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2004 Legislative Update
P.R.I.D.E. Final Update: May 3, 2004 From Mixon and Associates: We have reviewed the records from the legislative session and are pleased to report that the amendment to reinstate the FMG exam did NOT pass; no amendment on dermatology practice restrictions passed; and the Family Practice to change specialty practice requirements did NOT pass. The budget does include funding for a program at Miami Dade College to help prepare FMGs to take the NCCPA PANCE. Thanks to everyone for their support with the emails, letters, calls and faxes to legislators on these issues. The Board will be working hard in the next few weeks to come up with a strategy to use in facing theses issues again next legislative session, which we surely will. Your help in the future is vital also. Have you made your donation to the PRIDE campaign? This was a costly effort on our part and we need your financial support. Update 9:00 a.m. May 1, 2004 From Mixon & Associates in Tallahassee: The Legislative session concluded at about 11:45 p.m. on April 30, 2004. At this time we do not believe any amendment was passed that would reinstate the FMG exam. But we are awaiting final review of House and Senate actions before we relax on that issue. In 1993 the initial legislation establishing the exam was done last minute and very quiet like and we did not find out about it till later. We are hoping that it did not happen to us again. We will let you know as soon as we can for certain on this issue. The Budget that was passed did include funding the training program at Miami Dade college to train FMG's to take an examination, and this was clarified on the floor of the Senate to be the NCCPA PANCE examination. So the waters are still somewhat muddy and We will have to review this when the final copy of the budget is published. Also we do not believe there were any bills or amendments passed on the dermatology issue. Again, we will have to wait and see for sure. There were some small victories for us in some of the legislation passed but we are awaiting a final review of the session and we will give a final report at the Board meeting in Orlando next weekend. If we dodged the bullet this year that does not mean we will do so next year. They have some strong supporters and we have not heard the end of this issue once again. The Board and the Legislative & Government Affairs Committee will be discussing strategy at the Board meeting next weekend in Orlando. Thank you for your support with all your calls, letters, emails and faxes during the session this year.
Update 11:30 A.M. April 29th, 2004 Thanks to all of you who called, emailed, or faxed to your Senators and Representatives on the CE Broker issue and the FMG exam issue. Please do not make any more calls or emails to the Senate at this time. They have heard our concerns and now we just have to wait and see what happens. We have a day and half left in the session to be concerned about. It does NOT look like at this time the legislature will have to go into special session as they have apparently agreed on a budget. Unfortunately, the budget did include in the items for Miami Dade College, funds for “development of a four week training course for foreign trained physicians to prepare for the state administered physician assistant exam.” But there is no funding yet for DOH to develop such as exam which will cost $1.5 million or more just to develop, and there was no funding for administration of the exam. As yet neither the House nor the Senate has passed any amendment that will require such an exam, but we are fairly sure the House will do so and it is still up in the air as to whether or not the Senate will do so. The FMA joined us in opposing this amendment and the DOH is opposed also. However the FMG lobby has put tremendous pressure on their legislators to “do something for their constituents.” The final hours of a legislative session make for some strange bedfellows. We just do not know what backroom deals have been made if any on this issue. And the Derms are still up there fighting for their amendment also. It just keeps getting better and better for us doesn’t it? We are watching out for this issue as well. We hate to sound all doom and gloom but there appear to be plenty of wolves at our door this year and all are hungry for a bite of our rump. We will do our best to keep you informed of the legislative actions. We appreciate your support. Have you made your donation to the PRIDE campaign yet? We hope you can see the need now for your financial support along with the calls and such. You must understand that if the FMG exam is reinstated by the legislature FAPA will not stand idly by and let this happen without a fight. We would be in for a costly legal battle to prevent this by any legal means we can use. No one is going to pay for this except US. No other group if going to fight for our rights. If you are not a member of FAPA join now. If you have not made a significant donation the PRIDE campaign do so now. We do not know what else to do to impress upon each and every PA practicing in Florida that FAPA needs your support by membership and money, it is just that simple. Thank you.
EMERGENCY ALERT ! 7:25 P.M. TUESDAY APRIL 27TH, 2004 The FMGs in South Florida are mobilized like never before and pushing like crazy to get this amendment passed that will force the DOH to set up another cycle of exams for them to take to be licensed as PAs. We need your help more than ever before to stop this NOW!! Because the hispanic caucus is so powerful in the House it will pass there. We have to work to defeat it in the Senate NOW, tonite and tomorrow! We really need PAs and their friends to call the Senate President, Senator King to voice their opposition to any amendment to any bill that will allow this. But we especially need PAs in South Florida to contact Senator Rudy Garcia to let him know how bad this decision would be for Florida Citizens. YOU MUST CALL TONITE OR TOMORROW, WEDNESDAY, APRIL 28TH. It is even better if you are one of his constituents. WE NEED HUNDREDS OF CALLS, EMAILS, AND FAXES ON THIS TO BOTH OF THESE SENATORS, AND TO YOUR OWN SENATOR AS WELL. DO NOT DELAY!!! Here are the contact numbers:
Senator Jim King
Senator Rudy Garcia Watch the FAPA website for updates. The link is on the homepage. URGENT EMERGENCY ALERT !!!
ACTION NEEDED BY TUESDAY APRIL 27TH, 2004
April 26 at 7:30 p.m. The language in the amendment provides for DOH beginning August 1, 2004 to administer at least three times, a state developed written examination to be offered not less than nine months apart and not more than 12 months apart an examination to allow foreign trained physicians to become licensed physician assistants. There will be a companion amendment in the Senate but we do not know which bill they will try to amend it to for passage. WHAT YOU MUST DO TONITE OR TOMORROW!!!
1. Contact your state representative and ask them to vote NO on Amendment 860347 to HB 1921 that would re-instate the
exam to allow foreign trained physicians to become licensed at physician assistants. Points to use:
1. We would be the only state to do so. Call Mixon and Associates in Tallahassee at 850-222-2591 if you have any questions.
April 16, 2004
HB 367 / SB 1124 Dermatological Services HB 357 by Rep. Vana in its original form would have required that a dermatologist directly supervise the PA or ARNP for all new patients and all new conditions. This was totally unacceptable to the Florida Academy of Physician Assistants and the Florida Nurses Association as well as many dermatologists. The Academy has fought this bill with a great deal of energy and financial commitment. The bill passed the Health Care Standards Committee with a strike all amendment that would require reporting by physicians as to how many PAs and ARNPs they supervise, the location of all their offices, the amount of time they are in each facility and a requirement that you must inform the patient when they make an appointment that you can see the doctor, PA or ARNP. In addition, the nurses’ protocols would have to be reviewed by the DOH. This language was presented by the Derms as compromise language although no one had agreed to it from the PA or ARNP association. The nurses were very opposed to the review of protocols as this would be a tremendous cost to their trust fund. At any rate it was passed as amended but, has not been placed on any agenda in the full Health Care Committee to date. The derms and their lobbyist will attempt to amend this language on another bill before the end of the session. We will have to be very vigilant in order to keep that from happening.
HB 1561 Relating to Medical Practice HB 1561 by Rep. Ritter is a bill designed to seriously restrict physicians, PAs and ARNPs. It was workshopped several weeks ago by the Health Standards Sub-committee. This bill would limit the number of PAs/ARNPs a doctor could supervise in a satellite office to a total of two. Currently, a doctor can supervise up to four PAs totally so this bill would have cost people their jobs. In addition, it would require the doctor be in the practice community 50% of the time and in the office 30% of the time. The PA and the ARNP would have to practice in that specialty for 4 years before they could be left alone to see patients. As you can see this was a terrible bill. It was put forth by the Family Practice Doctors. Jeff Hulley met with their President of that association to discuss this issue and they have a agreed to meet members of our Board on a regular basis to discuss concerns prior to them getting to the point that bad legislation is created. At the workshop we had excellent testimony by PAs, ARNPs and Ron Meyer our General Counsel. This testimony made it evident that this was very oppressive language that was largely due to misconceptions as to how PAs are allowed to practice. At this point the bill has not been placed on the agenda for another committee.
HB 121/ SB 5560 This bill creates disclosure language in the medical discipline section of law. In its current amended form it requires that all health care practitioners inform the patient of the type of licensure they have on the first encounter. It exempts hospitals, ambulatory surgical centers and emergency situations. The practitioner must also disclose there licensure in any advertising. This is the bill the derms used last year to put their bad amendment on. The amendment would have put PAs and ARNPs under direct supervision in dermatology. The bill has three committees to go so we will have to watch it very carefully throughout the rest of the session.
HB 1557/ SB 2380 This bill would allow unlicensed surgical assistants to be reimbursed directly for assisting in surgery. The Academy is philosophically opposed to unlicensed people being reimbursed as their is no process for discipline. If you have any questions on this issue you can contact John Byrnes who is very familiar with this legislation.
HB 807/ SB 1666 These bills would repeal the CE Broker System set up by the Department of Health to track all medical licensee continuing education. Language was passed in 2001 that gave the DOH the authority to set up an electronic tracking system for CME. The language all so stated that providers would submit their information to the DOH. It gave the DOH little other authority to implement this system. The DOH signed an agreement that seriously over stepped what they were authorized in law to do. When the 2004 renewal packets went out a letter was sent that stated you must file your CME with CE Brokers or you could lose your license. This was not the case and the information was very misleading. FAPA has been working with a coalition of 23 associations to repeal this language. This system will not fit all groups. In addition, the DOH does not have a rule in place to implement this law in the way the contract was written. The bill is on second reading in the Senate and is stalled in the House for the moment. We will continue to work hard on this issue.
SB 2380 Relating to Health Care Clinics This bill is trying to fix a few issues that were not addressed in the clinic registration bill that passed last year. We have been watching this bill closely to make sure no changes are made that would effect the ability of PAs to own clinics. We have been working with Jeannie Gossman to make sure the language they have is acceptable.
HB 579/ SB 656 Relating to Anesthesiologist Assistants This bill has been very controversial for two years although it appears it will pass this year. It has passed the Senate and is in Messages to the House. In the House it is in the Appropriations Committee. It will probably be withdrawn from Appropriations and placed on the Calendar.
FMG Issue We continue to work daily to protect your rights to practice in Florida.
March 19, 2004 SB 664 passed its first committee in the Senate. This is a bill for home health which would expand the PA role by allowing assessment orders, establish and review care plans and sign DNRs. HB367 the famous "derm" bill has not yet been placed on an agenda. Rep. Harrell wants a meeting between the PAs, NPs and Derms in her office Wednesday morning to try to reach a compromise. If no agreement is reached, she may put the bill on the agenda for Thursday which happens to be FMA Legislative days. There will be hundreds of doctors there to possibly support the issue. We will need PA participation in this and if your doc is going to Tallahassee, ask him or her to speak against the measure. You may have seen or heard about the ads placed by the Derms in several newspapers around the state. The ad states among other things "Call your dermatologist and ask one question. Will the doctor be there? These five words could save your life." This is a new low for the derms. We are working on an appropriate response. The ARNPs controlled substances bill sank this week in the Senate Committee. The docs were very much against it, believing it to be a further bid for independent practice. HB1561 the Family Practice Bill to limit the spread of facilities which don't always have a doctor on site was heard in a workshop this week and our representatives did an excellent job of pointing out the many deficiencies of the bill. Thanks to The Franz's, Ron Meyer and the others who spoke on our behalf. I met with Dr. Fleur Sack the President of the FAFP and Tad Fisher their Executive VP last night in Ft. Lauderdale. We had a very good meeting and agreed to work together to solve their perceived problems. Thanks for the tremendous response to the Cap Wiz emails; we were very successful in sending emails to legislators. FAPA has had to hire to additional lobbyists to protect ourselves from the multiple assaults on our profession. These people don't work for free and you will be receiving a mailing for the PRIDE Campaign. Please be generous with your donations
March 18, 2004 The House Health Care Committee met on Monday night, March 15th and conducted a hearing on Representative Stacy Ritter’s bill that would restrict physician’s ability to use PA’s and NP’s in their practice. Her bill (House Bill 1561) would: - Restrict physicians by limiting supervision to a total of two PA’s, NP’s or one of each. - Restrict service by requiring (the physician) him/her to practice 50% of their time in a medical community where they supervise a PA/NP. - Restrict physicians by requiring them to work at least 33% of the time in the facility where the PA/NP works. - Restrict physicians by requiring them to supervise a PA’s/NP’s for 4 years before they can be under indirect supervision. Representative Ritter told the Committee that this bill was filed as a result of the medical malpractice issue last Legislative Session. She alleged that PA’s and NP’s lack supervision and are “insufficiently trained practitioners” implying that PA’s/NP’s are a threat to patient health. Her testimony was supported by Dr. Sack of the Florida Academy of Family Practice, who said that the bill was directed at rogue physicians who never visit satellite offices staffed by PA’s and NP’s. Further, it was suggested that in some instances the supervising physician doesn’t even practice medicine in Florida. Of course, the lobbyist for the Florida Dermatological Society agreed in his testimony supporting the bill. Ron Meyer, General Counsel for the Florida Academy of Physician Assistants, presented a study by the National Practitioners Data Bank which concluded, “...PA’s have low rates of reported malpractice payments. This finding supports the notion these healthcare professionals pose a minimal malpractice liability risk in clinical practice”. He also said that the Florida Boards of Medicine had not heard even one case against a PA/physician regarding supervision in a satellite office. He also questioned the definition of “medical service community” which was tied to the 50% requirement and other provisions of the bill. Angela Fronz, a PA from Marianna and FAPA Region Director, asked the Committee to delete the language of the bill which states that PA’s/NP’s are “insufficiently trained”. She asked the Committee, “How can the State of Florida license inadequately trained practitioners? Obviously, if PA’s and NP’s are licensed, the State believes they are adequately trained to practice medicine”. She read quotes from the current laws which encourage the use of PA’s and encourages using them in innovative ways. Representative Ritter’s proposed law would be diametrically opposed to existing laws. Many others testified against this terrible bill. The most telling moment in the meeting was when the Chairperson, Rep. Gayle Harrell, asked Dr. Sack, President of Florida Academy of Family Practice, to give her a specific example of where physicians were not adequately supervising their PA or NP. Dr. Sack said she didn’t have one example in mind, but would try get the information back to the Committee. Once again the Legislature is trying to deal with an issue which no one can provide specific incidences of poor medical practice or supervision. The FAPA does not believe this particular bill will resurface this Legislative Session. However, we expect that an attempt will be made to amend similar language onto another bill. Please be ready to write, e-mail, or call your legislator if this issue resurfaces. This bill could resurface at anytime and if it does so we will notify you on this website. March 17, 2004 We gladly report our first legislative victory this year! A bill, HB103/SB132, proposed by a State Senator Mike Fasano and Representative Quinones is now awaiting the governor's signature. It will provide information to clearly inform patients who is prescribing their medication. The legislation was introduced in the Senate by Senator Mike Fasano and by Representative Quinones in the House. It unanimously passed both the House and Senate. Under this law the pharmacist will presume the prescription is valid. The bill states the name and professional license number of the advanced registered nurse practitioner or physician's assistant who prescribes a medication will appear on the prescription. A pharmacist, or person dispensing the medication must include the prescribing professional's name and license number on the drug container. "This legislation will provide needed consumer safety protections," Fasano said in a press release. "It will make it clear to every patient who is prescribed medication by a nurse practitioner or a physician's assistant the name of the individual who actually wrote the prescription." We also hope this will help with the problem we have been having getting prescriptions covered by insurance companies because of a lack of a DEA number. So if you are from Senator Fasano's, or Representative Quinones districts be sure to let them know " a big thanks" for this one. March 12, 2004 FAPA President Jeff Hulley attended the Emergency Medicine Days conference in Tallahassee at the invitation of their board and was introduced to the attendees as a "special guest". The Florida College of Emergency Physicians has extended an offer for us as PAs to become more involved with their organization. Those who are interested please contact Jeff Hulley directly. He also met the President of the FMA at this conference as well as their Director of Policy Management. They were very encouraging and assured us that they were on our side. They did present their legislative agenda and second on the list was preventing the ARNPs from passing their controlled substances act. Later in the day the Mixons and President Hulley met with the leadership of the FOMA. Their President, Past President, Legal Counsel and Executive Director all were extremely positive and sympathetic to our concerns. We have agreed to set up liaisons between our two organizations and to meet three times a year to discuss matters of mutual concern. They promised not to run to the legislature for a law change every time they have a concern with PA practice. We would like to remind you that FOMA changed their by-laws to allow PAs as Associate Members. The Derms bill has not been set for hearing in the House subcommittee and so nothing to report there. However the FAFP's bill HB1561 has been put up for a workshop on Monday night. (These notices are only given two business days before the fact which is why you are always getting "urgent" requests for action.) HB 1561 was (according to their lobbyist) aimed at curtailing the NPs independent practice clinics which are springing up everywhere and taking patients from the FPs. However, PAs are caught squarely in the middle. The bill states that if a physician is not in a facility 33% of the time it is not a physician office practice setting. This would require certain restrictions on the facility including: the physician must practice 50% in that medical service community, the physician must have only two "supervisory relationships", and requires the PA or NP to have four continuous years of experience in the medical specialty area. Clearly this will cause PAs to lose jobs and put rural health facilities out of business. Please contact the members of the House Health Care Standards Subcommittee before Monday afternoon. They are Gayle Harrell, Eleanor Sobel, Larry Cretal, Roger Wishner, Juan Zapata, Stan Mayfield, Joe Negron, Gus Bilirakis, Ray Sansom and Shelley Vanna. Their information is available on CapWiz or from the Mixons at 850-222-2591. We will keep you advised as things develop, but please write or call your legislator today. March 5th, 2004 Well, the legislative session has kicked off this week and we are already on a real roller coaster ride. Please give a prayer of thanks for Juhan and Pat Mixon, they are doing an excellent job for FAPA spending all day at the capital working on our issues. Senator Peadon offered an amendment to the Derms bill in the Senate yesterday to put PAs back in requiring direct supervision while allowing the NPs to remain out of the bill. However the amendment was withdrawn and today the bill passed the Senate unamended. The House version still has not been heard in sub-committee so nothing happening there just yet. HB 103, the bill to put the PAs name on prescription bottles, passed the House and is now on its way to the Senate.
Last but certainly not least, HB 1561 was introduced by Rep Ritter. It has very offensive language stating that the public is in danger
from insufficiently trained practitioners as well as several other phrases. It states that if
a physician is not in the office 33% of the time it is not a "physician office practice setting" and shall
be subject to special rules. These rules include: More updates to follow as information becomes available. It looks like it will be a long legislative session for us. And it will be financially costly too. Have you made a donation to the PRIDE campaign this year? Start thinking about it because fighting these bills is going to cost us thousands, and if the FMG groups get active in seeking PA licensure.......well it could get even more costly to protect our rights. Click on the link above to make a donation online now.
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