Ensuring High Standards
Critics and supporters of the forensic use of DNA typing agree that there has been a lack of standardization of practices and uniformly accepted methods for quality assurance. The lack is due largely to the rapid emergence of DNA typing and its introduction in the United States through the private sector.
As the technology developed in the United States, private laboratories using widely differing methods (single-locus RFLP, multilocus RFLP, and PCR) began to offer their services to law-enforcement agencies. During the same period, the FBI was developing its own RFLP method, with yet another restriction enzyme and different single-locus probes. Its method has become the one most widely (albeit not exclusively) used in public forensic-science laboratories, as a result of the FBI's national offering of free extensive training programs to forensic scientists. Each method has its own advantages and disadvantages, databanks, molecular-weight markers, match criteria, and reporting methods. In some courts, there have been differences of opinion as to the reliability, acceptability, and applicability of the various methods and particularly the degree of their specificity or discriminating power.
Regardless of the causes, practices in DNA typing vary and so do the educational backgrounds, training, and experience of the scientists and technicians who perform these tests, the internal and external proficiency testing conducted, the interpretation of results, and approaches to quality assurance.
It is not uncommon for an emerging technology to go without regulation until its importance and applicability are established. Indeed, the de-
velopment of DNA typing technology has occurred without regulation of laboratories and their practices, public or private. The committee recognizes that standardization of practices in forensic laboratories in general is more problematic than in other laboratory settings: stated succinctly, forensic scientists have little or no control over the nature, condition, form, or amount of sample with which they must work. But it is now clear that DNA analytic methods are a most powerful adjunct to forensic science for personal identification and have immense benefit to the public—so powerful, so complex, and so important that some degree of standardization of laboratory procedures is necessary to assure the courts of high-quality results. DNA typing is capable, in principle, of an extremely low inherent rate of false-positive results, so the risk of error will come from poor laboratory practice or sample handling and labeling; and, because DNA typing is technical, a jury requires the assurance of laboratory competence in test results.
At issue, then, is how to achieve standardization of DNA typing laboratories in such a manner as to assure the courts and the public that results of DNA typing conducted and reported by a given laboratory are reliable, reproducible, and accurate.
DEFINING THE PRINCIPLES OF QUALITY ASSURANCE
Quality assurance can best be described as a documented system of activities or processes for the effective monitoring and verification of the quality of a work product (in this case, laboratory results). A comprehensive quality-assurance program must include elements that address education, training, and certification of personnel; specification and calibration of equipment and reagents; documentation and validation of analytic methods; use of appropriate standards and controls; sample handling procedures; proficiency testing; data interpretation and reporting; internal and external audits of all the above; and corrective actions to address deficiencies and weigh their importance for laboratory competence. An instructive example is Guidelines for a Quality Assurance Program for DNA RFLP Analysis, developed by the Technical Working Group on DNA Analysis Methods (TWGDAM).1
TWGDAM is a practitioners' group that comprises over 30 scientists who work in DNA typing in 24 state, local, and federal forensic laboratories in the United States and Canada. Its purpose is to assemble forensic scientists actively involved with DNA typing methods and have them discuss the methods being used, compare work and results, and share protocols. The FBI has subsidized and hosted the meetings and plays a central role in the activities of the group.
The TWGDAM guidelines established functions to be followed systematically in the RFLP typing procedure and cover many important aspects of the laboratory process. In addition, they provide documentation designed to ensure that DNA analysis is operating within the established performance criteria and provide a measure of the overall quality of results. TWGDAM has also published a more detailed description of the proficiency-testing portion of the quality-assurance guidelines.2 The proficiency-testing guidelines for RFLP analysis describe the necessary elements of open and blind proficiency testing, including guidelines for documentation, review, and reporting of proficiency test results and deficiency and corrective actions.3
The TWGDAM guidelines, however, are just guidelines—they must be implemented in a formal, detailed quality-assurance program. The committee recommends that laboratories engaged in forensic DNA typing adhere to the TWGDAM guidelines for quality assurance and proficiency testing and implement them in formal programs. Although we admire the TWGDAM guidelines, we note that they do not go far enough in some ways. In some important respects, the technical recommendations contained in Chapters 2 and 3 of this report exceed the TWGDAM guidelines and should be seen as augmenting them.
TWGDAM is an excellent resource for forensic scientists and can play an important role to complement the National Committee on Forensic DNA Typing (NCFDT) recommended in Chapters 2 and 3. Whereas NCFDT should focus primarily on the key issues of scientific foundations and technology transfer, TWGDAM can serve as a forum for practitioners to discuss details of laboratory practice. Although TWGDAM was originally an FBI initiative, it should be restructured under broader auspices that represent the full range of forensic laboratories and societies.
Finally, on the subject of quality assessment and quality control, we note that the National Institute of Standards and Technology (NIST) has a program to test and develop a series of standards and controls for use in DNA typing. Because of its extensive experience in the development of standards, NIST can play a highly important role in standardization by developing lists of approved controls, equipment, and devices (including molecular-weight markers, monomorphic markers, cell lines, and typing kits).
POTENTIAL METHODS FOR ENSURING QUALITY
The principles of quality assurance discussed above must be enforced through appropriate mechanisms. Potential mechanisms include certification of individuals, accreditation of laboratories, mandatory licensing, and funding incentives contingent on adherence to standards. We discuss the advantages and disadvantages of these in turn.
Certification of Individuals
In the certification approach, a certifying body dictates that fulfillment of specified education, training, and experiential requirements be demonstrated by documentation and examination. An examination can also include a laboratory practicum. Individual certification has many advantages, but it is not adequate. A person does not perform DNA typing tests in isolation. A person's ability to produce high-quality results consistently depends heavily on the procedures, reagents, equipment, management, and attitudes in the work environment. It is impossible to separate a person from his or her organization and physical setting. In addition, personal certification can be expensive and usually requires funding support from the employing institution.
We recommend that the National Institute of Justice, given its interest in training, develop training programs in association with the American Society of Crime Laboratory Directors. Such a cooperative effort would allow continuity of candidate selection, training, examination, and certification.
Accreditation is a more comprehensive approach to regulation. It requires that a laboratory demonstrate that its management, operations, individual personnel, procedures and equipment, physical plant and security, and personnel safety procedures all meet standards. Laboratory accreditation programs can be voluntary or mandatory. Although voluntary programs can have a positive effect, they suffer from the limitations that laboratories need not comply, that standard-setting need not be open to public scrutiny, and that accreditation might be contingent on membership in a professional organization. Accreditation programs required by federal or state law provide a greater level of assurance.
Licensing of Laboratories
Licensing involves vesting, by the federal government or a state government, of a regulatory body with the responsibility and authority to establish a series of requirements that a laboratory must satisfy if it is to be allowed to operate in a defined jurisdiction or to present evidence in its courts. The licensing approach does not suffer the disadvantage of being voluntary. State or federal laws can place sanctions on a laboratory that is not licensed by the specified body. A potential drawback is that the development of such a program can be time-consuming and expensive. In addition, licensing can be anticompetitive and can discourage innovation. In the
case of state (as opposed to federal) regulation, there is the potential problem that different practices will be mandated in different jurisdictions, although this can be avoided if a few states take the lead and others follow suit by adopting similar regulations or recognize other states' licensing. The most efficient path seems to be for a federal licensing procedure to standardize the process for the nation and avoid state licensing, which can be restrictive and redundant. The federal license would be most cost-efficient and provide the field with a mechanism of quality assurance.
Funding Contingent On Adherence to Standards
The ''stick" of licensing can be replaced by the "carrot" of funding. Such an approach would provide an incentive for adhering to standards, reduce costs for states and localities, and increase the number of laboratories able to afford DNA typing. A medical specialty laboratory typically spends $1,000-3,000 per annum for its licenses and accreditation. But the approach has numerous problems. The use of an equitable funding formula within state eligibility requirements might be problematic and controversial. Private laboratories would be unlikely to be covered (or even to want to be covered) by such a program. Expanding the number of practicing laboratories might decrease, not increase, the general standard of practice for a complex technology. Most important, the funding incentives alone do not provide an adequate guarantee of quality; they must be backed up by a regulatory program.
QUALITY ASSURANCE IN RELATED FIELDS
It is useful to consider the experience with various approaches in related fields. Medicine provides an appropriate analogy to forensic science, because it involves the application of sophisticated scientific methods to serious decisions that the practitioner must make on the basis of only partial information. Medicine has general mechanisms for setting standards of education and training of people, of laboratory practices and performance, and of quality assurance. The mechanisms involve both voluntary standard-setting by professional organizations and mandatory regulation through public licensing.
In pathology and laboratory medicine, the College of American Pathologists (CAP) is the dominant standard-setting organization. It has its roots in pathology, but has recently indicated its interest in working collaboratively with other laboratory-based professional groups toward establishing standard-setting for specialty laboratories. In medical genetics, the American Society of Human Genetics (ASHG) operates a personnel-certification program for clinicians and laboratory directors. ASHG recently agreed to
provide expert consultants to CAP to establish laboratory certification in cytogenetics, biomedical genetics, and DNA-based diagnostics. In paternity testing, the American Association of Blood Banks (AABB) has developed laboratory-certification actions for protein typing methods and is establishing a set of standards for clinical DNA testing laboratories. AABB has also entered into discussions with CAP to codevelop proficiency testing for specialty laboratories. Additionally, the American Society for Histocompatibility and Immunogenetics has considered standards for histocompatibility testing, including DNA analysis.4
Mandatory government accreditation plays an essential role. Personnel certification and laboratory licensing are required in medicine, and formal requirements are set by state and federal regulatory bodies. Physicians, physician's assistants, medical technologists, laboratories, and others are licensed by states. Moreover, since 1967, a federal process of accreditation has been mandated for medical laboratories under the Clinical Laboratory Improvement Act (CLIA). In 1988, that process was expanded and restructured to enhance performance of laboratories involved in human DNA diagnostic programs. Officials responsible for implementing CLIA have recently initiated discussion with CAP for the purpose of codeveloping proficiency testing.
Medical accreditation programs have substantial force behind them. Government accreditation is mandated by law; private accreditation is often mandated as a component of government regulation; and both kinds of accreditation are required by third-party payers (e.g., insurance carriers) for payment.
INITIAL EFFORTS TOWARD ESTABLISHING STANDARDS IN FORENSIC DNA TYPING
Some initial efforts at developing accreditation and licensing standards for forensic DNA typing are already under way, as follows.
The American Society of Crime Laboratory Directors (ASCLD) is a professional organization of approximately 350 members that has represented forensic-science laboratory directors since 1975. Although most forensic laboratories in the United States are publicly funded and mandated by state or federal statutes to examine physical evidence and perform forensic testing, a voluntary laboratory-accreditation program has been in operation since 1985 through the auspices of the American Society of Crime Laboratory Directors-Laboratory Accreditation Board (ASCLD-LAB), which is an independently chartered organization affiliated with but separate from ASCLD. Some 77 forensic laboratories in the United States and in Australia are accredited by ASCLD-LAB. Such accreditation is available to all public and private forensic DNA laboratories, including ones that do not meet
the membership requirements for ASCLD. There has, however, been no listing of laboratories that failed examination, had deficiencies, or were advised to discontinue providing services, and that constitutes a flaw in voluntary laboratory accreditation as carried out by ASCLD-LAB.
The New York state legislature has developed legislation to create a licensing program that was recommended by the Governor's Select Commission on DNA Typing, which was chaired by the state commissioner of criminal justice and consisted of lawyers, molecular biologists, forensic scientists, and population geneticists. It proposes that New York administer a licensing program with the advice of a scientific review board and a DNA advisory committee. Those bodies would consist of independent scientists in molecular biology and population genetics with no ties to forensic laboratories, through financial relationships, extensive collaboration, or provision of extensive testimony. This pioneering effort is consistent with the leadership role that New York has assumed in other laboratory testing—it is the national leader in the regulation of cytogenetics, for example. Both houses of the New York legislature passed a bill establishing a regulatory framework but it later was withdrawn. A similar bill has been reintroduced in the current legislative session.
A third approach is reflected in legislation recently introduced in the U.S. Congress "to provide financial assistance to state and local governments wishing to upgrade their crime laboratories with DNA genetic testing capability" contingent on their adherence to particular standards. The proposed law, entitled the DNA Proficiency Testing Act (H.R. 339, introduced by Rep. Frank Horton),5 would promote increased quality assurance by providing grants from the Department of Justice (DOJ) Bureau of Justice Assistance to state and local forensic laboratories and mandating the FBI to publish "advisory standards for testing the proficiency of forensic laboratories" and to carry out certification for DNA proficiency-testing programs. The Bureau of Justice Assistance would make grants to state or local forensic laboratories. Within 6 months of enactment, the FBI would publish standards for testing the proficiency of laboratories that conduct DNA typing. The standards would "specify criteria to be applied to each procedure used by forensic laboratories to conduct analyses of DNA." The FBI would revise the standards from time to time, as necessary.
Under H.R. 339, the FBI could approve a DNA proficiency-testing program offered by a private organization, if the program satisfied the proficiency-testing standards and the testing laboratory were prepared to issue to each forensic laboratory that participated in the program a document that certified the participation and specified the period for which the proficiency test applied to the forensic laboratory. The FBI would have to withdraw approval for a DNA proficiency-testing program if the program or testing laboratory failed to satisfy the proficiency-testing standards.
In addition to those formal efforts for standardization now under consideration, the FBI has promoted standardization through various programs and initiatives.
The FBI's Forensic Science Research and Training Center (FSRTC) in Quantico, Va., developed the analytic methods most commonly used or under development in forensic laboratories and promotes their acceptance through an excellent training program. Since January 1989, the FSRTC has provided training for over 200 forensic scientists from 74 state and local laboratories in the United States, South Korea, Turkey, and Portugal.
The FBI has initiated, sponsored, and hosted the TWGDAM meetings at the FSRTC and published its guidelines.
The FBI has proposed the establishment of a national DNA databank. The proposal has serious implications for the standardization of practices, in that its success would require participating forensic laboratories to be capable of producing nearly identical results on a given sample. That requirement would drive the forensic community to adopt some standardized analytic methods, including molecular-weight markers, probes, controls, and methods for allele measurement.
The FBI provides educational and training opportunities (although it has not indicated an interest in developing and implementing personnel or laboratory testing programs for outside laboratories).
A REGULATORY PROGRAM FOR DNA TYPING
Components of a Suitable Program
In evaluating the relative merits of possible approaches, the committee developed a list of general requirements that a regulatory program adopted for the standardization of DNA typing technology should include. The ideal program would contain mechanisms to ensure that:
Individual analysts have education, training, and experience commensurate with the analysis performed and testimony provided.
Analysts have a thorough understanding of the principles, use, and limitations of methods and procedures applied to the tests performed.
Analysts successfully complete periodic proficiency tests and their equipment and procedures meet specified criteria.
Reagents and equipment are properly maintained and monitored.
Procedures used are generally accepted in the field and supported by published, reviewed data that were gathered and recorded in a scientific manner.
Appropriate controls are specified in procedures and are used.
New technical procedures are thoroughly tested to demonstrate their
efficacy and reliability for examining evidence material before being implemented in casework.
Clearly written and well-understood procedures exist for handling and preserving the integrity of evidence, for laboratory safety, and for laboratory security.
Each laboratory participates in a program of external proficiency testing that periodically measures the capability of its analysts and the reliability of its analytic results.
Case records—such as notes, worksheets, autoradiographs, and population databanks—and other data or records that support examiners' conclusions are prepared, retained by the laboratory, and made available for inspection on court order after review of the reasonableness of a request.
Redundancy of programs is avoided, so that unnecessary duplication of effort and costs can be eliminated.
The program is widely accepted by the forensic-science community.
The program is applicable to federal, state, local, and private laboratories.
The program is enforceable—i.e., that failure to meet its requirements will prevent a laboratory from continuing to perform DNA typing tests until compliance is demonstrated.
The program can be implemented within a relatively short time.
The program involves appropriate experts in forensic science, molecular biology, and population genetics.
The Role of Professional Organizations
One guarantee of high quality is the presence of an active professional organization that is committed and able to enforce standards. Historically, the professional societies in forensic science have not played a very active role—certainly much less than medical societies. That has been due to a variety of circumstances, including the fact that accreditation and proficiency testing can be expensive and can lead to serious repercussions for laboratories with poor performance. Voluntary programs have few incentives and offer relatively little credibility for participating laboratories. Moreover, courts have not required certification, accreditation, or proficiency testing for admissibility of evidence. Together, those factors have worked against the development of rigorous accreditation programs.
Recently, however, ASCLD-LAB has shown a substantial interest in assuming an active role. At the annual meeting of ASCLD and ASCLD-LAB in September 1990, the boards of both organizations passed—with near unanimity—a resolution to expand requirements for accreditation of forensic-science laboratories engaged in DNA typing, including mandatory proficiency testing at regular intervals.6,7
Specifically, new standards require:
Mandatory participation in an external proficiency-testing program administered by a contractor that meets rigid specifications for adequacy and reliability (it is envisioned that two sets of tests will be required each year).
The requirement that each examiner in a laboratory take proficiency tests and submit results independently.
Review of test results by ASCLD-LAB.
Inclusion in the board's DNA Advisory Committee of both forensic DNA scientists and leading experts in nonforensic DNA technology, to provide guidance and advice in forensic DNA testing.
Periodic on-site inspections of accredited laboratories.
Documentation of conduct of internal, blind, and open proficiency testing.
Adherence to TWGDAM guidelines for quality assurance and proficiency testing (endorsed by ASCLD and ASCLD-LAB).
A mechanism to revoke or suspend accreditation on documentation of unsatisfactory performance.
ASCLD has unanimously recommended that any forensic laboratory engaged in DNA typing or actual case materials be accredited by ASCLD-LAB for the typing method used. The committee supports the effort by ASCLD and ASCLD-LAB, because it holds the promise of rallying the profession to enforce high standards on its members. Of course, it remains for ASCLD-LAB to demonstrate that it will actively discharge the role of accreditation and mandatory proficiency testing. Any accreditation program would need to be advised by persons without ties to forensic laboratories that are engaged in DNA typing, in order to assure the public—especially defendants—that it is independent and objective. To that end, program leadership should consist primarily of persons who have no financial stake in the practice of forensic DNA testing.
The Role of Government
Voluntary accreditation programs are not enough. Because professional organizations, such as ASCLD-LAB, lack regulatory authority, forensic laboratories could avoid accreditation and still offer DNA typing evidence in criminal proceedings. In view of the important public-policy goal that this powerful technology be practiced only at the highest standard, compliance with high standards must be mandatory. Two approaches should be used to accomplish this, as set forth below.
First, courts should require that a proponent of DNA typing evidence have appropriate accreditation—including demonstration of external, blind
proficiency testing (as well as other accreditation that might be mandated by government or come to be generally accepted in the profession)—for its evidence to be admissible. There is strong legal foundation for such a position. As a number of courts have correctly recognized, the admissibility of scientific evidence depends not just on a technology's being sound in principle, but on the testing laboratory's having applied it in the case at hand according to generally accepted standards. Courts should view the absence of appropriate accreditation as constituting a prima facie case that the laboratory has not complied with generally accepted standards. Until accreditation programs are fully implemented, there will be a period during which some laboratories will not have completed the accreditation process. In the interim, courts should require forensic laboratories at least to demonstrate that they are effectively in compliance with the requirements for accreditation as outlined by TWGDAM and by this report; that would be taken as meeting generally accepted standards of practice.
Second, the federal government should adopt legislation requiring accreditation of all forensic laboratories engaged in DNA typing. The committee recommends the following approach:
Establishing mandatory accreditation should be a responsibility of the Department of Health and Human Services (DHHS), in consultation with the Department of Justice (DOJ). DHHS is the appropriate agency, because it has extensive experience in the regulation of clinical laboratories through programs under the Clinical Laboratory Improvement Act and has extensive expertise in molecular genetics through the National Institutes of Health. DOJ must be involved, because the task is important for law enforcement. However, the committee feels that primary responsibility should rest with DHHS for two reasons. First, DOJ lacks expertise in quality assurance and quality control and in molecular or population genetics. Second, DOJ may be perceived as an advocate for application of the technology. Oversight by DOJ may not be perceived as providing adequate assurance to the public or to a defendant facing prosecution by DOJ or affiliated agencies.
DHHS, in consultation with DOJ, should contract with an organization to create and administer an appropriate laboratory-accreditation program, including proficiency testing. Preferably, the organization would be a private professional group; that would avoid the creation of additional government bureaucracy. One choice would be ASCLD-LAB, provided that it followed through on its announced intentions to assume a more active standard-setting role and demonstrated rigorous independence from the laboratories that it would regulate. Another choice would be CAP, which has unparalleled experience in administering such laboratory-accreditation programs in a wide variety of fields. Alternatively, the organization could be a government agency, provided that it were not itself engaged in operat-
ing forensic laboratories or closely tied to such a laboratory. Thus, NIST might be appropriate, whereas the FBI and TWGDAM (suggested for this role by H.R. 339) would not be.
Mandatory accreditation falls within the interstate commerce clause, inasmuch as the standard of practice of forensic DNA typing laboratories profoundly affects citizens from states other than those of the laboratories. Thus, even state forensic laboratories would be covered.
With the aid of an outside panel of experts, DHHS, in consultation with DOJ, should periodically determine whether the accrediting organization and the accreditation program are performing satisfactorily and, if not, select a new organization.
As in medicine, federal legislation should not preclude additional state licensing, but it might avoid the need for duplication of equivalent licensing programs at multiple levels.
The committee considers mandatory accreditation to be essential for ensuring high standards in DNA typing.
Support for Education, Training, and Research
In the long term, high quality in a field depends on first-rate programs of education, training, and research. Such programs are crucial for developing the necessary foundation of people and knowledge. The National Institute of Justice (NIJ) is the appropriate organization for such efforts and for assisting in education, training, and research. It is our opinion that NIJ has been given inadequate financial resources to meet these needs and that the level of support should be re-evaluated.
SUMMARY OF RECOMMENDATIONS
Although standardization of forensic practice is somewhat problematic because of the nature of the samples, DNA typing is such a powerful and complex technology that some degree of standardization is necessary to ensure high standards.
Each forensic-science laboratory engaged in DNA typing must have a formal, detailed quality-assurance and quality-control program to monitor work, on both an individual and a laboratory-wide basis.
The TWGDAM guidelines for a quality-assurance program for DNA RFLP analysis are an excellent starting point for a quality-assurance program, which should be supplemented by the additional technical recommendations made in Chapters 2 and 3 of this report.
TWGDAM should continue to function, playing a role complementary to that of the National Committee on Forensic DNA Typing. To increase
its effectiveness, TWGDAM should include more independent technical experts from outside the forensic community and should not be closely tied to any forensic laboratory.
Quality-assurance programs in individual laboratories alone are insufficient to ensure high standards. External mechanisms are needed, to ensure adherence to the practices of quality assurance. Potential mechanisms include individual certification, laboratory accreditation, and state or federal regulation.
One of the best guarantees of high quality is the presence of an active professional-organization committee that is able to enforce standards. Although professional societies in forensic science have historically not played an active role, ASCLD and ASCLD-LAB recently have shown substantial interest in enforcing quality by expanding the ASCLD-LAB accreditation program to include mandatory proficiency testing. ASCLD-LAB must demonstrate that it will actively discharge this role.
Because private professional organizations lack the regulatory authority to require accreditation, further means are needed to ensure compliance with appropriate standards.
Courts should require that proponents of DNA typing evidence have proper accreditation for each DNA typing method used. Lack of accreditation should be considered to constitute a prima facie case that a laboratory has not complied with generally accepted standards.
In view of the compelling public interest in ensuring high standards for DNA typing, the federal government should enact legislation to establish a mandatory accreditation program. DHHS, in consultation with DOJ, should be assigned responsibility for engaging an appropriate organization to develop and administer the program. Possible choices for such an organization include ASCLD-LAB, CAP, and NIST.
NIJ does not appear to receive adequate funds to support education, training, and research in this field properly. The level of funding should be re-evaluated and increased appropriately.
1. Technical Working Group on DNA Analysis Methods (TWGDAM). Guidelines for a quality assurance program for DNA restriction fragment length polymorphism analysis . Crime Lab Dig. 16(2):40-59, 1989.
2. Technical Working Group on DNA Analysis Methods (TWGDAM). Guidelines for a proficiency testing program for DNA restriction fragment length polymorphism analysis. Crime Lab Dig. 17(3):50-60, 1990.
3. Technical Working Group on DNA Analysis Methods (TWGDAM). Statement of the Working Group on Statistical Standards for DNA Analysis. Crime Lab Dig. 17(3):53-58, 1990.
4. American Society for Histocompatibility and Humunogenetics. Standards for histocom-patibility testing. ASHI Quart. 14(1), Winter-Spring, 1990.
5. H.R. 339, DNA Proficiency Testing Act of 1991, 102nd Congress, 1st Session. January 8, 1991.
6. Resolution of the ASCLD-LAB Delegate Assembly, Sept. 26, 1990.
7. ASCLD Board of Directors Resolution of Support, Sept. 27, 1990.