Not much happened at Monday’s SIM steering committee meeting. The lists of recommended workgroup members from both the SIM personnel committee and the Consumer Advisory Board were distributed but not voted on. There was dispute over the number of physicians on workgroups centered on a recommendation from physician groups to add significantly to their numbers. Arguments were made that a wide variety of physician specialties must be represented on each workgroup as they have unique interests. Concerns were raised that this would violate the balance between interested stakeholders. Observers found this an ironic contrast with earlier discussions about types of “real” consumers vs. advocates. There were also objections raised to language in the Equity and Access group charter that they would only monitor for “intentional” underservice. In legal settings “intentional” requires an extremely high standard of proof. Advocates are concerned that requiring proof of intention may make any monitoring system ineffective. The group respondedto the independent consumer advocates’ latest letter with concerns about workgroup composition denying that our solicited input was not given consideration, advocates are not excluded from membership, references to expectations that members must agree to support final workgroup recommendations were deleted, and workgroups will not meet during usual business hours but they will circulate meeting times and locations. There was no commitment to post materials for reasonable public review before meetings, to take public comment at workgroup meetings, or to explicitly state that workgroup members are free to follow their best judgment about recommendations.