• TOA President's Update
• TMA Grants TOA Full CME Accreditation
• Texas District By District: John Zerwas, MD
• This Week In Texas: Mignon McGarry Memos
• Nonphysicians Bypass Legislatures, Use Own Boards To Expand Scope
• Worth Repeating: The Most Physician Friendly States
• CME Programs Begin To Emphasize Improvement

TOA President's Update
  

By David Teuscher, MD TOA President The current issue of Physicians Practice listed Texas as one of the most attractive states to practice medicine in.  The main reason cited for this is our professional liability climate. The AMA has now taken Texas from crisis status all the way to safe status for medical liability in less than three years. The tort reform you helped pass in 2003 is really working

Already, Senator Rodney Ellis (D) of Houston has filed a bill that would lower the evidentiary standard in emergency care cases from the new “willful and wanton” negligence standard. This is the same level of proof that burdens the plaintiff in a “good Samaritan” case. If passed, his bill would exempt any physician who is “regularly in the business of providing emergency medical care”. That sounds like he is taking a shot at every one of us who provides ER coverage. In fact that standard applies to emergency care provided in the surgical suite. You and I know that the unique challenges and liability risks providing emergency care deserve the new and higher burden of proof, and if repealed would seriously and negatively impact ER staffing and patient access. We will remain vigilant to ensure that this bill dies on the east wing of the Capitol.

More good news keeps rolling in as the number of doctors applying for a Texas license has jumped 57 percent since 2003. Unfortunately the staff levels are unchanged and the average processing time has jumped from 60 days in 2004, to six months or longer now. If you are recruiting an orthopaedist who does not have a Texas license, better get them started now. Fortunately this is a very fixable problem, as only a $400,000 emergency appropriation from the Legislature would get the Texas Medical Board adequately staffed. Unfortunately, the legislature is hearing proposals to raise our license fees again. When your license fees are paid to the state they go into the General Revenue account. Less than one third of those dollars are then given to the TMB. Don’t you agree that they should use the money we have already given them and fix the problem now?

The non-economic damage cap is the cornerstone of our reform, so it is only natural that the trial bar (plaintiff and defense) along with the so-called “consumer groups” are attacking it. They have proposed making a “hole” in the cap with exceptions for certain ill defined egregious behavior, raising the cap to a higher level, and indexing the cap to an economic index. All of these would have a corrosive and deleterious effect on the protections the non-economic cap provides and should be resisted with all our efforts. We will need to defend our reforms with the same efforts that it took to win them. Our response to the cap busters must be: Hell no, leave our caps alone!

Next time you see your Senator or Representative, be sure to remind them how well the reforms are working, even if they voted against them in 2003. Better yet, write them both a letter today and tell your story of the positive impact on the patients you care for.
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Texas District By District: John Zerwas, MD
    

Dr. John Zerwas is proud to represent the people of the 28th District in the Texas House of Representatives. The district and its diverse mix of urban, suburban, and rural populations is as unique as its new State Representative, Dr. John Zerwas. An active family-oriented conservative, Representative John Zerwas has served our area families as a physician for over 20 years. As a community advocate, Representative Zerwas understands the

importance of providing lasting tax relief while adequately funding our children’s education, ensuring the safety of our borders and protecting the property rights of all Texans. Representative Zerwas is the only physician currently serving in the House of Representatives at a time when Health & Human Services spending makes up roughly 40% of the Texas budget and is the fastest-growing area of state spending. As Chief Medical Officer of the Memorial Hermann Healthcare System in Houston, Representative Zerwas has overseen a transformation that has reduced the cost of treating certain medical problems while increasing patient satisfaction and outcomes. A physician and administrator, Representative Zerwas is uniquely equipped to find common-sense solutions to help Texas deal with the increasing complexities and cost of health care. John and his wife, Cindy, are 1973 graduates of Bellaire High School and were married in 1978. They have four children, John, Joseph, Brandon, Sherry, and son-in-law Matthew. Representative Zerwas knows public education is one of our greatest assets in Texas. Since all of his children graduated from Lamar Consolidated High School in Rosenberg and have attended a Texas university, he knows the challenges today’s public school students and education professionals face. Representative Zerwas will advocate for our public schools to receive adequate funding and to ensure our schools can teach the values and principles of the founders of the United States. Representative Zerwas has a strong commitment to faith and community. He helped form the First Colony Church of Christ, and was one of its first deacons. He worked with the Boy Scouts of America to initiate Troop 1656 in the Pecan Grove area, was very active in his children’s junior high and high school booster clubs, has also served as president of his local homeowners’ association for two terms and has been active in local politics. Representative John Zerwas will work to bring lasting property tax relief to all Texans, to ensure our healthcare system remains one of the best-respected, most efficient ones in the nation and to keep Texas schools equipped to prepare our children to compete with the best and the brightest students in the world. Representative John Zerwas will be a strong conservative voice in the Texas House of Representatives for the values we hold dear as Texans. Email John Zerwas to thank him for his work. [top] [back to e-connect archive page]

A growing number of allied health professions seeking scope-of-practice expansion are going through their regulatory boards instead of state legislatures, physician leaders say.

Executives at national groups such as the American Optometric Assn., state groups such as the Texas Podiatric Medical Assn. and other organizations say their boards are amending regulations within their authority and that their professions are not putting patients at risk. But physicians view the actions as illegal and a threat to patient safety.

"To get a state board to issue an advisory opinion is a quick way to get [scope changes], and the only way to challenge it is in court, which is expensive," said John B. Neeld Jr., MD, past president of the American Society of Anesthesiologists. "If they get a friendly state board, they're home free. It's a big train that's left the station, and it's gathering momentum."

Oklahoma gained national attention in 2004 when the Oklahoma Board of Examiners in Optometry adopted rules permitting optometrists to perform surgery with a scalpel, a move the state legislature backed with legislation later that year.

The Texas Medical Assn. is in legal battles with the state's chiropractors and podiatrists, whose boards have made regulatory changes the TMA considers scope expansions. At least seven other state medical associations are seeing allied health professions pursue scope changes through their boards. Podiatrists, optometrists and certified registered nurse anesthetists are among the most active groups, the medical society leaders said.

William A. Hazel Jr., MD, a member of the American Medical Association Board of Trustees, said allied professionals are overstepping their regulatory authority as they include aspects of medicine into their scope. Those in the allied professions may consider themselves competent to make diagnoses, prescribe drugs or perform invasive procedures, he said. But without a medical degree, they do not have the expertise, said Dr. Hazel.

"The problem with limited license boards expanding their scope is that the hardest thing to know is what you don't know," Dr. Hazel said. "As boards expand the scope of their licensees, they'll run into more things that have been done only by physicians before."

Allied health professionals making regulatory changes say they are not dodging the lengthy legislative process or the unpredictability of legislators' votes. They say their boards are acting within their legislative mandate to regulate their licensees, which includes interpreting their governing statutes and amending them.

Jason Ray, an attorney for the Texas Chiropractic Assn., which the Texas Medical Assn. has sued, said legislatures commonly give regulatory bodies authority to define parameters in which they have responsibility. "Every regulatory agency that licenses a profession to some extent defines what that scope is going to be."

Most allied health professionals are still more likely to go to state legislatures seeking scope-of-practice expansions. This year, at least 17 non-physician associations are expected to approach legislatures with bills in 30 states. But the regulatory route is becoming increasingly popular.

In Ohio, Todd Baker, executive director of the Ohio Ophthalmological Society, said optometrists there are using the regulatory process to expand on prescribing legislation passed in 1992. Using this law, he said, the optometric board has been adding drugs to its formulary, such as antivirals for treating shingles involving the eye. "This is the optometric community adding scope by adding new drugs," he said.

The executive director of the Ohio Optometric Assn. said the group does not view it as an expansion.

Elsewhere:
 

• In New York, nurse anesthetists have asked regulators to create a category of nurse anesthetists that would practice without doctor supervision.
• In Idaho, the Idaho Medical Assn. and Idaho Society of Ophthalmology, along with the medical board, approached the Idaho State Board of Optometry about its decision to include certain eyelid procedures within optometrists' scope.
• In Massachusetts, the state podiatric board, through a regulatory hearing, defined the scope of podiatry to include the ankle and amputation. That occurred after legislative attempts failed. The Massachusetts Medical Society has not decided whether it will pursue legal action.

Meanwhile, the Texas Medical Assn. is appealing an Austin district court decision upholding the podiatric board's action to define the profession's scope to include the ankle. The TMA's case against the chiropractic board for allowing needle electromyography and spinal manipulation under anesthesia is still in pretrial proceedings.

Mark J. Hanna, legal counsel for the Texas Podiatric Medical Assn., and Ray, for the Texas chiropractic board, said their boards were not expanding either profession's scope.

The Scoop on Scope

Allied health professionals are looking to state legislatures to expand their scope of practice.
 

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