Apr 20, 2011

Physicians Stand Up for Patient Safety in the House

TMA Legislative News Hotline

Wednesday, April 20, 2011

With so many white coats prepared to take the witness stand today, it almost looks like First Tuesdays at the Capitol. We have physicians from Austin, Fort Worth, Eagle Lake, and other parts of Texas in town to testify on behalf of TMA, the Texas Academy of Family Physicians (TAFP), Texas Pediatric Society, and Texas Orthopedic Society. Most of the physicians are testifying before the House Public Health Committee later today against these bills:

Gary Floyd, MD
APN scope expansion: Gary Floyd, MD, a Fort Worth pediatrician, executive vice-president of medical affairs at John Peter Smith Health Network and member of the TMA’s Council on Legislation; Lloyd Van Winkle, MD, a Castroville family physician and past president of TAFP; Tricia Elliott, MD, director of the family medicine residency program at The University of Texas Medical Branch at Galveston; and Jeff Jekot, MD, an anesthesiologist from Austin will testify against House Bill 708 by Rep. Kelly Hancock (R-North Richland Hills), HB 915 by Rep. Wayne Christian (R-Center), and HB 1266 by Garnet Coleman (D-Houston). All three bills have slight nuances. However, each would allow advanced practice nurses (APNs) to practice independently of physician supervision. The bills would apply to nurse practitioners, nurse anesthetists, and clinical nurse specialists. All would be allowed to (1) prescribe, (2) diagnose, and (3) order and prescribe therapeutic care independently of physician supervision. They would allow care to be provided to patients under the supervision of the Texas Board of Nursing, not the Texas Medical Board.

Telemedicine: Russell Thomas, DO, an Eagle Lake family physician who formerly served on the Texas Medical Board and currently serves on the National Federation of State Medical Boards, will testify against HB 2333 by Rep. Rick Hardcastle (R-Vernon). The legislation would allow a physician to diagnose and treat a patient via the Internet without first establishing a relationship in person or doing a physical exam on the patient. The bill also would allow a physician or telemedicine service to use an unlimited number of physician assistants and APNs to provide care to patients via the Internet.

Clinical autonomy: Debra Patt, MD, an Austin oncologist, will testify against HB 669 by Rep. James White (R-Hillister). The legislation would tell physicians what they must tell a woman facing breast surgery about their options for breast reconstruction. Physicians also would have to tell patients how much of the cost would be covered by their health plan. Dr. Patt will tell the committee that legislation should not dictate what physicians should discuss with their patients regarding their health care. She also will explain why it’s impossible for physicians to tell patients exactly how much of their medical care will be covered by their health plan.

Kimberly Avila Edwards, MD
Food safety: Kimberly Avila Edwards, MD, an Austin pediatrician and medical director of the Texas Center for the Prevention and Treatment of Childhood Obesity at Dell Children’s Medical Center, will testify against HB 75 by Rep. Dan Flynn (R-Van). The bill would expand access to unpasteurized, raw milk. Dr. Edwards will explain to committee members why raw, unpasteurized milk is a health hazard.

Physical therapist scope expansion: Eddie Seade, MD, an Austin orthopedic surgeon will testify against HB 637 by Rep. Craig Eiland (D-Galveston). The measure would allow direct access to ALL physical therapists without a physician’s referral for all patients ― children and adults ― for all services. Dr. Seade is testifying on behalf of TMA and the Texas Orthopedic Society.

Other bills before the committee, which TMA supports are:
  • HB 1893 by Rep. John Zerwas, MD (R-Simonton), which calls for a physician to directly supervise anesthesiologist assistants.
  • HB 2414 by Rep. Borris Miles (D-Houston), which would extend the Healthy Food Advisory Committee that was established last session. This committee looks at the retail availability of fresh fruits and vegetables in lower income areas and directs the committee to find funding sources for promoting retail availability.
  • HB 2546 by Representative Zerwas, which would create the emergency and trauma care education partnership program. The partnership would consist of one or more hospitals and one or more nursing or medical education programs with the goal of increasing enrollment and graduation of physicians and registered nurses with training in emergency and trauma care.
Advance directives: Last week, the House Human Services Committee took up HB 3520 by Rep. Bryan Hughes (R-Mineola). The measure would force physicians and hospitals to provide medically unnecessary care indefinitely. Committee Chair Richard Peña Raymond (D-Laredo) formed a subcommittee to further explore end-of-life issues. Today, the subcommittee is revisiting HB 3520. Amy Arrant, MD, an Austin hospitalist and chief of staff of St. David’s South Austin Medical Center, and Mark Casanova, MD, a Dallas internist, will tell subcommittee members why the measure would cause terminally ill patients more pain and suffering.

Yesterday the Senate Finance Subcommittee on Fiscal Matters, chaired by Sen. Robert Duncan (R-Lubbock), unveiled its proposal — SB 1811, which outlines how the Senate could pay for part of its budget plan. The subcommittee recommendations added up to $4.8 billion. The list included mostly accounting maneuvers, including putting off certain payments until the 2014-15 budget, and accelerated tax collections on motor fuels, alcoholic beverages, corporate franchise, and sales. Physicians could be affected by the franchise tax speedup. Although details may change, one plan discussed would require businesses that pay more than $10,000 in franchise tax to make an early payment on their 2013 tax bill. Usually this payment is not due until spring the following year. The early payment amount would be equal to 25 percent of your 2012 tax. Here’s the complete list of recommendations. The committee will vote on SB 1811 this afternoon. Thursday, the senators will decide whether to use any of the state's Rainy Day Fund to pay for the rest of the spending plan and will vote on the 2012-13 budget. TMA yesterday released a letter to Finance Committee Chair Steve Ogden (R-Bryan) explaining why Texas physicians prefer the Senate budget plan over the House version.

Physician employment protections: The Senate Intergovernmental Relations Committee will take up two bills today that provide physicians protections if they choose to be employed by the Harris and/or Bexar county hospital districts. Both bills already were approved by the Texas House.
  • SB 1263 by Sen. Leticia Van de Putte (D-San Antonio) would allow the Bexar County Hospital District to employ physicians to meet its statutory mission of providing care to the indigent. TMA, the Bexar County Medical Society, and the hospital district worked together to develop an employment structure that protects a physician’s clinical autonomy and the patient-physician relationship. The framework of the employment arrangement is a nonprofit healthcare corporation — a 501(a) — with a physician board of directors to oversee all clinical issues related to physicians and the care they provide their patients.
  • SB 1795 by Sen. Mario Gallegos (D-Houston) would put responsibility for supervising all clinical issues related to the practice of medicine at the Harris County Hospital District in a medical executive board (MEB). It uses the existing MEB as a physician-led group in charge of the practice of medicine by all physicians — employed or medical-school affiliated — providing care in district facilities. Most importantly, it is the product of local discussions, facilitated by TMA, that included the district; the Harris County Medical Society; and both medical schools, The University of Texas Medical School at Houston and Baylor College of Medicine. It, too, helps the district meet its statutory mission to provide care to the indigent.
Interstate compact: HB 5 by Rep. Lois Kolkhorst (R-Brenham) is before the full House today. The measure would authorize the state to participate in a multistate compact to help fund and administer Medicaid. If passed, the compact would be submitted to Congress for its consideration. If approved, member states could pursue waivers that would relieve the state of federal mandates regarding Medicaid; the Children’s Health Insurance Program (CHIP); and all other health care programs, such as mental health and public health services. If successful, Texas likely would receive a block grant of around $60 billion, based on 2010 state/federal health care spending. Texas would then create its own health care program to replace Medicaid, CHIP, and all the other public health services. TMA submitted comments and questions in March.

Daniel Voss, MD
The physician of the day at the capitol is Daniel Voss, MD, of Jarrell. Dr. Voss has practiced family medicine for 23 years. He graduated from The University of Texas Medical Branch in 1985. Dr. Voss is a member of TMA and the Williamson County Medical Society.

Needed in Austin: patient advocates. Join hundreds of your colleagues and make a difference in legislation affecting you and your patients. Sign up now to attend First Tuesdays at the Capitol on May 3. Register today.

Listen to ReachMD XM 160: Sidney Ontai, MD, MBA, a Plainview, family physician and TMA physician is the first featured doctor in a new national radio franchise premiering this week. ReachMD, an award-winning network for professional medical news, information, and continuing medical education, premieres the new programming series “Voices From American Medicine.” The series features “physicians on the frontlines of medicine discussing their personal stories of triumph, tragedy, humanitarianism and innovation.” “Voices From American Medicine” is produced in cooperation with TMA and other medical associations and societies from across America.

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