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Executive Summary

The American Medical Association is supporting a one-year moratorium on payments from the National Childhood Injury Compensation Program in order to provide time to resolve the program's medical, financing and administrative problems. AMA's House of Delegates, voting at the Association's June 23- 27 annual meeting in Chicago, endorsed a resolution stating that the association should use "all available legal and political resources [to] seek a moratorium on all compensation payments through the National Childhood Vaccine Injury Act until the medical inaccuracies are corrected, the administrative disarray is resolved and viable funding is established." During the delegates' June 25 debate on the vaccine issue, James Felsen, MD, an HHS Public Health Service official, informed the delegates that a "moratorium is under very, very active consideration within the department right now." He noted that HHS is considering legislation on the recommendation of both the American Academy of Pediatrics and the National Childhood Vaccine Commission. That idea, he added, "is being very, very actively discussed." HHS Assistant Secretary for Health James Mason, MD, recently acknowledged that a "legislative fix" is needed to keep the program operating ("The Pink Sheet" March 18, T&G-4). The program is administered by the Public Health Service's Health Resources and Services Administration. Another report adopted by the delegates suggests AMA should convene a committee composed of physicians, public health experts, manufacturers and legal experts to review the program and suggest ways to improve it. As of April 15, 1991, 4,078 claims were filed for injuries occurring before October 1988, which are compensated through general Treasury funds, the report notes. Sixty-six claims had been filed by that date for post-1988 injuries, which are compensated through a federal trust fund derived from a surtax on childhood vaccines. A total of 164 awards and $ 104 mil. in compensation had been paid, with individual awards ranging from $ 6,000 to $ 2.9 mil. The average for pre-1988 injury awards is $ 1.2 mil. The AMA report notes "that the vaccine injury compensation program could reach $ 3 bil. for pre-1988 injuries . . . based on the 1991 compensation rate of 65% of costs which is double the 1990 payment rate." The report points out that the 1991 budget approved by Congress included $ 62.9 mil. for pre-1988 claims, $ 154 mil. for post-1988 claims and $ 2.5 mil. for administrative expenses. A supplemental appropriations act added $ 17 mil. for the pre-1988 claims. The cost of vaccine injury compensation is "skyrocketing because the compensation program has received more than 4,000 petitions (more than quadruple the 1,000 annually that had been predicted)," the report adds. Some delegates argued that a moratorium could wind up killing a promising pilot effort and perhaps return more cases to litigation. Others criticized the program as cumbersome for those warranting help, and for granting awards to some patients when medical reviewers recommended against compensation. The resolution originally proposed by Oklahoma delegates and adopted by the association asserts that "there is an increasing vendetta against diphtheria-pertussis-tetanus vaccine by the Dissatisfied Parents Together pushing for larger and more frequent awards." On the other hand, it states, "British and Canadian authorities have essentially absolved DPT vaccine of alleged problems of encephalopathy and a pending report of the Institute of Medicine is also expected to similarly absolve DPT vaccine." Of the first 23 DPT/encephalopathy claims adjudicated, the program's medical staff recommended that 10 receive compensation but the claims court granted awards to 20, according to a chart contained in the AMA report. Another key concern is claims alleging that use of the DPT vaccine led to Sudden Infant Death Syndrome. Of the first 22 DPT/SIDS claims adjudicated, medical reviewers recommended that none receive compensation but the claims court granted awards for 20, for a total of $ 5.5 mil. The awards were granted despite "a number of scientific studies" that "have shown no causative relationship between administration of DPT vaccine and SIDS," the report maintains.

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