UNDER THE ROTUNDA
Deciding how to spend the final days and hours of life is highly a personal decision, and it’s one physicians encourage their patients to make long before the need arises. Today, the Senate debated end-of life-bills after voting yesterday to approve its version of the state’s 2020-21 budget and to raise the minimum age to purchase tobacco and vape products.
In the Senate Health and Human Services Committee, Dallas internist Robert Fine, MD, testified on several bills that could subvert the Texas Advance Directive Act, signed into law by then-Gov. George W. Bush in 1999.
Senate Bill 2089 by Sen. Bryan Hughes (R-Mineola) would require hospitals, physicians, nurses, and other health care professionals to provide what physicians believe amounts to medically inappropriate and potentially harmful care for an unlimited period of time.
Dr. Fine explained to lawmakers that requiring care essentially in perpetuity would prolong the dying process, exacerbating suffering for both patients and loved ones. Moreover, by mandating treatment in perpetuity, SB 2089 violates physicians’ personal liberties of conscience and ethics by requiring them to provide care they may believe is medically inappropriate or outside the standard of care. TMA strongly opposes this bill.
Dr. Fine also testified in opposition to Senate Bill 2129 by Sen. Brandon Creighton (R-Conroe), which not only would impose limits on physicians’ professional medical judgment but also allow nonphysicians to determine what is reasonable medical judgment. TMA strongly opposes this bill, too.
Conversely, TMA supports Senate Bill 2355 by Sen. Eddie Lucio, Jr. (D-Brownsville). SB 2355 would require hospitals to establish policies prohibiting members of hospital ethics committees from discriminating against patients with disabilities or from serving on such a committee if they have conflicts of interest.
Dr. Fine stressed the importance of keeping ethics committees a reliable resource for resolving end-of-life care disputes. In the rare event that an ethics committee deliberates on the medical care of a patient, a patient’s disability should not be considered unless it is medically relevant, and ethics committee members should not be constrained by health care or financial conflicts of interest, Dr. Fine testified. The patient’s best interests must be the singular focus of the ethics committee during any review.
Another bill in the committee, Senate Bill 1519 by Sen. Lois Kolkhorst (R-Brenham), would create a statewide council on long-term care facilities. TMA submitted written testimony recommending the inclusion of both a long-term care facility medical director and an infectious disease or public health physician on the council.
In the Senate Transportation Committee, Houston pediatrician Amelia Averyt, MD, testified in support of Senate Bill 1524 by Sen. Judith Zaffirini (D-Laredo), which would require transporting a child younger than 2 in a rear-facing car seat unless the child meets certain height and weight thresholds.
Dr. Averyt shared some eye-popping statistics with the committee, noting that, “Children under the age of 2 are 75% less likely to die or be severely injured in a crash if they are riding in rear-facing car seats.” TMA also supports the companion bill, HB 448, in the House.
These bills were all left pending.
Yesterday, the Senate debated and unanimously approved its version of House Bill 1 by Rep. John Zerwas, MD (R-Richmond), the state’s budget for the 2020-21 biennium. The budget is the only bill that the Texas Legislature is constitutionally required pass.
Some notable inclusions in the budget:
- Article II, which covers health and human services, is the largest item in the budget at $85.6 billion.
- The AIM bundles recommended by the Maternal Mortality and Morbidity Task Force are fully funded.
- Women’s health programs funding totals $314.6 million, an increase of $35.6 million in all funds from the current biennium.
- Several requested improvements to the Department of State Health Services’ state lab were funded:
- $12.8 million for lab repairs;
- $17 million to replace lost revenue; and
- $7.7 million for X-ALD gene testing.
- The addition of $59.1 million will expand outpatient mental health treatment capacity.
- An additional $4.3 million will go to infectious disease surveillance.
- Medicaid cost containment mandates are in Rider 19, directing the state to find a savings of at least $350 million through fraud, waste, and abuse detection, and programmatic efficiencies.
- Medicaid payment rate increases were not explicitly funded, but that request is still included in Article XI, which is akin to a parking lot of issues for later discussion. HB 1 recommends a study of opportunities to increase payments via value-based payment initiatives.
Next, the House and Senate will appoint conference committee members who will negotiate the final budget to be presented for approval by both chambers.
BILLS THAT ARE MOVING
Yesterday, an amended Senate Bill 21 by Sen. Joan Huffman (R-Houston) – which would raise the minimum age to purchase tobacco or vape products to 21 years – passed out of the Senate and now heads to the House. The amendment excludes active-duty military between the ages of 18 to 21 years. The companion bill (House Bill 749 by Representative Zerwas) has already passed the House Public Health Committee, so SB 21 should meet with little to no opposition.
GETTING A BILL MOVING
So far this session, lawmakers have filed 7,693 bills. TMA is monitoring 1,940 of them. Bills must be voted out of committee before they can be heard on the floor and voted on by the full body. Then the process repeats in the other chamber. Bills in the House must be out of committee by May 6 to be considered by the Senate this session. Forty-seven days remain until sine die.
BILLS OF NOTE
Here are some bills TMA is watching. Keep an eye on your email inbox for Action Alerts as we work to pass or kill bills.
- House Bill 1501 by Rep. Poncho Nevarez (D-Eagle Pass) would create the Texas Behavioral Health Executive Council and transfer oversight of psychologists, marriage and family therapists, professional counselors, and social workers to the newly created Council. The bill does not expand scope of practice. HB 1501 received preliminary House approval yesterday and awaits third reading. TMA is monitoring this bill.
- House Bill 1579 by Rep. Briscoe Cain (R-Houston) would allow the classification of the Texas National Guard and the Texas State Guard as first responders for the purposes of access to vaccination information, allowing them to more readily assist during disasters. HB 1579 passed the House 145-2 yesterday and heads to the Senate. TMA supports this bill.
ARE YOU A LEGISLATIVE JUNKIE?
If talk of bills and committees and backroom deals initiate tachycardia, you might want to join TMA Leading Advocates. It’s TMA’s exclusive Facebook group for legislative advocacy. Enjoy special features, news in advance, and a community of TMA members who are excited to talk about the Texas legislature and medicine's advocacy priorities. This closed group is open only to TMA and TMA Alliance members, and TMA and county medical society staff. Join today.
TMA’s 2019 legislative agenda includes priorities to help advance patient care in Texas.
At the top of the list are the state budget, insurance reform, scope of practice, maternal health, the Texas Medical Board and Medical Practice Act, and public health.
TMA member physicians and medical students, and TMA Alliance members play a significant role in advancing medicine’s priorities at the Capitol. Here are some ways you can help:
Make sure you receive TMA’s Legislative News Hotline each day, via Texas Medicine Today. Here’s how: Just log in to the Edit My Interests page on your TMA profile. Ensure you get all the legislative updates by selecting "Health care issues in the Texas Legislature" as one of your Grassroots and Advocacy interests. TMA’s updates on the latest bills affecting medicine will arrive in your inbox as part of Texas Medicine Today at 2 pm each day lawmakers convene at the Capitol throughout Texas’ 86th legislative session.
PHYSICIAN OF THE DAY
Today’s physician of the day is Jackson Griggs, MD, of Waco. Dr. Griggs graduated from the McGovern Medical School at UTHealth in Houston and is a member of both TMA and the McLennan County Medical Society.
WHAT WE’RE READING
Confirmed case of ‘whooping cough’ at area middle school, health officials say – KXAN-TV
Save lives, raise Texas smoking age to 21, and for military too [Opinion] – Waco-Tribune Herald
Bill to Allow Physicians to Distribute Medicine at the Office Takes a Hit – D CEO Healthcare
House bill could raise tobacco purchasing age from 18 to 21 – Waxahachie Daily Light