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Debate Begins on Scope of Practice for Physician Assistants
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A subcommittee of the Senate Medical Affairs committee met Wednesday morning before a full room to hear testimony on S.132, a bill to expand the scope of practice authority for physician assistants (PAs). Like a law enacted last year regarding advanced practice registered nurses (APRNs) and their scope, this legislation would increase the physician to PA ratio from 1:3 to 1:6 and eliminate the mileage requirement, replacing a 60-mile radius with the borders of the state.
SCHA supports this legislation as it is consistent with our position that clinicians should work at the top of the license, skills, and education level while maintaining a physician as the head of the care team. Expanding the ratio and mileage radius is especially important to rural communities, in which the physician shortage is particularly pronounced.
Expected to have opposition, the subcommittee met to hear testimony only and not advance a bill this week. Two PAs spoke in favor of the legislation and touched on the need to update the statute to allow better practice and access to care for patients. Three physicians shared their concerns with the bill, including some of the proposed prescriptive authority and the need for more continuing education requirements.
Chairman Tom Davis (R-Beaufort) indicated this hearing was the first of multiple that would be required to get the bill to an agreeable point. Another subcommittee hearing has been scheduled for next week. As with the APRN scope of practice bill last year, this bill is expected to be worked through over the next few months by interested parties, but a compromise is expected among stakeholder groups at some time during this session.
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Senate Committee Continues Discussion on Tort Claims Act Liability Limits
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The full Senate Judiciary Committee met Tuesday and debated S.7, a bill to increase the liability limits in the Tort Claims Act, which came out of subcommittee last week. There was a lot of discussion on what the limits should be based on inflation, adequate coverage for catastrophic injuries, and insurance premium increases resulting from the increases.
A subcommittee approved the bill last week, including two amendments to the originally filed bill. The bill as approved by the subcommittee would do the following:
- Increase liability limits from $300,000 per person to $1,000,000 and from $600,000 per occurrence to $2,000,000
- Tie limits to an annual index
- Apply to claims with a date of loss after July 1, 2020
Many members of the committee felt the jump to $1,000,000 and $2,000,000 was too much, too quickly. Others felt the increases did not go far enough to appropriately compensate some individuals who may be severely injured by governmental entities or employees.
Senator Massey (R-Edgefield) proposed an amendment with three parts:
- Increase liability limits from $300,000 per individual to $500,000 and $600,000 per occurrence to $1,000,000
- Remove annual tie to CPI
- Cap noneconomic damages at $300,000
He withdrew his amendment after some discussion.
Senator Fanning (D-Great Falls) proposed an amendment to raise the limits to $400,000 and $800,000, which was tabled. Senator Kimpson (D-Charleston) said he would like to introduce an amendment for the limits to be higher than those proposed by the subcommittee, a sentiment shared by other committee members.
Ultimately, the legislation was passed out of committee as approved by the subcommittee last week. Senator Malloy said he expects much debate on this on the Senate floor and a number of amendments to be presented at that time. Another bill, aimed to address exceptions and other deficiencies in the Tort Claims Act, has been introduced and will be debated next week, but no details are available yet.
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In Other News
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- Governor McMaster Gives State of the State: Governor McMaster called South Carolina "red hot" as he gave his annual State of the State address Wednesday. He expanded on his vision for the state, first laid out during his inauguration address earlier this month. McMaster and the General Assembly have identified education reform as a top issue, with the Governor calling for bold changes to the education system this year. McMaster also called attention to the opioid crisis and work being done to combat it, as well as our robust telehealth system and improvement in access to care. A full transcript of the speech can be seen here.
- Health Agencies Present Budget Requests: Many of the state's health agencies presented their budget requests to a panel of lawmakers this week as the House Ways and Means committee prepares their version of the 2019-2020 budget. DAODAS and DHHS were among the agencies, both with many successes to share with the group. DAODAS has increased capacity for substance abuse treatment and would like to continue to see increases for individuals affected by the opioid crisis and other addictions. DHHS has implemented the changes called for last year related to behavioral health services and noted that they have stayed under budget. Both agencies were well received by the panel.
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Intros of Interest
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- H.3726 (Weeks) - a bill to require continuing education for certain professionals on identifying death from opiates - referred to House 3M Committee
- H.3727 (Fry) - a bill to require Medicaid plans to ensure access to treatment of opioid use disorder - referred to House 3M Committee
- H.3728 (Alexander) - a bill to require hospital ED physicians and pharmacists to submit information on opioid administration to DHEC - referred to House 3M Committee
- H.3729 (Fry) - a bill to require reporting when a fetus or infant is exposed to alcohol or drugs - referred to House Judiciary Committee
- H.3730 (Fry) - a bill to create an offense for trafficking fentanyl - referred to House Judiciary Committee
- H.3731 (Hewitt) - a bill to allow the Director of DHEC to place a drug on the Schedule I list in an emergency - referred to House Judiciary Committee
- H.3732 (Hewitt) - a bill to require veterinarians to receive continuing education on controlled substances - referred to House Ag Committee
- H.3733 (Weeks) - a bill creating a partnership to deflect individuals who need substance abuse treatment from entering the judicial system - referred to House Judiciary Committee
- H.3734 (Fry) - a bill to conform the language in the law regarding trafficking of drugs to the law regarding possession and distribution of drugs - referred to House Judiciary Committee
- H.3735 (Fry) - a bill to add the sale or distribution of a drug that causes overdose death to the definition of involuntary manslaughter - referred to House Judiciary Committee
- H.3760 (Sandifer) - a bill to merge the JUA and the PCF and to provide an assessment mechanism to reduce the unfunded liability of the entity - referred to House LCI Committee
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January 25, 2019
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