2004 Legislative Session:
The Good, The Bad, The Ugly

The 2004 Legislative Session has ended, not with a roar or a triumphant beating of drums, but with a dull thud. In fact, the end came around midnight on April 30 with no fanfare at all. More than 3000 bills were filed and less than 500 passed, most of which were non issue-related, but were mostly related to local bills and trust funds. This Session was noteworthy because so little passed. For example, ARNP prescribing of controlled substances did not pass, the Department of Health bill did not pass, the Agency for Health Care Administration bill did not pass, Pharmacists’ Immunizations bill did not pass, and legislation supported by Governor Bush requiring stronger regulation of physicians prescribing controlled substances did not pass. Nor did an Infant Crib Safety Bill, Seat Belt Bill and Children Summer Nutrition pass. That being said, here is our synopsis of the other outcomes of the 2004 Legislative Session.

THE GOOD
PRESCRIPTIVE: Physician Assistants had an early victory! A bill by Representative Quinones (R) Orlando and Senator Fasano (R), Pasco County, passed in the first weeks of the session. It sought to clarify to insurance companies that prescriptions written by PAs and NPs, within their practice setting should be presumed to be valid, even without a DEA number. At issue are insurers that refuse to pay for prescriptions because a PA or an NP does not have a DEA number. This law (it was signed by the Governor) provides that the PA’s name and prescriber number must be on the prescription whereas in the past, only the physician’s name was included. The Academy worked with the Florida Medical Association, Pharmacy Association and others who supported the bill. It was a pleasure to work together to pass this legislation. ANESTHESIOLOGY ASSISTANTS: Another bill that passed did not directly impact PAs but was important for what it did not do! This bill by Senator Fasano (SB 579) and Representative Frank Farkas (HB 1629) established Anesthesiologists Assistants as a profession under the Board of Medicine. It took the Anesthesiologists three years to pass this law. Under earlier proposals, they would have been under the PA Council and PAs would have had to absorb the cost of implementing their licensure act. The final bill established them as a committee of the Board of Medicine under a separate section of law. They will have to pay for their own licensure and activities of the AA Committee. AFFORDABLE HEALTH CARE ACT: This bill provides for “bare bones” insurance policies to be offered statewide. Currently, under normal insurance policies there are 30 mandates such as mammograms, surgical assisting and osteoporosis screening. These plans eliminate most of those mandates and premiums would be seriously reduced, thus, making these limited insurance benefit policies more affordable for the uninsured. The bill also created a Patient Safety Corporation whose charge it is to assist health care providers with improving quality and safety of the delivery of health care.

THE BAD
Several bills were filed that were just plain bad. House Bill 1561 by Representative Ritter would fall into this category. Her bill, in the intent section, referred to PAs and NPs as insufficiently trained practitioners whose care “could seriously harm the public health and safety.” Thus, the bill language proposed the supervising physician be physically present at least 33% of the time for an office to be considered a business location. If a PA or NP worked in a setting outside this business location, the physician must be on site one-half of the time in the medical service community where the PA or NP worked. Additionally, the bill limited the physician to a total of two PAs and/or NPs. If that was not enough, the PA or NP had to have worked for 4 years with the supervising physician before they could work under indirect upervision. Finally, PAs and NPs would have to clearly identify themselves to patients. This bad bill was work-shopped by the House Health Care Standards Committee and then was not heard again. Another bad piece of legislation that did not pass was the Certified Surgical Assisting bill. This bill (HB 1557) by Representative Ritter provided that a physician could retain unlicensed surgical assistants to assist in surgery. In addition, it mandated that insurance companies would reimburse these assistants for their services. Ultimately, in the last week of the Session, a final bad idea was proposed as an amendment to another bill (SB 2170) on the Floor of the House. The amendment provided that the Board of Medicine or the Department of Health would provide three opportunities for applicants to pass a state developed written exam to be licensed as a physician assistant in Florida. It was written to allow FMGs to take a state exam but as drafted it opened the test up to anyone. With significant opposition from the Florida Medical Association, the FAPA, the Florida Department of Health and an adamant Senate, the amendment was not adopted and the legislation died.

THE UGLY
The most contentious and controversial issue facing PAs this Session was an “up close and personal” attack on the profession by the Florida Society of Dermatology and Dermatologic Surgery (FSDDS). The attempt began with a bill to place PAs and NPs under direct supervision. FAPA quickly got an opinion from the Florida Attorney General’s Office that PAs ractice medicine under the supervision of the physician and thus were automatically excluded from the impact of the bill. The nurses amended the bill to exclude them as well. The amended bill then passed the Senate and was sent to the House. In the House, the FSDDS tried to avoid their Senate mistake by proposing alternative language which would place additional reporting requirements on about half of the approximately 670 Derms in Florida. Knowing how the process works, Pat and I, along with Ron Meyer, FAPA’s General Council, Fred Leonhardt, a prominent attorney from the Grey Robinson Law Firm, and Alan Grossman, worked to keep the House Bill from being heard in Committee. Had the bill with new reporting requirements been passed by the full Health Care Committee, we believed the FSDDS would then amend their original language back into the bill. As a result of their failure in the Legislature, the FSDDS tried to demean Dermatologists who supervise mid-level practioners along with their PAs and NPs. A series of ads were run in newspapers throughout the State that sought to destroy the small number of physicians who improperly supervise physician extenders. Coincidently, the ads were written in such a way as to raise doubts in the minds of patients about all Derms who properly supervise well trained PAs and NPs. This broad-based attack on their own membership caused several Derms to write an open letter from concerned dermatologists to the FSDDS membership spelling out their reasons for disagreeing with the FSDDS, and several outstanding Dermatologists quit the Society altogether. FAPA was caught in this fight. Leadership of the FSDDS blamed the letters on the PAs. However, our position has remained consistent throughout this fight. We believe current law and rules provide ample protection for the public. If the FSDDS or anyone believes a physician or a physician extender is practicing below the standard of care, they should be reported. The Boards of Medicine have a long history of disciplining those who endanger patients. The Academy also believes that there is no data to justify restricting the practice of PAs in dermatology or to provide burdensome reporting requirement on 300+ physicians who supervise physician extenders. For the FSDDS to propose this and then blast those physicians who disagree with their position is tantamount to “eating your young.”

A BRIGHTER FUTURE
The Florida Academy of Physician Assistants was able to survive, protect and promote the PA profession throughout these good, bad and ugly scenarios because of PAs who wrote emails and letters to legislators. PAs Mary Ann Crumlish, Angela Franz, Brigitta Nuccio, Jeff Johnson and Jeff Hulley, actually came to Tallahassee and met with House and Senate members. Hundreds contributed to the PRIDE Campaign and to the FAPA-PAC. And, finally, we know most PAs discussed these issues with their doctors.

If the Academy is to continue to fight for you, we need: 1) For you to get involved in one political campaign this summer and/or; 2) For you to contribute to the PRIDE or FAPA-PAC and/or; 3) For you to continue to talk with your physician about these issues.

The PA profession is strong: let’s work together to ensure its brighter future!

This article is courtesy of Pat and Juhan Mixon, the FAPA Legislative Consultants, in Tallahassee.