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CHICAGO -- The American Medical Association (AMA) adopted new policies calling for greater police accountability and increased community involvement in policing practices, during its House of Delegates special meeting on Tuesday.

"The AMA is strongly invested in the betterment of public health and remains committed to advocating for actionable reform to eliminate excessive police violence in historically marginalized communities," Willie Underwood III, MD, MPH, a member of AMA's Board of Trustees, said in a .

In addition to advocating for reviews following "sentinel" events such as in-custody deaths, the new policy calls for promoting "evidence-based" policing and law enforcement standards, for encouraging more research related to the transfer of military equipment to law enforcement agencies, and for supporting "procedurally just policing models."

Some delegates, however, pressed the association to take an even stronger position, one that advocates for reforming qualified immunity and the demilitarization of law enforcement.

Qualified Immunity

Qualified immunity is a legal doctrine that shields police officers, and other government officials from liability for misconduct.

Luis Seija, MD, a delegate for the Minority Affairs Section, argued on the virtual floor of the House that addressing the issue of qualified immunity is key to tackling systemic racism in policing and to curbing law enforcement's use of excessive force.

While the Board of Trustees' report on the matter is "thoughtful," it only touched on qualified immunity in absolutes -- potential abolishment or repeal -- and what's needed is "a critical examination of reform in general," he said.

Qualified immunity reform "offers to people protection of their constitutional right to due process ... and to justice for egregious misconduct at the hands of law enforcement," Seija added.

Rather than limiting the scope of the AMA's advocacy, the amendment called for examining the types of policy solutions that can lead to "real accountability," he said.

Zachary Dunton, a delegate from Wisconsin, shared the story of a patient whom he treated for traumatic injuries. The patient had called the police to respond to a domestic assault; however, the patient also had a history of bipolar disorder. By the time the police arrived, the patient was in the midst of a manic episode and struggled to follow police commands. The police were not at all equipped to deal with the patient's health crisis, Dunton said.

"As a result, police exerted physical force to detain the patient, causing greater injuries than the assault that prompted the 911 call," Dunton said. "When physicians cause harm to patients they're subjected to malpractice for accountability. Reforming qualified immunity would improve accountability in the police force. This improved accountability will reduce police misconduct and prevent patients like mine from being unnecessarily harmed."

Gregory Pinto, a delegate from New York, speaking on his own behalf, argued that "crime is definitely a determinant of health." As crime rates increase in a community, residents' overall health status declines, he said.

With regard to qualified immunity, Pinto quoted from : "Qualified immunity balances two important interests: the need to hold public officials accountable when they exercise their power irresponsibly and the need to shield officials from harassment distraction and liability when they perform their duties reasonably." (In Pearson v. Callahan, respondent Afton Callahan sought damages, stating that police officers had violated his Fourth Amendment rights following a warrantless search of his home.)

Police officers are still accountable for violating a person's rights, Pinto stressed, but qualified immunity allows them to approach a possibly dangerous situation without having to also worry that they could be "sued by an unhappy suspect," he said. "For the health and safety of our patients and ourselves, we need to be able to let the police do their job without interfering."

Mary Carpenter, MD, speaking for the Council on Legislation, said the council had "significant concerns" about the AMA taking a stance on qualified immunity. The issue was discussed at length in committee sessions over the weekend, and the Board of Trustees report concluded that "no evidence supports the notion that repealing or reforming qualified immunity would change the behavior of law enforcement, reduce police violence, or improve health outcomes," she said.

Carpenter also stressed that issues of constitutional law are beyond the scope of the AMA's expertise.

Police violence is a "grave matter of public health" and reforms are needed, but the proposed policy on qualified immunity is the wrong strategy for achieving those goals, said Carpenter. She urged others to vote down the amendment.

Following a vote of 240-236, the amendment was not adopted.

Demilitarizing Police

Sarah Mae Smith, an alternate delegate from California speaking on behalf of the Medical Student Section (MSS), introduced a second amendment that called for the AMA to support eliminating "the inappropriate militarization of community law enforcement interactions with civilian populations."

Smith acknowledged that the language of the amendment was similar to what was offered in committee, but the MSS disagreed with the conclusion of , that the issue requires more study before the AMA can take a stance.

The MSS had cited multiple studies in an online discussion of the policy that indicated a "direct relationship between military weapon transfers and police violence against civilians," said Smith. Given the currently available evidence, she argued that "our AMA has the ability and the moral obligation to oppose the unnecessary militarization of law enforcement agencies and to advocate for actionable reform to eliminate police violence."

Anna Yap, MD, a delegate speaking on behalf of Public Health Physicians, supported the amendment.

"For the past 8 years over a thousand people have been killed, per year, by the police," she said, adding that in 2019, around 24% of victims of police violence were Black. "Many of the victims were unarmed, wearing hoodies, some are experiencing a mental health crisis. Some are children."

Militarization of the police played a role in the deaths of Breonna Taylor, George Floyd, Tamir Rice, and many other victims, stirring subsequent protests over police brutality that continued a "vicious cycle," she said. "The police use more violence to quell protests of police brutality, which results in more death."

Carolynn Francavilla, MD, a delegate from Colorado, opposed the amendment, recalling a situation where a physician colleague was caught in a hostage active-shooter situation. The physician was at work and was rescued by a SWAT team in an armored vehicle after a standoff that lasted several hours.

"That armored militarized vehicle saved his and many patients' lives," she said, noting that in that situation, the shooter was arrested and taken into custody unharmed.

Moreover, Francavilla argued that physicians make their decisions based on evidence, and "there's very little at this time on this topic."

Francavilla was called on by another delegate to state any conflicts of interest she had, as is protocol during testimony. When prompted, Francavilla, who appeared visibly flustered by the insinuation she had not been transparent, acknowledged that her husband is a police officer and said she thought the conflict of interests policy was limited to financial conflicts.

Underwood, speaking for the Board of Trustees, stated that the issue of demilitarization of law enforcement was considered, as is detailed in . Based on its own review, the Board found that there was "not enough evidence ... one way or the other to make a decision ... thus more research is needed," he said.

The House of Delegates declined to adopt the second amendment in a vote of 205-274.

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