omproving performance in the discipline and hence to an improvement in the health outcome of patients. Through targeted interventions and responses to the specific needs of a country, the pathology services of a country can be enhanced and better focussed. This can result in a better use of resources and the ways of delivery of the services improved. The educational goals of WASPaLM must be:

1. STRATEGIC To ensure that the outcome of the workshops make a significant and demonstrable contribution to the health care of the country. In both Sri Lanka and India the Pathology services have improved following the workshops.

2. SYSTEMATIC To ensure that knowledge, skills and competencies are built in a systematic way based on careful analysis and feedback from host count country. In Sri Lanka Blood Transfusions practices and Histo- compatibility testing have been enhanced.

3. SUSTAINABLE To recognise that a long term view as needed to promote a culture of continuing education and learning.

The implications for these goals to be achieved entail the allocation of regular funding so that our edudational initiatives are not perceived as “one off” ventures. We have had “left off” – now we must maintain a “cruising mode”. The workshops are now an established feature on the medical landscape. Dr. Robby Bacchus



PROPOSED STRATEGIC PLAN OF EDUCATION

ALAPAC/ML - WASPaLM 2007 Dr. José M. Carreón PERMANENT SECRETARY ALAPAC/ML 1. INTRODUCTION In the process of the world globalization in Sciences of Laboratories of Health the existing gap among developed and underdeveloped countries is bigger. The differences among them are more remarkable when dealing with the application of new automatic versus semiautomatic technologies and manuals. The automation and the exclusivity in terms of trades force the laboratories to have new technical actors and specialized office workers who are committed to guarantee the constant operation of the equipment. These transformations induce to changes and adaptations to look for balances which allow standardized comparisons with the purpose of fulfilling the requirements of quality and competition suggested in the international regulations. Nowadays, there are still some problems dealing with the application of those regulations in many countries, particularly due to the laboratories sizes of the public and private institutions of health. The difference is remarkable in the competition. The experience in Latin America demonstrates that big private laboratories with more economic movement acquire their accreditation more easily. The countries constantly increase in population, but with stagnation of their economic growth. This fact produces structural weaknesses with poor grades of quality, efficiency and effectiveness. 2. PROPOSAL So, and in order to propose some solutions to those problems, it is important to strengthen the administration of education as well as the socialization of the information. A globalized system operating with an international administration of educational cooperation which would benefit



both the developed and the underdeveloped countries would be a way of making this proposal feasible. Therefore, and since the most important problems occur in the operative area, our proposal lays in the necessity of implementing a system of quality administration of educational exchange of professors and specialists willing to live temporarily in a country of their choice after a predetermined agreement is signed. 3. POLITICAL PLAN

The labour market in all the countries is becoming smaller by the time being, time and the

unemployment rates are bigger, inclusive for doctors with specialization. However, it is crucial for these countries, to avoid "the flight of brains" and so many restrictive conditions are imposed to control their exit and return.

With those activities of apparent protection of brains, the globalization turns out to be a myth for

the countries in need. Therefore, in front of this situation ALAPAC/ML wants to propose the WASPaLM some possible strategies, such as:

* Systemic Policies - To modernize the educational administrations in the specialties and Sub specialities of

Pathological Anatomy and Clinical Pathology. - To promote the exchange of specialists among the countries. * Programmatic Policies - To encourage the development of programs of presence and virtual educational

promotion for the appropriate exchange of information. - To look for the assignment of minimal economic resources for the transport

expenses of the professors (This program also applies to retired professors who are willing to transmit their experiences by the time they get to know other countries).

* Organizational Policies - To promote the virtual registration of professors willing to receive and/or to visit

countries in need or developed countries for a certain time. - To obtain and administrate a database of professors in the web page of

ALAPAC/ML and WASPaLM, indicating their educational proposal of exchange or of investigation in the country of their election.

* Instrumental Policies - To offer lodging in the house of one of the members of the proposing Scientific

Society to have family experiences as well as of the daily life in the country they have chosen to go.



WASPaLMWASPaLM Bureau MeetingBureau MeetingInformatics ReportInformatics Report

RajRaj C. Dash, MDC. Dash, MDAugust 2007August 2007

OutlineOutline

►►Financial StatusFinancial Status►►Statistics (2004 Statistics (2004 -- July 2006 July 2006 –– July 2007)July 2007)►►Future DirectionFuture Direction

WASPaLMWASPaLM IS Report IS Report –– Financial Status (US$)Financial Status (US$)

►► Initial Capital:Initial Capital: 15000.0015000.00►► Development Server 2/02:Development Server 2/02: --2830.772830.77►► Web site hosting 2/03:Web site hosting 2/03: --335.40335.40►► Failed UPS replaced 2/03:Failed UPS replaced 2/03: --496.82496.82►► Web site search 10/03:Web site search 10/03: --17.9717.97►► Web site hosting 2/04:Web site hosting 2/04: --335.40335.40►► Web site search 3/04:Web site search 3/04: --17.9717.97►► Web site search 10/04:Web site search 10/04: --17.9717.97►► Web site hosting 2/05:Web site hosting 2/05: --335.40335.40►► Web site search 3/05:Web site search 3/05: --17.9717.97►► Web site search 10/05:Web site search 10/05: --17.9717.97►► Web site hosting 2/06:Web site hosting 2/06: --335.40335.40►► Web site hosting 2/07:Web site hosting 2/07: --335.40335.40------------------------------------------------------------------------------------►► Total Expenditure:Total Expenditure: --5112.415112.41►► Remaining Funds:Remaining Funds: 9887.599887.59

Statistics Statistics –– Past Few YearsPast Few YearsJuly 2004 July 2004 –– July 2006July 2006

2,6864091414FrontPage10

10,7481,03650127Opera98,7582,00394209Mozilla Suite8

24,9773,826146392Safari7107,51016,4596631,910Firefox6

28,3276,1377381,702Netscape53,2041,139876468Konqueror4

160,48617,5109,3256,293Unknown32,384,402307,60916,81951,659IE2

981,37776,82324,55465,719Bots, Spiders1

Bandwidth(KB)HitsVisitsPage ViewsBrowser

StatisticsStatisticsVisits & Page ViewsVisits & Page Views



StatisticsStatisticsNew VisitorsNew Visitors

StatisticsStatisticsVisit Length (Visit Length (secssecs))

StatisticsStatisticsBy Day of the Week 7/04By Day of the Week 7/04--7/067/06



Weekday Usage 7/2006 Weekday Usage 7/2006 –– 7/20077/2007

StatisticsStatisticsGeographic Locations, 7/04Geographic Locations, 7/04--7/067/06

Statistics 7/04 Statistics 7/04 --7/067/06

25,7833,006370892Average(s)3,712,707432,98853,291128,505Total(s)

776,00293,9637,09417,274Other Items (134)41,0316,4004321,499Australia1026,08810,8867,5901,666N/A990,21410,9357461,740United Kingdom8

34,5316,2139721,765Korea, Republic of7

84,85611,5197082,123Germany673,49510,4515982,263Turkey590,12812,3148163,283Canada4

216,62265,4841,1157,972Brazil3282,43161,5522,0768,745Japan2

1,997,309143,27131,14480,175United States1

Bandwidth(KB)HitsVisitsPage ViewsCountry

StatisticsStatisticsGeographic Locations, 7/06Geographic Locations, 7/06--7/077/07

Statistics Statistics –– Broken LinksBroken Links(Ignore (Ignore Robots.TxtRobots.Txt –– Used By Used By Automated Automated ““SpidersSpiders””))

Statistics Search Engines 2006Statistics Search Engines 2006--20072007

Statistics Statistics –– Search Keywords 06Search Keywords 06--0707

Statistics Statistics -- Computing PlatformsComputing Platforms



Statistics Statistics -- BrowsersBrowsers

Future EnhancementsFuture Enhancements

►►Next steps?Next steps?§§ Technology in placeTechnology in place§§ Support infrastructure in place for website Support infrastructure in place for website

content updatecontent update

►►WhatWhat’’s missing?s missing?§§ Fresh contentFresh content§§ Active participationActive participation


►► First Step First Step -- identify focus of organizationidentify focus of organization§§ MissionMission

►► To improve health throughout the world by promoting the teachingTo improve health throughout the world by promoting the teachingand practice of all aspects of Pathology/Laboratory Medicine.and practice of all aspects of Pathology/Laboratory Medicine.

§§ GoalsGoals►► 1. To promote education, research, and international quality sta1. To promote education, research, and international quality standards, ndards,

through the Committees and Secretariats of through the Committees and Secretariats of WASPaLMWASPaLM and the World and the World Pathology Foundation.Pathology Foundation.

►► 2. To promote high quality, cost effective medical laboratory se2. To promote high quality, cost effective medical laboratory services.rvices.►► 3. To promote the exchange of information between pathologists a3. To promote the exchange of information between pathologists and nd

laboratory scientists throughout the world.laboratory scientists throughout the world.►► 4. To encourage the formation of, and cooperation between, socie4. To encourage the formation of, and cooperation between, societies ties

of Pathology and Laboratory Medicine throughout the world.of Pathology and Laboratory Medicine throughout the world.►► 5. To foster cooperation between 5. To foster cooperation between WASPaLMWASPaLM and other international and other international

health health organisationsorganisations..


►► Education and TeachingEducation and Teaching§§ Publish academic Publish academic powerpointpowerpoint presentations on the web? presentations on the web?

Scientific data on laboratory tests?Scientific data on laboratory tests?►►Electronic lab manual? Other reference material? How to set Electronic lab manual? Other reference material? How to set

up a pathology lab?up a pathology lab?

§§ Mentor residents, students?Mentor residents, students?§§ Surveys on resident education?Surveys on resident education?

►► ResearchResearch§§ Promote cross institution communication?Promote cross institution communication?§§ Surveys? On quality standards? On hospital practices? Surveys? On quality standards? On hospital practices?


►►Laboratory ServicesLaboratory Services§§ Provide access to international laboratories for Provide access to international laboratories for

specialized testing?specialized testing?►►Specify price per test?Specify price per test?►►Outsource tests?Outsource tests?►►Decrease costs?Decrease costs?

►►CommunicationCommunication§§ What organizational topics for discussion board?What organizational topics for discussion board?

►►Anatomic / Clinical Pathology disciplines?Anatomic / Clinical Pathology disciplines?




►►Commercial Products / Services?Commercial Products / Services?§§ BooksBooks§§ DataData§§ Slide archives?Slide archives?

►►Teaching, QA, testing etc.Teaching, QA, testing etc.►►Digital image archive?Digital image archive?►►CME for online exams?CME for online exams?

►►What is the strategic plan for What is the strategic plan for WASPaLMWASPaLM??§§ The website should support that planThe website should support that plan……

ConclusionConclusion

►►The technology is largely in place and The technology is largely in place and appearance now professional (with many appearance now professional (with many thanks to thanks to ControlLabControlLab) )

►►Do we take the next steps? Do we take the next steps? ►►If so, which direction to pursue and what If so, which direction to pursue and what

are the priorities?are the priorities?►►Do we put a plan in place to allow Do we put a plan in place to allow

expansion of infrastructure to support web expansion of infrastructure to support web activities?activities?

WhatWhat’’s Missing?s Missing?

►►Administrative assistant to monitor website Administrative assistant to monitor website and enhance communication between and enhance communication between WASPaLMWASPaLM community and Bureaucommunity and Bureau§§ Discussion forum is left unattendedDiscussion forum is left unattended§§ TranscriptionTranscription§§ Follow up of agenda itemsFollow up of agenda items§§ Coordination for future IHTSDO meetings Coordination for future IHTSDO meetings

►►Mechanism for funding?Mechanism for funding?



Council on World Standards and Accreditation August 20, 2007 The COWSA Secretariat is located at the CAP Offices in Chicago, Illinois and the administrative functions are done by Sandi Larsen with all correspondence handled i9n her office. I function as a liaison to standard organizations worldwide but mainly to CLSI and ISO. ISO/TC 212 Plenary sessions and ISO/TC 212 Working Groups One and Three committee meetings were held in Beijing, People’s Republic of china on May 21-23, 2007. I attended the ISO/TC 212 meeting as a representative of the COWSA and CAP and in my role as a member of the executive committee of the US Technical Advisory Group(US TAG).. The meeting was sponsored by the Standardization Administration of the People’s Republic of China and the China Institute of Medical Device Testing. Plenary sessions of the TC 212 were held in conjunction with committee meetings of Working Group One(Quality and Competence in the Medical Laboratory) and Working group Three(In Vitro Diagnostic Products). There was representation from twenty member countries and representation from the USA included members of CAP, AACC, CDC, and CLSI along with industry members of US companies. There are currently 19 authorized projects being worked on, 15 ISO/TC 212 standards have been published, and 12 projects with input from CEN/TC140. ISO TC 212 currently consists of 32 participating countries, 17 observer countries, and 19 international organizations in liaison with ISO/TC212. The CAP through the Secretariat of COWSA of the international organization WASPALM effectively sits as a liaison member of ISO/TC 212. Working Group One reported and simultaneously met at this meeting. A new convener was elected to replace the deceased Des Kenny. The new convener is Dr. John James from the UK. Current projects of Working Group One include ISO 15189, ISO 15190, ISO 22869, ISO 22870 and ISO 22367. ISO 15189(Medical Laboratories-Particular requirements for quality and competence) is in a committee draft stage that adopts amendments accepted in previous meeting. This is effectively a revision in the document that was just published in 2007. ISO 15190(Medical Laboratories-Requirements for Safety) will submit a new work proposal to revise this document. Professor Mike Noble will send out a questionnaire to laboratories using this document to identify the problem area in using it and this information will be used to revise the document. Also ISO 15190 needs to correlate with ISO 15189, references and bibliography need updating. No action on ISO 22869(Medical Laboratories-Guidance on laboratory implementation of ISO 15189 and ISO 22870(Point of care testing-requirements for quality and competence) ISO



22367(Medical laboratories-Reduction of error through risk management and continual improvement) was approved for publication as a Technical Specification. Dr. Joe Boone will head a project group to review the OECD document “Guidelines for quality assurance in molecular genetic testing” and consider if the recommendations would be appropriate for the basis of an international standard and report on a possible new work item at the next meeting of ISO TC 212. Working Group Two(Reference Systems) did not meet at this meeting. The following projects are currently being worked on ISO 15193, ISO15194, ISO 15195, ISO 17511, ISO 18153 and ISO 25680. After review by the central secretariat of ISO there are title changes of ISO 15193, ISO 15194 and ISO 25680 without change of content. There is a new work item proposal to revise ISO 15195 requirements for reference measurement laboratories. Working group Three(In Vitro Diagnostic Products) current projects are ISO 15197, ISO 15198, ISO 17593, ISO 19001, ISO 18112, ISO 18113 and ISO 14971. Title and scope changes for the parts of ISO 18113 were approved to be in compliance with ISO. Content remained the same as previous versions of the documents. Since Don Powers was elected chairman of TC212 a new convener of Working Group Three was elected and this is Kay Setzer from USA A new work item proposal was approved to revise ISO19001 with possible incorporation into ISO 18113 as part 6. Working Group Four(Antimicrobial susceptibility testing) did not meet at this meeting. ISO 20776-1 and ISO 20776-2 are current approved work items. A new work proposal on antifungal susceptibility testing in conjunction with CEN TC140 has been initiated. A new business plan is being developed for the ISO/TC212. Close cooperation with CEN/TC 140 is an important element of the plan along with cooperation with the global Harmonization Task force(GHTF). The next meeting of ISO/TC212 will be 2-4 June 2008 in Vancouver, Canada hosted by the Standards council of Canada and the Canadian Standards Association. CLSI: Numerous documents have been submitted to COWSA for comment and review. These documents concern US Guidelines and Standards and are forwarded to various CAP Resource Committees for comment and vote. WASPALM relationship to ISO/TC 212: I was directed at the last bureau meeting to provide a short narrative on the relationship of WASPALM to the ISO/TC 212 Committee. First, a little background information is provided. Three bodies are responsible for the planning , development, and adoption of international standards. These are ISO, IEC and ITU. ISO is responsible for all sectors except electrotechnical and telecommunications. ISO is a legal association comprising members from National Standards Bodies of 140 countries supported by a Central Secretariat in Geneva, Switzerland. ISO Technical Committees(ISO/TC) are formed to address a certain sector. ISO/TC 212 is a Technical Committee addressing laboratory medicine through a focus on quality management, reference systems, in vitro diagnostic products, and antimicrobial susceptibility testing. Each area has Working Group that write documents on approved projects. ISO/TC 212 has 33 active participating countries, 15 observing countries,



liaisons with seven other ISO or IEC technical committees and liaisons with 11 international organizations. The ISO/TC 212 cooperates and exchanges information with CEN/TC140. Liaison members of ISO/TC212 are IEC/TC 66, ISO/TC 48 , ISO/TC76, ISO/TC 176, ISO/TC 210, ISO/TC 215, ISO CASCO, BIPM, EC4, EDMA, ELM, EUROM, IFBLS, IFCC, ILAC, IUPAC, OECD, WASPALM, and WHO. Liaison members are approved by the ISO Central Secretariat. No dues are paid by liaison members. Liaison members can send a delegate to Technical Committee and Working Group meetings, provide input and receive documents and information, and nominate candidates directly for committees. Liaison members have no voting rights. Voting rights are reserved for participating countries with one vote per country through the national standards body of that country. All ISO documents are copyrighted and can not be distributed without paying a royalty. Respectfully submitted, Alfred E. Hartmann MD ACTION ITEM #17: Secretary-treasurer to send email list and contact people of WASPaLM membership to COWSA which will send out a letter informing them what COWSA can send them regarding ISO information and a questionnaire asking for a contact person who should receive this information. Secretariat for Quality Assurance Report for 2006/2007

1. International activities 1.1 INSTAND e.V. was redesignated as WHO-Collaborating Centre for Quality

Assurance and Standardization in Laboratory Medicine for the period 2006 to 2010.

1.2 The activities of INSTAND and SEQUA in 2006/2007 were: Ø Istanbul, March 24, 2006:

Conference on Quality Management in Clinical Laboratory.

Ø Warsaw, May 16, 2006 Conference with the Polish Society for Laboratory Diagnostics on quality assurance and

standardization in laboratory medicine.

Ø WHO Audit of the Central Public Health Laboratories of Kuwait. April 4-12, 2006

Ø Consultation of the Yemeni Government for strengthening a quality controlled laboratory medicine and initiation of EQA programs in virology.

March 7-11, 2006



1 1.3. Other international activities

Ø International Conference on Past, Present and Future of EQAS. Düsseldorf, September 8, 2006

Ø WHO-Training of Mrs. Iman Zoeter, Syria, in Düsseldorf, Berlin, Bonn, Hannover. February 6-17, 2006

Ø German-Russian Cooperation under the auspices of the Petersburg Dialogue: 1st International German-Russian Conference of the Koch-METCHNIKOW-Forum. Berlin May 2-23, 2006

Ø Enterovirus Surveillance System (WHO) Survey of March/April 2006 with 20 participating laboratories from developing countries.

Ø Amsterdam 2007, June 4-5 IFCC-Working Group on HbA1c Dr. Kaiser became coordinating chairlady of reference measurement procedure group for HbA1c .

1.4 Activities in Standardization organizations:

ISO/TC 212 Working Group 1

Working Group 2 Working Group 4

CEN/TC 140

2. National activities 2.1 Symposium on occasion 70th anniversary of INSTAND e.V.

Ø Düsseldorf 2006, September 8 International Symposium Quality Assurance in Medical Laboratories:

Past, Present, Future. Ø Munich 2007, July 5-7

Symposium on Quality Assurance in Medical Laboratories 2007. 3. General informations

The name of INSTAND e.V. was extended to Society for Promoting Quality Assurance in Medical Laboratories e.V.

Prof. Reinauer became Editor-in-Chief of the open-access internet journal:

German Medical Science.

Hans Reinauer



Secretariat on Medical Ethics 1 Review on behalf of the Bureau of WASPaLM of the Council for International

Organizations of Medical Sciences (CIOMS) draft entitled "Special ethical considerations for epidemiological research".

CIOMS had requested comments on this draft. This was reviewed together with the “parent” CIOMS document “the 2002 CIOMS

International Ethical Guidelines for Biomedical Research Involving Human Subjects”. A draft response on behalf of WASPaLM was developed by the Secretariat in a Briefing Note with attachments to the Bureau dated 5th November 2006.

Following its approval and adoption by the Bureau it was submitted as the WASPaLM response in mid-December 2006.

A consultative committee of CIOMS developed a redraft which was received by Hon Secretary Treasurer on 22nd May and forwarded to the Ethics Secretariat for comments. Review confirmed that the suggestions made by WASPaLM to the relevant sections impacting on pathology practice had been substantially taken up and used by CIOMS. No further proposals were offered in a reply of 31st May for the CIOMS Epi Gls Consultative meeting scheduled for 4th - 6th June 2007. Recommendation: That the Bureau on behalf of WASPaLM adopt the 2002 CIOMS “International Ethical Guidelines for Biomedical Research Involving Human Subjects” and the supplement “Special ethical considerations for epidemiological research” (as finally approved) as the ethical basis for guidance internationally on “Ethics in Medical Research on Human Subjects”.

ACTION ITEM #18: WASPaLM approves the above recommendation and adopts these guidelines as the official “International Ethical Guidelines for Biomedical Research Involving Human Subjects”.

2 Revised declaration of Helsinki

The WMA Council, at its May 2007 meeting in Berlin, accepted the recommendation of the WMA Medical Ethics Committee that a review of the Declaration of Helsinki be undertaken immediately and that proposed amendments be presented to the WMA General Assembly in Seoul, South Korea in October 2008. On 4th June 2007 Dr Travers forwarded to the Bureau including all members of the Ethics Secretariat an e-mail sent originally by World Medical Association Secretariat to Dr Masami Murakami calling for comments. Dr Travers asked for comments to be sent to him to formulate a response for discussion to be sent to the WMA Secretariat immediately after the Bureau meeting at the World Congress in August.

The current version of World Medical Association Declaration of Helsinki Ethical Principles for Medical Research Involving Human Subjects was adopted by the 52nd WMA General Assembly, Edinburgh, Scotland, October 2000 with additions of a Note of Clarification on Paragraph 29 added by the WMA General Assembly, Washington 2002 and a Note of Clarification on Paragraph 30 added by the WMA General Assembly,



Tokyo 2004. For further information and periodic updates on the review process will be available on the WMA website.

The current version of this Declaration has been reviewed and a number of changes have been proposed. These have been distributed to the Bureau for comment.

Recommendation: That the draft commentary (with any further amendments) be submitted to the World Medical Association as the formal suggestions of WASPaLM. ACTION ITEM #19: The Bureau fully supports this recommendation and the President will forward it to the World Medical Association by the deadline.

3 Items from Bureau meeting Chicago 27th to 30th July 2006

3.1 Ethics framework CHICAGO ACTION Item # 13: Dr. Davies will draft a position statement in regards to WASPaLM ethics as proposed above for review by the Bureau.

A Briefing Note with two (2) attachments is provided for discussion. Recommendation: That The briefing note is received and that its proposals be adopted subject to amendments by the Bureau.

3.2 Inappropriate practices – fee-splitting, bribery and inducements. CHICAGO ACTION Item # 8: Chair of the ethics committee of WASPaLM and the President will provide a statement for South American countries addressing the issue of illegal honorary splitting (Fee splitting - 'dichotomy’)

A Briefing Note is provided for discussion. Recommendation: that the briefing note is received and its proposals be adopted subject to amendments by the Bureau.

3.3 Risks of bioterrorism CHICAGO ACTION Item # 8: Chair of the ethics committee of WASPaLM and the President will provide a statement for South American countries addressing the issue of:

2. “Securing and protecting potentially dangerous biohazardous materials that could be misused.”

A Briefing Note is provided for discussion.

Recommendation: That the Briefing Note is received its proposals be adopted subject to amendments by the Bureau.

D. J. Davies 28th July 2007



BRIEFING DOCUMENT

FEE SPLITTING

1 Object: To provide for WASPaLM a position statement on inappropriate practices in pathology including fee-splitting, bribery and inducements.

2 Background: At the meeting of the Bureau in Chicago in July 2006 it was agreed that the Chair of the ethics committee of WASPaLM and the President will provide a statement for South American countries addressing the issue of “Illegal honorary splitting” (Fee splitting - 'dichotomy").

The general dictionary definition of fee splitting is a payment (usually by doctors or lawyers) of part of a client or patient’s fee in return for the referral. In terms of fundamental statements of ethical principles the following are relevant:

World Medical Association International Code of Medical Ethics: A PHYSICIAN SHALL not allow his/her judgment to be influenced by personal profit or unfair discrimination. A PHYSICIAN SHALL deal honestly with patients and colleagues, and report to the appropriate authorities those physicians who practice unethically or incompetently or who engage in fraud or deception. A PHYSICIAN SHALL not receive any financial benefits or other incentives solely for referring patients or prescribing specific products.

ISO 15189 annex C C.2.1 The general principle of healthcare ethics is that the patient's welfare is paramount. However, the relationship between the laboratory and the patient is complicated by the fact that there could also be a contractual relationship between the requester and the laboratory. Although this relationship (which is often commercial) can frequently be seen as the more important, the laboratory's obligation should be to ensure that the patient's welfare and interest are always the first consideration and take precedence.

American Medical Association:

E-6.02 Fee Splitting: Payment by or to a physician solely for the referral of a patient is fee splitting and is unethical. A physician may not accept payment of any kind, in any form, from any source, such as a pharmaceutical company or pharmacist, an optical company, or the manufacturer of medical appliances and devices, for prescribing or referring a patient to said source. In each case, the payment violates the requirement to deal honestly with patients and colleagues. The patient relies



upon the advice of the physician on matters of referral. All referrals and prescriptions must be based on the skill and quality of the physician to whom the patient has been referred or the quality and efficacy of the drug or product prescribed. (II) Issued prior to April 1977; Updated June 1994.

E-6.03 Fee Splitting: Clinics, laboratories, hospitals, or other health care facilities that compensate physicians for referral of patients are engaged in fee splitting which is unethical. Health care facilities should not compensate a physician who refers patients there for the physician’s cognitive services in prescribing, monitoring, or revising the patient’s course of treatment. Payment for these cognitive services is acceptable when it comes from patients, who are the beneficiaries of the physician’s services, or from the patient’s designated third party payer. Offering or accepting payment for referring patients to research studies (finder’s fees) is also unethical. (II) Issued prior to April 1977; Updated June 1994 and updated June 1996 based on the report "Finder's Fees: Payment for the Referral of Patients to Clinical Research Studies," adopted December 1994.

In some jurisdictions such conduct is specifically prohibited and could lead to criminal prosecution or civil sanctions. In the Australian Health Insurance Act 1974 in the section related to pathology such conduct is regarded as Bribery as contrary to Section 129AA and other activities in which a material benefit of some sort is considered to be offering an inducement which is contrary to Section 129AAA.However because these offences are “victimless” prosecution has been infrequent and when undertaken seldom successful.

Also there are some who argue that it may not always be wrong. It has been suggested that “in a principal-agent context it is possible for fee splitting to offer incentives which actually improve patient welfare. Fee splitting occurs when there is a divergence between price and the referral partner's marginal opportunity cost. A restructuring of fee levels to yield physicians equal net income per unit time would remove the incentive for fee splitting. In the absence of this reform it is shown that fee splitting may induce the first-contact physician to refer instead of performing a lower quality procedure himself, and can also be a tool for eroding specialist monopoly power.” (Pauly MV. “The Ethics and Economics of Kickbacks and Fee Splitting”; Bell Journal of Economics. (The RAND Corporation) 10 (1), pp. 344-352, 1979

While the situation is comparatively straightforward in a fee-for-service payment system in the case of a referral of an individual patient from a community physician (general practitioner) to a medical specialist is concerned the situation has now become much complex particularly for diagnostic services (both pathology and diagnostic imaging). This complexity arises from several sources:

• Corporatisation of medical practices: both those which refer patients and those which provide diagnostic tests.

• “Commodification” of pathology as an “industry” which provides diagnostic tests as an item of “goods and services” and is perceived by some managers both in the corporate private sector and in public sectors as more like linen services and catering than an element of medical practice

• Intervention of “third party payers” who may be either government or non-government corporate agencies and whose interests may be more aligned with the funders of the agency than the patients who are the recipients of the pathology service



• “Scaleability” of much of pathology testing in which increased quantities of testing can be done with lower marginal costs so that in a system with fixed fee for service payments larger numbers of tests generate higher profit for the providers.

In this environment the basics of medical ethics become obscured and the arrangements become subject to those of “normal commercial practice”. Argument that such practices are unethical are then disparaged as using ethics as a shield for promoting “restrictive trade practices” and may be subject to attention by commerce regulators.

3 Issues:

• how best to argue and demonstrate that payment for the making of a referral without any

associated demonstrable medical service is contrary to the safety and quality of patient care;

• to determine what principles should apply for financing of medical services in general and to pathology in particular which minimise opportunities and incentives for inappropriate financial practices;

• what regulatory arrangements are most likely to detect and prevent inappropriate benefits being accrued by non-contributory third parties which ensure adequate return to service providers and allow a reasonable opportunity for the benefits of increased productivity to benefit both providers and users of pathology service;

4 Proposals: 4.1 That WASPaLM declares that fee-splitting and any other arrangement of “kick-backs” is

contrary both to the World Medical Association International Code of Medical Ethics and the provisions of ISO standard 15189 annex C and is therefore unethical.

4.2 Constituent organisations are advised to recommend that their individual members exercise prudence and caution when contemplating entering into any arrangement in which charges for their professional services are made to the requester rather than to the “end user” who is either the patient or an independent third party payment agency properly at “arms length” from both the provider of patient referrals or of the diagnostic testing. This should include a determination of whether there is any nexus between the referring practitioner or his or her corporate employee and the provider of diagnostic services.

4.3 Constituent organisations having to represent individual members interests in these matters need to be fully aware of the position in the jurisdictions in which they operate on fee-splitting and equivalent practices of the rules of medical registration authorities, the ethical statements by local medical societies and the legislative position, policies and practices of relevant commercial regulators.

D. J.Davies 29th July 2007



BRIEFING DOCUMENT

WASPaLM Ethics Statement

1 Object: To further develop the policy framework for WASPaLM Ethics Statement(s).

2 Background: A briefing paper on this topic was presented to the meeting of the Bureau in November 2004 in Rio de Janeiro and was discussed further in Chicago in July 2006. This noted that individual medical associations including professional bodies of pathologists traditionally have each developed statements on Ethics which have attempted to be both comprehensive and detailed. However with increasing complexity both of modern societies and modern medical practice this approach has become increasingly difficult to sustain. In consequence there has been a change in approach with statements now becoming relatively short and consisting mainly of statements of general principles. Traditional codes have been long and some complex so that unless considerable resources are expended they may, at least in some parts, quickly become out of date and irrelevant. Issues previously raised were: • What form should a WASPaLM ethics statement take? • What should be the scope of a WASPaLM ethics statement? • How should it relate to and interact with ethics statements of other international

medical organisations? • How should it relate to and interact with ethics statements of is constituent societies?

Adopting the more contemporary approach still allows for organisations to develop formal position statements on matters that fall particularly within its area of interest and expertise and may be of particular concern. Since producing the previous Briefing Document there have been two developments that are of relevance. The first was the invitation by the Council for International Organizations of Medical Sciences (CIOMS) of which WASPaLM is a member to comment on a draft entitled "Special ethical considerations for epidemiological research". A comprehensive review was undertaken of this and a submission made on aspects of the draft relating to which had or were likely to have implications for pathology practice. These were mostly taken up and incorporated into the revised draft. Secondly the Bureau has now been invited to contribute to a re-draft of the Declaration of Helsinki by the Secretariat of the World Medical Association. In addition to these specific events WASPaLM has a continuing policy of increasing its international profile with the World Health Organisation.

3 Issues: • Should the WASPaLM ethics statement formally align itself with those of the World

Medical Association?



• To what extent should WASPaLM formally adopt as “foundation statements” those made by World Medical Association subject to agreement by that organisation?

• How should it relate to and interact with ethics statements of other international medical, scientific and organisations? E.g.:

∝ International Federation of Clinical Chemistry and Laboratory Medicine (IFCC),

∝ ISO 9001 Auditing Practices Group Guidance on: Auditor Code of Conduct and Ethics.

∝ ISO 15189 annex C which is related to ethics in Laboratory Medicine (attachment).

• How should it relate to and interact with ethics statements of is constituent societies? 4 Proposals: 4.1 That the Principal Ethics statement of WASPaLM should be a short statement of general

principles which would fundamentally and formally align its ethical position with that of the World Medical Association (attached).

4.2 In keeping with 4.1 WASPaLM should formally adopt the Declaration of Geneva and the Declaration of Helsinki in their current versions but subsequently as amended from time to time (current version previously distributed to Bureau) .

4.3 WASPaLM should position itself so as to be able to contribute to any statements on ethics

being developed under the auspices of the World Health Organisation.

4.4 Each constituent society should be encouraged to have in its constitution a formal explicit statement on Medical Ethics as it pertains to its activities

4.5 That for existing constituent societies at the time of renewal of the annual subscription to

WASPaLM and for new members at the time of admission they be invited to provide WASPaLM secretariat with their current statement on ethics. This should be provided in the language in which it was written originally. However for it to be of use in developing policy some expenditure may be required to have made a validated translation into English.

4.6 Supplementary statements may be needed from time to time to deal with specific issues

which would need to be compatible with the general statement of Ethics Principles adopted by the organisation.

D. J.Davies 29th July 2007 ACTION ITEM #20: The Bureau adopts items 4.1 to 4.6 above. The wording of the letter suggested in item 4.5 should be approved by the Bureau.



World Medical Association International Code of Medical Ethics

Adopted by the 3rd General Assembly of the World Medical Association, London, England, October 1949 and amended by the 22nd World Medical Assembly Sydney, Australia, August 1968 and the 35th World Medical Assembly Venice, Italy, October 1983 and the WMA General Assembly, Pilanesberg, South Africa, October 2006 DUTIES OF PHYSICIANS IN GENERAL A PHYSICIAN SHALL always exercise his/her independent professional judgment and maintain the highest standards of professional conduct. A PHYSICIAN SHALL respect a competent patient's right to accept or refuse treatment. A PHYSICIAN SHALL not allow his/her judgment to be influenced by personal profit or unfair discrimination. A PHYSICIAN SHALL be dedicated to providing competent medical service in full professional and moral independence, with compassion and respect for human dignity. A PHYSICIAN SHALL deal honestly with patients and colleagues, and report to the appropriate authorities those physicians who practice unethically or incompetently or who engage in fraud or deception. A PHYSICIAN SHALL not receive any financial benefits or other incentives solely for referring patients or prescribing specific products. A PHYSICIAN SHALLrespect the rights and preferences of patients, colleagues, and other health professionals. A PHYSICIAN SHALL recognize his/her important role in educating the public but should use due caution in divulging discoveries or new techniques or treatment through non-professional channels. A PHYSICIAN SHALL certify only that which he/she has personally verified. A PHYSICIAN SHALL strive to use health care resources in the best way to benefit patients and their community. A PHYSICIAN SHALL seek appropriate care and attention if he/she suffers from mental or physical illness. A PHYSICIAN SHALL respect the local and national codes of ethics. DUTIES OF PHYSICIANS TO PATIENTS A PHYSICIAN SHALL always bear in mind the obligation to respect human life. A PHYSICIAN SHALL act in the patient's best interest when providing medical care.



A PHYSICIAN SHALL owe his/her patients complete loyalty and all the scientific resources available to him/her. Whenever an examination or treatment is beyond the physician's capacity, he/she should consult with or refer to another physician who has the necessary ability. A PHYSICIAN SHALL respect a patient's right to confidentiality. It is ethical to disclose confidential information when the patient consents to it or when there is a real and imminent threat of harm to the patient or to others and this threat can be only removed by a breach of confidentiality. A PHYSICIAN SHALL give emergency care as a humanitarian duty unless he/she is assured that others are willing and able to give such care. A PHYSICIAN SHALL in situations when he/she is acting for a third party, ensure that the patient has full knowledge of that situation. A PHYSICIAN SHALL not enter into a sexual relationship with his/her current patient or into any other abusive or exploitative relationship. DUTIES OF PHYSICIANS TO COLLEAGUES A PHYSICIAN SHALL behave towards colleagues as he/she would have them behave towards him/her. A PHYSICIAN SHALL NOT undermine the patient-physician relationship of colleagues in order to attract patients. A PHYSICIAN SHALL when medically necessary, communicate with colleagues who are involved in the care of the same patient. This communication should respect patient confidentiality and be confined to necessary information.



DECLARATION OF GENEVA

Adopted by the 2nd General Assembly of the World Medical Association, Geneva, Switzerland, September 1948and amended by the 22nd World Medical Assembly, Sydney, Australia, August 1968and the 35th World Medical Assembly, Venice, Italy, October 1983 and the 46th WMA General Assembly, Stockholm, Sweden, September 1994 and editorially revised at the 170th Council Session, Divonne-les-Bains, France, May 2005 and the 173rd Council Session, Divonne-les-Bains, France, May 2006

AT THE TIME OF BEING ADMITTED AS A MEMBER OF THE MEDICAL PROFESSION:

I SOLEMNLY PLEDGE to consecrate my life to the service of humanity; I WILL GIVE to my teachers the respect and gratitude that is their due;

I WILL PRACTISE my profession with conscience and dignity; THE HEALTH OF MY PATIENT will be my first consideration;

I WILL RESPECT the secrets that are confided in me, even after the patient has died; I WILL MAINTAIN by all the means in my power, the honour and the noble traditions of the

medical profession; MY COLLEAGUES will be my sisters and brothers;

I WILL NOT PERMIT considerations of age, disease or disability, creed, ethnic origin, gender, nationality, political affiliation, race, sexual orientation, social standing or any other factor to

intervene between my duty and my patient; I WILL MAINTAIN the utmost respect for human life;

I WILL NOT USE my medical knowledge to violate human rights and civil liberties, even under threat;

I MAKE THESE PROMISES solemnly, freely and upon my honour. 14.10.2006

ISO 15189 Ethical and Security Statements “The ISO 15189 standard also provides two important annexes. One of them has recommendations for LIS (Laboratory Information Systems) security. Differently from ISO 9001:2000, the ISO 15189 clearly describes Laboratory Information Systems recommendations in the annex B – System security, data entry and reports, data retrieval, system maintenance, etc. The other annex (annex C) is related to ethics in Laboratory Medicine. ‘C.2.1 The general principle of healthcare ethics is that the patient's welfare is paramount. However, the relationship between the laboratory and the patient is complicated by the fact that there could also be a contractual relationship between the requester and the laboratory. Although this relationship (which is often commercial) can frequently be seen as the more important, the laboratory's obligation should be to ensure that the patient's welfare and interest are always the first consideration and take precedence.” “C.5 Performance of examination: All laboratory examinations should be carried out according to appropriate standards and with the level of skill and competence expected of the profession. Any fabrication of results is completely unacceptable.” ’



BRIEFING DOCUMENT

Laboratory Security, Risk and Terrorism 1 Object:

To develop a position statement for WASPaLM on measures to reduce the risk of misuse of material possessed by pathology laboratories in acts of terrorism including bioterrorism

2 Background:

At the meeting of the Bureau in Chicago in July 2006 it was agreed that the Chair of the ethics committee of WASPaLM and the President will provide a statement for South American countries addressing the issue of: “Securing and protecting potentially dangerous biohazardous materials that could be misused.” Apart from biohazards the average laboratory has in its possession a range of substances that in the wrong hands have the potential to cause harm to the community by poisoning and manufacture of explosives and incendiary devices. In individual jurisdictions of constituent members, security agencies as well as health authorities may already have in place measures which may require management of this risk not only as a precaution against terrorism and other criminal acts but also part of good occupational health and safety practice. Accordingly the most useful practical approach for WASPaLM to recommend to constituent societies and their members is to encourage a risk assessment of all potentially hazardous material held by laboratories and to ensure they are held secure. Substantial information on these hazards in multiple languages additional to English including Spanish is available from USA Government Department of Health and Human Services Centers for Disease Control. .

3 Issue: • Need to determine more clearly the scope of this requirement from the perspective of

WASPaLM and its constituent members. 4 Proposals:

4.1 The Bureau notes and advises constituent members of comprehensive information available on this topic from the USA Government Department of Health and Human Services, Centers for Disease Control and Prevention, 1600 Clifton Rd, Atlanta, GA 30333, U.S.A. Switchboard: (404) 639-3311 / CDC Contact Center: 800-CDC-INFO / 888-232-6348 (TTY) http://www.bt.cdc.gov/

4.2 Constituent societies and their individual members are advised to ascertain useful sources of information available within their jurisdictions about measures to be adopted to



reduce the threat of bioterrorism and other illegal activities which could use material from pathology laboratories.

4.3 As part of periodic laboratory management review there should be continuing assessment of risks from chemical and biological agents in the laboratory including those from their possible use in criminal activities.

D. J.Davies 29th July 2007



Report of Delegates to the WHO

World Health Organization

Sixtieth World Health Assembly, May 14th-May 23rd, 2007

Commentary on Milennium Development Goals Mr/Madam Chairman, Excellencies, Honourable committee members On behalf of WASPaLM I wish to comment on EB 120/13, 30 November 2006, A60/26, 22 March 2007 and A60/26 Add.1, 10 May 2007 WASPaLM is a worldwide association of Constituent Societies whose members comprise physicians and scientists who are trained in the disciplines of Anatomical Pathology, Chemical Pathology, Haematology and Blood Transfusion, Immuno-Pathology and Molecular Pathology, Microbiology, Virology and Parasitology. WASPaLM notes with great concern that the secretariat main recommendations were “interrelated information sets on those technologies that are indispensable, at different levels of care and in various settings and environments, in dealing with groups of diseases, conditions and disabilities that are accorded a high public health priority”. Conspicuous by its absence is the lack of the human resources requisite for the operation of these technologies if the achievements of the health related Millennium Development Goals is to be realised. Neither in a developed nor in a developing country can these devices been operated without a core of properly trained and experienced pathologists and technologists. Medical devices are not self operating. Health authorities are encouraged to ensure that staff and patient’s safety is not compromised by ensuring that staff and patients receive appropriate and adequate instruction in the use of medical devices designed for their use. The diagnosis and treatment of diseases in both resource poor and resource rich countries is dependent on quality assured laboratory investigations. The discipline of Pathology is fundamental to the diagnosis and treatment of diseases. Inaccurate investigations not only compromises patient’s care it leads to an inappropriate use of resources very often limited and it stunts the scientific growth of the discipline resulting in inappropriate investigations and a waste of scarce resources. It is reckoned that 75% of clinical diagnoses are based on laboratory investigations and these investigations mandate the availability of a properly trained group of staff who have knowledge, skills and competences to operate medical devices.



We submit that WHO must ensure that not only must there be appropriate medical devices and instruments but more importantly staffing and training must be readily available for all personnel who operate medical devices. We therefore recommend that in the formulation of strategies for the attainment of the Millennium Development Goals that WHO asks that all member states ensure that all their personal receive adequate and continuing education and training. In her address to the General Assembly Dr. Margaret Chan alluded to the importance of more laboratories in the diagnosis and control of pandemics. Implicit in this statement is the unstated need for properly trained pathology and laboratory personal to enable the goals to be realized. Dr. med. Utz P. Merten WASPaLM Representative to WHO Past President of WASPaLM

Plenary meetings The representatives from WASPaLM attended the meeting on May 14th to 16th, 2007. The opening session was characterized by a very vigorous debate on the admission of Taiwan as a member of the WHO. Unfortunately yet again Taiwan’s application was not included in the agenda but a procedural motion was tabled to discuss the reasons for Taiwan’s application to be deleted from the agenda. Following vigorous debate Taiwan’s application was not discussed. In her address to the General Assembly Dr. Margaret Chan, Director General of WHO alluded the effects of Globalization and its effects on medical migration from the developing world to the developed world. She reported on the success of the global Polio eradication initiative which has resulted in a 99 % reduction of cases since 1988. The only countries in which there is very small reservoir of cases are Afghanistan, Nigeria, Pakistan and India. The guinea-worm eradication programme is continuing satisfactory. She emphasised the importance of proactive risk management to stop further outbreaks. Of singular importance and significance to our organization were her reference of the importance and the role of training for laboratory personal. The Director General also commented on the impact of chronic diseases on low and middle income countries. She stated that this be alleviated by the deployment of more resources and that there was a need to accelerate population coverage with the interventions and health systems that reach the poor. She also stressed that this assembly meeting was taking place I a tobacco free environment and there was an urgent need to shift our strategy from advocacy to an increase of strong interventions. She acknowledged the financial support of the Blumberg Foundation for an initiative to stop smoking. Concern was expressed about the prospect of the next pandemic of human Influenza triggered by the emergence of the new novel Influenza virus. The international health regulations (2005) now provide the international community with a new framework for preventing controlling and responding to the international spread of diseases.



Global surveillance of Influenza viruses is a critical element of that process enabling identification for potential threads and assessment of the risks they pose. It was recommended that member states with vaccine manufacturer capacity and access to Influenza vaccine supplies should make specific efforts to share the benefits with member states that do not have those capacities. The global surveillance should be cooperative voluntary public health activity to strengthen global health security and must not be a profit making activity. The rational use of medicines was also reported by the WHO secretariat. The evidence suggests that more than half of all medicines in the developing countries and those with economies in transition and a substantial amount of antibiotics in developed countries are used inappropriately thus vesting scarce resources. Antibiotic resistance is increasing dramatically worldwide as a consequence of inappropriate use of antibiotics. Data from monitoring surveillance reveal that at the primary health car level in Africa Asia and Latin America only 40% of patients were treated in accordance with clinical guidelines. The use of medicines in the private sector is worse that in the public sector e.g. 40% of cases of childhood diarrhoea in the public sector were treated in accordance with clinical guidelines compared to less than 20% in the private sector. The assembly was also addressed by the Prime minister of Norway who spoke of the global partnerships that are developing to improve health care systems throughout the world. The Prime Minister is a strong supporter of an improved health care and access especially for children. Meeting with Dr. Gaby Vercauteren, WHO, Blood Safety and Essential Health Technology (EHT) During our visit we again met with Dr Gaby Vercauteren. We discussed her participation for the World Congress in Malaysia. It was reported to us that Dr. Melo has offered a per diem allowance for her hotel and that the Congress registration fee be waved. The proposed joined activity between WHO and WSPaLM for education in countries in need has not materialized because of changes in WHO due to Dr. Lee’s untimely death. But it is hoped that this initiative will be taken up in the near future. We were introduced to Dr. Steven Groth , Director of the Department of Essential Health Technologies (EHT). In our discussion with Dr. Groth we gave him a synopsis of WASPaLM’s activities and a special focus on educational programs for developing countries. Dr. Groth’s responses were positive as he felt that there is a deficiency in WHO’s policies namely the absence of pathology in the strategies of WHO. It was our impression that Dr. Groth would be cooperative in some joined ventures on education. We were also introduced to Dr. Luc Noél, coordinator clinical procedures. He informed us of activities being undertaken by colleagues in France. He agreed to send us further details of this organization with whom we can cooperate. Meeting of Commission A During our attendance of the WHA meeting we were informed over a report by the secretariat on Health technologies (see document A60/26 - 22 March 2007) and a draft resolutions deferred from the Fifty-ninth World Health Assembly and the 118th session of the Executive Board (see document EB 120/13 - 30 November 2006). This report and the resolution were on the Agenda



12.19 of Commission A. We were advised by Dr. Vercauteren to support this resolution with a statement from WASPaLM. Therefore we agreed on the above letter in which we expressed the policy of WASPaLM. This statement was to be presented to the Commission by Dr. Merten on Friday 18th May 2007. We wish to thank the WASPaLM Bureau for the opportunity to represent our organization at the WHO and WHA. 18th May, 2007 Dr. Utz P. Merten Dr. Robby Bacchus



RCPA Pathology Update 2009 in conjunction with

XXV World Congress of WASPaLM Progress Report- August 2007

Overview The Royal College of Pathologists of Australasia will be hosting Pathology Update 2009 in conjunction with XXV WASPaLM. This will be held from Friday 13 March - Sunday 15 March 2009 at the Sydney Convention and Exhibition Centre (SCEC), Darling Harbour, Sydney, Australia. The Bayside Convention Centre, Levels 1 and 2 will be where all sessions take place. Hall 5 will house the Trade Exhibition, Poster Display, refreshment breaks, and the Wine and Cheese Closing. The registration desk will be located inbetween. All information on the SCEC can be found at www.scec.com.au Venue Darling Harbour is Sydney's most exciting tourism precinct. Located on the waterfront within walking distance of the heart of the city, the area offers all that visitors love about Sydney - from great restaurants and live entertainment to beautiful gardens and fantastic attractions. With more than 17,000 hotel rooms located nearby, this vibrant region is easily accessible. Visitors can hop on the light rail or monorail, take a cab, jump on a ferry or water taxi or simply stroll to Darling Harbour from the central business district. Marketing and Design The College has created a special “look and feel” for 2009 that will carry through all our marketing material. This is already on our website www.rcpa.edu.au/pathologyupdate Please see the attachment as an example. Delegate Trends Pathology Update historically sees up to 1000 delegates attend over the 3 day conference. Pathology Update 2009 in conjunction with XXV WASPaLM needs to attract a minimum of 1500 delegates extra 500 delegates. The Royal College of Pathologists of Australasia has a membership of 2500 including College Fellows and Trainees and Pathology Update already attracts 1000, therefore we need to market to South East Asia, United States and the UK. We need the support of the WASPaLM Bureau and delegates to the House of Representatives to do this. Social Events and Accompanying Persons Social Program Pathology Update will include a Welcome Ceremony on Friday 13 March also on the Friday will be a Welcome Cocktail Reception at NSW Parliament House located at historic Macquarie Street. The Gala dinner will be on the Saturday night at Luna Park where delegates will be ferried across Sydney Harbour for a sumptuous feast and entertainment. There will be an official closing on the Sunday afternoon. A Destination Management Company- Aerius Travel have been appointed to program pre, post and during touring for delegates and partners. They will also book are travel and accommodation for speakers and any delegates. Please see the attachment – information on Sydney.



Delegates b y Discipline

Programming- Speakers Policy

Ø The Council of the RCPA determines how many international speakers will be invited. Council has determined that each major discipline should have an international speaker for 2009.

Ø Programming for each discipline is determined by the individual program committees.

Ø The Overseeing Committee is responsible for all facets of Pathology Update and meets

monthly by teleconference. Confirmed International Speakers Associate Professor Jón Jóhannes Jónsson Dr Jon J. Jonsson, MD, PhD was educated at University of Iceland Medical School. After basic postgraduate training in medicine at the University of Iceland Hospitals he trained in clinical pathology (laboratory medicine) at University of Minnesota where he also received his PhD. Subsequently he trained in medical genetics at Yale University. He has been on the faculty at the University of Iceland since 1997. Currently he serves as an associate professor and chair of the Division of Biochemistry, Clinical Biochemistry and Medical Genetics and as medical director of Dept. of Genetics and Molecular Medicine at Landspitali – University Hospital in Reykjavik, Iceland. His research group works primarily on method development in molecular genetics. The main focus is on analysis of complex nucleic acid samples with two-dimensional electrophoresis. These techniques can be used in preparative work in direct isolation of specific sequences of interest. They can also be used in analytical work to assess characteristics and quality of samples and in manipulations such as amplification, renaturation, cDNA synthesis and microarray hybridization. Dr. Jonsson has an interest in the role of genetics in society. His department is responsible for genetic services in the Icelandic health care system. He has been involved in discussions on the ethics of human genetics research including databases. Dr Jónsson will be invited to present as part of Innovations Day on World Issues facing Pathology and as part of the Genetics stream and a combined Genetics and Chemical

Discipline 2005 2006 2007 Anatomical 385 338 368 Chemical 74 60 78 Forensic 34 32 31 General 76 57 64 Genetics 18 18 21 Haematology 152 160 141 Immunology 53 63 59 Microbiology 63 57 58 Oral Pathology 10 12 8 865 797 828



Pathology session. Associate Professor Ona Marie Faye-Petersen Dr Faye-Petersen completed her training in Anatomic and Clinical Pathology in Denver, Colorado and additional Fellowships in Surgical Pathology and Paediatric Pathology in New York, New York, at Memorial Sloan-Kettering Cancer Centre and Mt Sinai Medical Centre, respectively. She then became a staff pathologist at Primary Children's Medical Centre in Salt Lake City, Utah, and, through exposure to multidisciplinary conferences in perinatal medicine, there, became interested in perinatal pathology. She pursued specialty training in embryofetal pathology at British Columbia's Children's Hospital, under Dagmar Kalousek, MD, and, in 1990, she moved to Birmingham, Alabama to follow her dream of establishing a diagnostic referral service in perinatal pathology, in the U.S. She is currently an Associate Professor of Pathology and Obstetrics and Gynecology, at the University of Alabama at Birmingham, and is well-recognised for her expertise in fetoplacental pathology and congenital cardiovascular malformations. Her diagnostic and research laboratory recently celebrated its eleventh year. She has participated in many research studies in perinatal medicine, as a placental pathologist, and her activites in several professional societies have included spearheading the establishment of a Perinatal Section and symposia in the Society for Paediatric Pathology, and the Society's offering of multidisciplinary courses in diagnostic perinatal pathology for general pathologists. She is also is the lead author of a textbook in placental pathology. Dr Faye- Petersen will be invited to present as part of the Anatomical Pathology stream and a combined session with Paediatrics and Anatomical Pathology. Dr Michael Pollanen Dr Michael Sven Pollanen the Chief Forensic Pathologist for the province of Ontario, Canada employed and an Associate Professor of Pathology in the Department of Laboratory Medicine and Pathobiology in the Faculty of Medicine at the University of Toronto. He was awarded a 1995 Gold Medal of the Governor General of Canada and has published widely in pathology. Dr. Pollanen has consulted for East Timor (United Nations), Kazakhstan, Uzbekistan, Cambodia, Thailand (Indian Ocean Tsunami), Canadian Department of National Defense and was a visiting professional at the International Criminal Court in The Hague. Dr. Pollanen has recently worked in the area of ‘miscarriages of justice and medical evidence’ and testified in the historical appeal of Steven Truscott, about 50 years after his initial conviction. Dr. Pollanen has recently developed an experimental model to study hypostatic neck hemorrhages, a mimick of strangulation. Dr Pollanen has been invited to present as part of the Forensic Pathology session. Dr Lester Thompson Born in Zimbabwe-Rhodesia and raised in the Republic of South Africa, Dr. Lester D.R. Thompson immigrated to the United, completed a Bachelor of Science degree in Business Administration. He completed medical school at Loma Linda University in 1988 while teaching anatomy for the dental and physical therapy students. After an Orthopedic Surgery internship in 1989, he continued with a Pathology Residency at University of California, Los Angeles. He did advanced training in Cytopathology, before joining the United States Navy. With triple Board Certification in Pathology, Dr Thompson worked for a decade at the Armed Forces Institute of Pathology, Washington, DC, developing a specific interest and expertise in pathology of the Head and Neck and Endocrine



organs. During this time, he served as Chief of the Division of Otorhinolaryngic-Head & Neck Pathology and Chief, Division of Immunopathology. He recently published two books and is the co-editor of Head and Neck Pathology. Dr Thompson will be invited to present as part of the Anatomical Pathology stream and a combined session with Oral and Anatomical Pathology. Invitations are about to be extended to international speakers for the Microbiology and Haematology Program. These two speakers are determined by the individual scientific program committees. Confirmed Australian Speakers: Prof Sunil Lakhani Sunil R Lakhani is Professor and Head of Molecular & Cellular Pathology in The School of Medicine, University of Queensland. He is Head of the Molecular Pathology Laboratory and Principal Research Fellow at the Queensland Institute of Medical Research (QIMR) and Visiting Breast Pathology Specialist at The Royal Brisbane and Women’s Hospital. Prior to his move to Australia in 2004, he was Professor of Pathology at The Institute of Cancer Research and The Royal Marsden Hospital, London, UK.His current research interests include lobular carcinoma and its variants, genomic profiles on normal breast epithelial and stem cells, molecular genetics of tumours with a basal phenotype and molecular pathology of familial breast cancers.He has authored/edited 5 undergraduate & postgraduate textbooks in pathology and published 150 scientific papers. He is a series editor for the WHO Classification Books and on the panel for the Classification of Tumours of the Breast. Clinical Associate Professor Michael Bilous Clinical Associate Professor Michael Bilous studied Medicine at Cambridge and Birmingham Universities and commenced his Pathology training in the UK. He subsequently spent 2 years working in New Zealand and finished his Pathology training in Australia before accepting an appointment as a Staff Specialist Pathologist at the Institute of Clinical Pathology and Medical Research (ICPMR) at Westmead Hospital in Sydney. He is currently the Director of the Tissue Pathology Department at that institution and holds the appointment of Clinical Associate Professor at the University of Sydney.

Michael has had a long-standing interest in breast pathology and is a member of a number of federal and state committees and advisory boards concerned with best practice in breast pathology. He was directly involved in organising the pathology components of the national mammographic screening and assessment program for Breast Screen Australia. He was also chairman of the Australian Cancer Network Working Party that wrote the 1st and 2nd editions of “The Pathology Reporting of Breast Cancer – A Guide for Pathologists, Radiologists, Oncologists and Surgeons”. The 3rd edition of this guide is now in the final stages of revision, again under his chairmanship. Michael is a member of the International HER2 Testing Advisory Board and is Chairman of the Australian HER2 Testing Advisory Board. Promotion of Pathology Update 2009 in conjunction with XXV WASPaLM The College is investing a lot of resources to ensure the success of 2009. Some examples are as listed below:

• RCPA College booth promoting the 2009 program and coming to Sydney for WASPaLM Malaysia.

• Producing 1000 Expression of Interest flyers and a high volume of Sydney collateral material to promote Sydney.



• Dr Debra Graves, RCPA CEO and Ms Eve Propper, RCPA Events Coordinator along with other RCPA and RCPA QAP staff attending WASPaLM Malaysia.

• Professor Lai Meng Looi President of WASPaLM 2007 and RCPA Councillor Malaysia with Dr Beverley Rowbotham, Senior Vice President RCPA hosting a cocktail party at WASPaLM Malaysia.

• Dr Debra Graves and Dr Chris Hemmings , Chair of the Pathology Update Overseeing Committee hosting a cocktail party in Sydney to promote WASPaLM 2009.

• Dr Debra Graves speaking at WASPaLM Malaysia Closing Ceremony and screening a DVD of highlights of a previous Pathology Update.

• Working closely with the Sydney Convention and Exhibition Centre along with the Sydney Convention and Visitors Bureau.

Satellite Meetings An invitation has been extended to members of the Pathology Associations Committees (PAC) to have satellite meetings. The International Liaison Committee of Pathology (ILCP) will be meeting during Pathology Update 2009. All Australasian and international associations are invited to have satellite meetings. Conference Day to Day Structure Thursday 12 March 2009

Ø WASPaLM Meeting at the Business Centre of the SCEC Friday 13 March 2009

Ø Opening Ceremony Ø Innovations Day Ø Trainees Program Ø Workshops Ø David Rothfield Memorial Oration Ø Welcome Cocktail Reception

Saturday 14 March 2009

Ø Scientific Program Ø Workshops Ø Combined Scientific sessions Ø Plenary Session Ø Eva Raik Lecture Ø DS Nelson Trainee Award Presentations Ø Awards Ceremony Ø Black Tie Dinner

Sunday 15 March 2009

Ø Scientific Program Ø Workshops Ø Combined Scientific Sessions Ø Closing Function- Handover to host Country for WASPaLM 2011.

Trade Exhibition and Sponsorship We be located in Hall 5 , the College we seek Exhibitors and Sponsors and request that WASPaLM advise of any international contacts for both Exhibitors and Sponsors for 2009.



Currently at Pathology Update we secure between 20-25 exhibitors we will need to double this for 2009 and need international support to do so. Social Program The social program will include:

Ø Welcome Ceremony Ø Welcome Cocktail Reception Ø Formal Dinner Ø Closing Function Ø Accompanying Persons Social Program

Pathology Update 2009 in conjunction XXV WASPaLM Congress Secretariat The Royal College of Pathologists of Australasia Events Coordinator: Ms Eve Propper Durham Hall 207 Albion St Surry Hills NSW 2010 t. 61 2 8356 5806 m. 0402 837 287 e. [email protected]



Proposal for the 26th World Congress of Pathology and Laboratory Medicine to be held in Italy,

2011 We joined our colleagues of AIPAC last Spring, and set up a working group exclusively devoted to the Congress Organization. The group is actively working on its topic. Since now they discussed the following:

a) Congress venue: Milan is by far the most probable choice. The new congress center inside the Fiera seems very fit for purpose. However the working group is still evaluating one or two alternatives equally suitable but a little bit less expensive;

b) Congress date: the chosen period is September, hopefully not so hot. c) Organizing Committee: its composition and job description. It will be my pleasure to inform you about upcoming details and informations as soon as they will be available.

Dott. Piero Cappelletti

SIMeL President ACTION ITEM #21: Dr Travers, Dr Raslavicus, Dr Murakami and Dr Bacchus will form a taskforce to make recommendations to the Bureau regarding administrative support of WASPaLM within 60 days following the end of the 24th World Congress. ACTION ITEM #22: The Bureau approves in concept acting as the convenor of the pathology working group for enhancement of SNOMED CT pathology content. The President shall communicate this to IHTSDO. ACTION ITEM #23: The Bureau appoints Dr Flavio to review Bureau concerns regarding a Spanish version of the WASPaLM website and report back to the Bureau within 90 days.



SUMMARY OF ACTION ITEMS ACTION ITEM #1: Dr Merten to draft amendment to be presented at house of representatives. ACTION ITEM #2: Secretary/treasurer to correspond with representatives in Australia/Japan/Europe/USA/UK to contact organizations for CME accreditation in their regions. Program from Sydney required for this. ACTION ITEM #3: The secretary/treasurer will communicate with USCAP for permission to place a link to USCAP on WASPaLM website. ACTION ITEM #4: Re-authorize funding for an administrative assistant for secretary/treasurer at $100 per month for period of 12 months beginning September 2007. ACTION ITEM #5: Authorize secretary/treasurer to request a local certified accountant to audit WASPaLM accounts in the United States annually. Bureau authorizes up to US$300 for this audit. Initial audit to be completed for calendar year 2007. ACTION ITEM #6: Authorize the President to develop an agreement with CAP foundation or another appropriate organization for fundraising for WASPaLM. ACTION ITEM #7: Authorize the President-Elect to contact the CAP foundation to establish whether it would be willing to fund certain WASPaLM educational programs. ACTION ITEM #8: The Bureau requires that formal preparations for World Congresses begin no later than 4 years prior to the Congress. This preparation would include development of relationships with WHO, commercial corporations and constituent societies. This requirement will be immediately conveyed to all constituent societies. ACTION ITEM #9: Based upon the 2008 budget to be discussed at the New Bureau meeting on 22 August 2007, the bulk of all current WASPaLM funds will be invested in higher interest bearing insured bank accounts. The US account will be composed of $100,000 operational expenses and $60,000 in one certificate of deposit. The Japanese Administration Office will put the remaining money up to $300,000 in one or two certificates of deposit. ACTION ITEM #10: Dr Merten is assigned the task of updating the WASPaLM history from 1975 to the present. The Japanese Administrative Office is requested to provide an electronic copy of the book in PDF format for the Bureau and to appear on the website.



ACTION ITEM #11: WASPaLM recommends to support the upcoming ALAPAC Workshop on Accreditation to be held in Cuba in March 2009. The organizers are kindly asked to reschedule the meeting so that an overlap with the 25th Congress can be avoided (before 8 March or after 20 March). ACTION ITEM #12: The Bureau unanimously approved the agreement between WASPaLM and JSLM for the WASPaLM Tokyo Administrative Office. ACTION ITEM #13: The Bureau agrees with this editorial change to the bylaws and will propose the change to the House of Representatives. The Bylaws Document will be editorially retitled ‘Articles of Incorporation’ and all references therein will be changed to ‘Articles of Incorporation’. ACTION ITEM #14: The dues statement directed to the larger, more financial countries should request donations or payment for dues for a less financially able country. ACTION ITEM #15: Bureau members are encouraged to talk to potential member societies in their region with the goal of incorporating their societies in WASPaLM. ACTION ITEM #16: The Bureau will introduce for discussion a proposal to modify article 4.1 of the Articles of Incorporation to add new section (c) ‘Representatives to the meetings of the House of Representatives should only be qualified physicians’ and renumber current section (c) as 4.1 (d). ACTION ITEM #17: Secretary-treasurer to send email list and contact people of WASPaLM membership to COWSA which will send out a letter informing them what COWSA can send them regarding ISO information and a questionnaire asking for a contact person who should receive this information. ACTION ITEM #18: WASPaLM approves the above recommendation and adopts these guidelines as the official “International Ethical Guidelines for Biomedical Research Involving Human Subjects”. ACTION ITEM #19: The Bureau fully supports this recommendation and the President will forward it to the World Medical Association by the deadline. ACTION ITEM #20: The Bureau adopts items 4.1 to 4.6 above. The wording of the letter suggested in item 4.5 should be approved by the Bureau. ACTION ITEM #21: Dr Travers, Dr Raslavicus, Dr Murakami and Dr Bacchus will form a taskforce to make recommendations to the Bureau regarding administrative support of WASPaLM within 60 days following the end of the 24th World Congress.



ACTION ITEM #22: The Bureau approves in concept acting as the convenor of the pathology working group for enhancement of SNOMED CT pathology content. The President shall communicate this to IHTSDO. ACTION ITEM #23: The Bureau appoints Dr Flavio to review Bureau concerns regarding a Spanish version of the WASPaLM website and report back to the Bureau within 90 days. Prof. Dr. med. Dr. h.c. M. Oellerich, FFPath (RCPI), FRCPath President-elect WASPaLM Göttingen, 18.10.07