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At last, it seems that spring is trying to emerge in Charleston as the weather warms and flowers start to bud. The Session is almost half over with the 30th day to arrive on March 12th. Since West Virginia “officially” only has a 60-day legislative session, activities will pick up significantly during the next several weeks. As of March 6, 504 bills were introduced in the Senate and 983 bills in the House of Delegates. You may click here for a complete list of healthcare related bills that have been introduced. |
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A well anticipated piece of legislation was finally introduced last week. HB 2978 would allow optometrists, to perform surgery; order laboratory or diagnostic tests; and to prescribe, administer and dispense any medications that the Board of Optometry desires. All of these protections are specifically prohibited under current law. The Ophthalmologists have been expecting this legislation and have developed and are implementing a strategy to combat this bill. Specifically the bill does the following:
Removes
- Patient Protections from Current law
- Standards by legislative rules for education, training for optometrists to prescribe limited drugs.
- Adequate (malpractice) insurance coverage for optometrists to prescribe limited drugs.
- Prohibition on emergency rules for a drug formulary.
- Limits on prescriptions to certain drugs – which would allow optometrists to prescribe Schedule II, and all other drugs.
- Requirement of the Optometry Board to consult with the Board of Pharmacy, Board of Medicine or Board of Osteopathy on any allowable drugs.
- Prohibition on surgery.
- Prohibition on injection into and around the eye.
- Statutory language for referral and consultation.
Adds
- Inappropriate Medical Provisions
- Allows optometrists the “administration” of drugs - which would include needle injections into and around the eye.
- Allows optometrists the “dispensing” of drugs – currently done by pharmacists - and not allowed by most physicians.
- Allows optometrist to perform anything they have been “trained” to do – even a weekend course, or if only one of the 19 optometry schools (none in West Virginia) “taught a procedure.”
- Allows optometrists to do any procedures unless specifically prohibited by the Optometry Board.
- Allows optometrists to order expensive and potentially invasive diagnostic tests such as CAT scans and MRIs, and laboratory analysis.
- Bill is Opposed - by Recognized Medical Organizations
There is a unified effort among the medical community to oppose this bill. This includes:
West Virginia Board of Medicine
West Virginia State Medical Association
West Virginia Academy of Family Physicians
West Virginia Association of Physician Assistants
West Virginia Academy of Ophthalmology
American Academy of Ophthalmology
Veteran’s organizations have also opposed similar attempts by optometrists to perform surgery on veterans in VA Hospitals, including the Vietnam Veterans Association and Blinded Veterans Association. |
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A bill, HB 2403, which came out of an interim study to revamp some regulations of Chapter 30 boards contains some troubling provisions. (Chapter 30 Boards are all the professional licensure boards including the Boards of Medicine, Osteopathy, Nursing and all other healthcare related licenses as well as lawyers, architects, engineers etc.) This bill has already passed the House of Delegates and is awaiting action in the Senate Government Organization Committee.
The bill re-states some responsibilities of the licensure boards and adds requirements for training of board members. The bill however contains language making a “duty” of any licensee to report other licensees for violating the practice act.
The following is the bill’s language:
§30-1-5. Meetings; quorum; investigatory powers; duties.
…“Any person may report to a board information he or she may have that appears to show that a person authorized to practice by the board may have violated the practice act or rules of the board, the provisions of this article, or engaged in practice without regard for the safety and welfare of the public.
A person who is authorized to practice by a particular board, who knows of or observes another person authorized to practice by that same board violating the practice act or rules of the board, the provisions of this article, or engaging practice without regard for the safety and welfare of the public, has a duty to report the alleged violation to the board. Any person who reports or provides information in good faith is not subject to civil damages.”
A very simple explanation of the far reaching implications of this language would be --when a licensee is disciplined by the board, the board now may have reason to then discipline any of that licensees partners/colleagues for their failure to report suspected (not confirmed) breaches of standard of care.
The bill also modifies certain requirements for persons serving on state licensing boards restricting an individual to serve on both the state association board or and on the licensure board.
The WVSMA has raised concerns with the Senate Government Organization Committee about this bill and will continue working to achieve modifications that are satisfactory. |
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HB 2979, introduced late last week, would give pharmacists the ability to prescribe. The bill, introduced by Delegate Hunt, simply directs the board of pharmacy to “develop guidelines and an approved list of medications that pharmacists may prescribe without a lawful order of a practitioner.” Though we have not gotten any indication that the House Health Committee would seriously consider this bill, the WVSMA is working to ensure this legislation does not move forward. |
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A bill, HB 2693, introduced last week would require all hospitals, birthing centers or any person attending the care of a newborn to test all infants for “illegal drugs”. The results of the test are required to be reported to the Bureau for Public health along with all other mandatory infant metabolic screening tests that are already required by law. |
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House Bill 2932 would require smoking regulations by local boards of health to gain approval from county commissions, and in some cases city councils, in order to become effective. This bill would politicize every proposed change in local clean indoor air regulations across the state and severely undermine the foundation of public health policy in West Virginia.
Boards of health are unique. As regulatory bodies they combine use of scientific data, local administration of public health policy, inclusion of experts and citizens, and a structure that sets the board one degree apart from the political establishment. This last point is critical - decisions regarding the prevention of disease and protecting the community from serious public health threats are too important to be mired in political battles. The Coalition for a Tobacco Free WV (of which the WVSMA is a member) is actively opposing this legislation. |
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Facing a topsy-turvy stock market, a stimulus package that’s a moving target and a decline in state revenues, Governor Joe Manchin’s office has confirmed the he may make adjustments to the multi-billion dollar budget he’s already submitted to the Legislature. The Associated Press quoted administration officials as confirming the governor is taking a hard look at the budget, but has not yet made a decision. “As the economy softens, we get more concerned that we have in the past,” said Deputy Revenue Secretary Mark Muchow. House Finance Chairman Harry Keith White indicated he would not be surprised to see Manchin reduce his original revenue forecasts. The governor has said he doesn’t want to raise taxes in difficult economic times. The Legislature is looking at raising cigarette taxes to fund proposed health programs that emerged from a year’s worth of work by the “Roadmap to Health” group. But word at the capitol is that the Cigarette tax bill is not moving. As is usually the case, “budget sets policy” – and it appears the main decisions on several health care initiatives won’t become clear until the budget is agreed to the week after the Regular Session ends.
An example of how closely the administration is watching the budget hit close to home for legislators Thursday when the Governor announced cancellation of this year’s legislative reception. The black-tie event -- held annually at the Governor’s Mansion for legislators and spouses/guests, key administration officials and staff -- is a decades-long traditional social highlight of the session. The Governor’s Office says the event, estimated to cost $13,000, was cancelled because of the economy, the governor’s spokesperson Matt Turner said. |
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Following up on recommendations made during last year’s extensive review of the health status of West Virginia’s residents, the House Health Committee put its stamp of approval on a bill to initiate a “Healthy Lifestyles Restaurant Calorie Posting Program.” It requires restaurants with more than 15 locations nationally to post calorie information for menu items. The program will be promoted by state agencies such as PEIA, the Bureau for Medical Services and the Insurance Commission. The bill, HB 2745, now goes to the Finance Committee.
During a lengthy debate, two physician members of the Legislature – Senator Dan Foster, MD of the Senate (a champion of this legislation) and Delegate Margaret Staggers, MD of the House – pointed to West Virginia’s extraordinarily high level of diabetes, hypertension, obesity and heart problems. Representatives of the hospitality industry favor awaiting results of national legislation pending in Congress. But in the end, noting that going through the rules process means the program would not become effective for over a year, and it is uncertain whether a national law will pass, the committee voted to proceed. “This is a public health issue,” Dr. Foster said, noting that more than 75% of meals eaten outside the home are eaten at fast food establishments. |
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West Virginia’s definition of “intractable pain” in state law would now be replaced by the term “pain” to conform to language used by the Federation of State Medical Boards, the Board of Medicine and the Board of Osteopathy. Essentially, the language in HB 2839 deletes the word “intractable” from the Management of Pain Act and redefines pain.
Advocates say the issue is especially important in treating severe pain in patients at the end of life and it brings our law in conformity with the language recommended by the boards and national organizations. The bill now moves to the Judiciary Committee. It is a key policy issue of the WVSMA and is endorsed by the West Virginia Controlled Substances Advisory Board, West Virginia Partnership for Community Well-Being, West Virginia Academy of Family Physicians, West Virginia Association of Physician Assistants, West Virginia Chapter of the American Cancer Society, Hospice Council of West Virginia and the West Virginia Center for End-of-Life Care. |
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The House Health Committee has resurrected HB 2415 that would identify Salvia Divinorum as a hallucinogen and add it to the list of schedule I controlled substances. The bill was pulled from the full committee agenda and studied by a subcommittee before it was re-considered by the full committee last Wednesday. A representative from the University of Charleston’s pharmacy school and representatives of the state’s sheriffs recommended the bill be passed, citing availability of the hallucinogenic plant in various forms at “head shops” in West Virginia. It is currently legal to manufacture, consume or sell the plant for purposes of “getting high.” The committee amended the bill to exempt it from non-use if institutional review boards (IRBs) of hospitals approve its use in research programs.
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SB 220 which implements the nurses prescribing rule came before the Senate Government Organization Committee this past week. The rule, which was hotly debated and negotiated between the WVSMA, Academy of Family Physicians and the Nurses Board over the past year and a half, modifies the list of drugs that nurse in advance practice (Nurse practitioners and Nurse Midwives) may prescribe under a collaborative agreement. The WVSMA and the Academy of Family Physicians ultimately agreed to the final language in the rule as filed in January by the Board of Registered Nurses. However the Board of Medicine had concerns remaining and asked for modifications. The Committee chose to move forward without any additional changes. The bill now resides in the Senate Judiciary Committee. |
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The deadline for introduction of rules bills was mercifully reached this past week. Now committees continue the review process. Both House and Senate Health Committees passed, and referred to their respective Judiciary Committees the following rules:
- HB 2829 (SB 366) permitting pharmacists to administer influenza and pneumonia vaccines once registered with the Board of Pharmacy and after having completed appropriate training. Legislation passed last year which called for the rules to be established.
- HB 2830 (SB 367), a new rule to implement legislation passed in 2008 stipulating that charitable clinic pharmacies must obtain permits from the Board of Pharmacy to operate. Free clinics are prohibited from dispensing controlled substances. It also requires their prescriptions to be checked by a pharmacist or prescribing practitioner prior to being dispensed. (The Senate version will be reviewed by both the Finance and Judiciary Committees.) The Senate adopted a minor amendment to remove the “legislative intent” language at the beginning of the rule saying that though regular bills are oftentimes drafted in this manner, rules never are. Several Senators commended pharmacists, representatives of the charitable clinics and the Board of Pharmacy for working for a year to come to a resolution on the issue.
- The Senate Health Committee passed and referred to Judiciary rules bill SB 365 (HB 2828) relating to the licensure and practice of pharmacy. Basically, the rules are updated to allow for electronic prescribing and storage of information and to clarify some definitions.
- The Senate Health Committee also recommended for passage SB 221, a rules bill mandating training for the use of bioptic telescopic devices for drivers with impaired vision. The rule would set criteria and vision standards and require an eye examination six months prior to participation in the program. Approximately 30 persons were grandfathered in when the original law passed. They will not have to take the training course, would be required to undergo an eye examination. The permits must be renewed every two years. The bill now goes to Judiciary Committee.
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The Senate Health Committee has recommended passage of SB 127, which would permit emergency medical technicians (EMTs) to administer epinephrine to patients to treat allergic reactions and anaphylaxis. Under the bill, the Office of Emergency Medical Services within DHHR would develop rules outlining when the procedure would be allowed. The rules must require licensed physician supervision through a delegated practice agreement. This bill has come before the legislature a few years in a row. The WVSMA has taken a supportive position of this bill. Senate Judiciary will next review the legislation. |
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Specific language clarifying that pharmacists and pharmacies are indeed health care providers would be added to the Medical Professionals Liability Act under provisions of SB 379. The Senate Health Committee unanimously passed this bill. WV Pharmacists Association Executive Director Richard Stevens told the committee the addition is necessary for purposes of liability protection following a recent court decision which determined that the absence of specific language was a problem. The bill was sent to the Senate Judiciary. The WVSMA is watching this bill closely to ensure that nothing harmful is amended in which could weaken our strong medical liability laws.
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Mental hygiene commissioners who originally commit a patient to an institution would be authorized to sign readmission orders under SB 344, recommended for approval by the Senate Health Committee. Under current law, such orders must be signed by a circuit judge. The Senate bill would allow either the mental hygiene commissioner or the circuit judge to sign the readmission order within the timeframe covered by the original order. A spokesperson for the West Virginia Supreme Court of Appeals told Senators both circuit judges and commissioners support the bill, which now advances to the Judiciary Committee. |
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A bill to establish a public-private long-term partnership program, HB 2884, has won approval of the House Senior Issues Committee and now is before the Finance Committee. The purpose would be to reduce Medicaid costs by encouraging the purchase of private long-term care insurance policies. Supporters say it provides a way for individuals to qualify for coverage of their long-term care needs under Medicaid without exhausting their resources. The program will be administered by the Bureau for Medical Services and the Insurance Commission. During interim sessions, it was pointed out that several insurance companies are supportive of the plan. It evolved from work by the Interim Select Committee on PEIA, Seniors and Long-Term Care. |
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March 10, 2009
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Contacting Your Legislator
The West Virginia Legislature has expanded information available through its Internet web-site www.legis.state.wv.us. On the bottom right of the legislature’s homepage is a spot to enter your zip code. A list of you your elected officials will come up with their contact information.
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UPCOMING LOBBY DAYS:
Children’s Day at the Legislature - March 19
Tobacco Free Day - March 31
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