TMA Legislative Hotline

Hotline is a daily electronic newsletter exclusively for TMA members that reports the legislature's latest actions on bills affecting Texas medicine.

Texas Physicians Fight End-of-Life Bill With Passion

(TAKE ACTION NOW, End-of-Life Care) Permanent link

1.30 curran

When the Texas Medical Association urged members to ask their state senators to vote “no” on a key bill regarding treatment disputes at the end of life, they didn’t hold back.

“I believe the whole thing is motivated by a lack of faith in physicians and a desire to impose one group's political will on everyone else without their say so,” Mary Elizabeth Paulk, MD, wrote in an email to Sen. Nathan Johnson (D-Dallas). “This is just wrong.”

Dr. Paulk wasn’t alone. Hundreds of Texas physicians took up the call, using TMA’s Grassroots Action enter to share very personal and passionate messages with their senators.

The outpouring came in response to a TMA action alert against Senate Bill 2089. That bill would require hospitals, physicians, nurses, and other health care professionals to provide medically inappropriate and potentially harmful care for an unlimited period of time.

“Deciding how to spend the final days and hours of life is a highly personal decision, and it’s one we encourage our patients to make long before the need arises,” TMA President Doug Curran, MD, wrote in the alert. “Requiring care in perpetuity would prolong the dying process, exacerbate suffering for both patients and loved ones, and violate the standard of care to do no harm.”

When writing their lawmakers, some physicians shared personal stories of their experiences; excerpts of some of those emails are below:

“SB 2089 takes decisionmaking about dying patients out of the hands of ethicists and physicians who have spent their lives dedicated to training and study so that we understand how best to provide care in exactly these kinds of situations. … When I think of the amount of suffering this bill is going to cause for patients, families, hospitals, and our health system as a whole, I am overwhelmed with sadness.”

- Faith Holmes, MD, to Sen. Donna Campbell (R-New Braunfels) 

“In all honesty there isn't going to be another physician who will accept the transfer. So the patient will be on life support indefinitely without the physician in the current hospital being able to withdraw care. In effect, the first physician could not withdraw care, but a second physician will not likely accept, and therefore, the first physician will be legally obligated to continue care for the patient on life support indefinitely.”

- Amber van den Raadt, DO, to Lt. Gov. Dan Patrick  

“During my intern year, I had a patient with metastatic breast cancer who was only in her 50s. Unfortunately, her cancer was so aggressive that she had now begun to develop fluid buildup (ascites) due to liver failure and later developed renal failure. Because of this, she also had a tremendous amount of acid build-up in her body. She had a husband and two children, and we went above and beyond extraordinary measures trying to save her life as they continued to want aggressive care. Throughout the final stages of our aggressive treatment, I felt sick to my stomach, because it was obvious our interventions were doing more harm than good, and the patient was clearly suffering.”

- Nitya Kumar, MD, to Sen. Borris Miles (D-Houston)

“End-of-life issues are not something that can be legislated in the fashion proposed in SB 2089. These things have to be individualized by patients, families, and their physicians. … It is foolhardy for legislators to presume to know what is correct on an individual basis from a global perspective. Perhaps God can do that but not the Texas Senate. Please keep the state rational and vote against this bill and any others like it that see the light of day.”

- Vik Wall, MD, to Sen. Kel Seliger (R-Amarillo)

TMA is vehemently opposed to SB 2089 by Sen. Bryan Hughes (R-Mineola), which is currently poised for debate on the Senate floor. TMA continues to encourage you to help stop it from making any further progress.

Please contact your state senator today and ask him or her to oppose SB 2089.

Legislative Hotline: Maternal Health, Network Directories, Cancer Research Bills Up for Debate Today

(Budget, Public Health) Permanent link



Today is the 122nd day of this session; 18 days remain.

Here’s a status check of several bills important to medicine that continue to move through the legislative process:

  • House Bill 744 by Rep. Toni Rose (D-Dallas), which would allow continued Medicaid coverage for eligible women up to 12 months postpartum, is set on today’s House Calendar. Medicaid coverage currently expires 60 days after delivery, but the vast majority of maternal deaths occur from 61 to 365 days postpartum. TMA supports this bill.
  • House Bill 1880 by Rep. Sarah Davis (R-West University Place), which would establish time limits for corrections and updates to be made to insurers’ online network directories, is set on the House Calendar for today. TMA supports this bill.
  • House Bill 39 by Rep. John Zerwas, MD (R-Richmond), which would repeal the 2022 sunset date for the Cancer Prevention and Research Institute of Texas (CPRIT) and extend it by 10 years, is set on the Senate Local Calendar for tomorrow. TMA strongly supports this bill.
  • House Joint Resolution 12 also by Representative Zerwas, is the funding mechanism for HB 39. HJR 12 proposes a constitutional amendment authorizing the legislature to increase the maximum bond funding for CPRIT. The institute will exhaust its initial allotment of $3 billion by 2021; HJR 12 would replenish those funds, with voter approval. HJR 12 is set on the Senate Intent Calendar for today. TMA strongly supports this measure.
  • House Bill 3345 by Rep. Four Price (R-Amarillo), which would allow physicians to choose the best platform for providing telemedicine services, rather than having health plans dictate the platform, received final approval by the House 135-1 yesterday. HB 3345 awaits committee referral in the Senate. TMA strongly supports this bill.
  • House Bill 2362 by Rep. Joe Moody (D-El Paso), which would create an exception to the willful and wanton emergency medical care standard if a physician or other health care provider negligently causes a stable patient to require emergency medical treatment, received final approval on the House floor yesterday with a 107-36 vote. It awaits committee referral in the Senate. After extensive negotiation and revision, TMA and the Texas Alliance for Patient Access agreed to support this bill.
  • House Bill 1065 by Rep. Trent Ashby (R-Lufkin) – which would create a grant program to develop residency training tracks to prepare physicians for practice in rural, underserved settings – was voted out of the Senate Higher Education Committee and awaits debate on the Senate floor. TMA submitted written testimony in support of this bill earlier this month.
  • House Bill 2732 by Rep. Dustin Burrows (R-Lubbock) would require physicians to receive from patients a signed disclosure form with an itemized statement of the amounts to be billed for nonemergency medical services before those services are provided. Otherwise, the physician would be prohibited from sending an unpaid bill to a credit reporting agency. HB 2732 is set on today’s House Calendar. TMA opposes this bill.
  • Senate Bill 2089 by Sen. Bryan Hughes (R-Mineola), which 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, is on today’s Senate Intent Calendar. TMA vehemently opposes this bill and encourages you to let your senator know you oppose it, too, by sending a message through TMA’s Grassroots Action Center.  

If a bill hasn’t passed out of committee by now, it is likely dead for this session. But legislative zombies aren’t uncommon creatures. Bills that aren’t voted out of committee can be proposed as amendments to legislation that is moving, a strategy that is not always successful. Conventional wisdom among legislators is that if a bill couldn’t get out of committee, it must not be worthy to be an amendment.

The next major hurdles: House bills must have won initial approval on the House floor by midnight tonight.

Tomorrow, Friday, May 10, is the deadline for the House to consider most House bills and House Consent Calendar bills for their final debate. Bills on the House Local Calendar have more time. The Senate deadlines come later this month.

TMA is watching each bill, committee substitute, and amendment for any changes. It is not uncommon for revised legislation to prompt a revised position from TMA, particularly when bad bills become better bills through rewriting or amendments. If you have a question about a specific bill, contact the advocacy team via the TMA Knowledge Center by email or call (800) 880-7955, Monday-Friday, 8:15 am to 5:15 pm CT. 


Healthy Vision 2025 – released in late January – is TMA’s all-inclusive, health care roadmap for legislators.

Want to help spread and promote TMA’s Healthy Vision for Texas? Become a TMA social media ambassador


Today’s physician of the day is Lawrence Gibbs, MD, of Mansfield. Dr. Gibbs graduated from the University of Pittsburgh School of Medicine and is a member of both TMA and the Dallas County Medical Society.


Mothers dying needlessly: CDC says most pregnancy-related deaths can be prevented – USA TODAY

Cortez: Ensuring Health Coverage for Texas Children [Opinion] – Rio Grande Guardian

Feds Want To Show Health Care Costs On Your Phone, But That Could Take Years – Kaiser Health News

Texas House passes second, more limited bill expanding access to medical cannabis – The Texas Tribune

Severe alcohol-related liver disease on the rise, study finds – NBC News

Smallpox Was Eradicated, So Why Not Measles? –  Houston Public Media


When the Sausage Starts to Smell

(Public Health) Permanent link


Are you ready for some chubs? How about a little POO? 

No, we’re not talking bait fish nor a diminutive for the ‘60s Twist-master. Not a typo for a stuffed bear nor the stuff of excrement. 

It’s a civics lesson … or the warped civics that happens in Austin for precisely 140 days leading up to Memorial Day every odd-numbered year. Today in the Texas House of Representatives is not for the meek or faint of heart. Sometimes even the boldest of women and men just have to look away. 

And say you’re an important piece of legislation riding the very caboose of the train that the House Calendars Committee has assembled. Say you’re House Bill 1335, a bill to set up behavioral health centers in public schools, a bill written in the aftermath of the Santa Fe High School shooting last May. Like some of the 10 students and teachers killed in that massacre, you don’t stand a chance. 

So what’s all the fuss about today? And what about those chubs and POOs? 

Well, it’s all about the rules. Yes, this seemingly chaotic sausage kitchen does have rules. Lots of rules. The House writes its own rules (most of them; some are in the constitution, but we don’t have time for that right now), and your representatives voted to adopt those rules way back in January. Way back when today's marathon calendar was but a distant foreboding. 

Most pertinent right now among those rules is this one: For a contested House bill to become law, it must at least have won preliminary approval on the House floor by the 122nd day of the 140-day session. That 122nd day ends at midnight, Central Time, on Thursday, May 9. If a bill doesn’t pass that gauntlet today, it’s curtains. (Uncontested bills get one extra day to remain in play.) 

Today’s House calendar contains exactly 158 pieces of legislation, arranged by the Calendars Committee in the order by which they’ll be considered. That list includes 67 bills leftover from yesterday’s calendar, leftover even though the House worked until a little past 11 pm yesterday. 

House Bill 1335 – you remember, the one that sets up behavioral health centers in public schools – is No. 158 on the list. Highly unlikely it would make it through by midnight even if the chamber were working efficiently. 

But the chamber isn’t working efficiently. It’s not supposed to. The rules and traditions purposefully make it easier to defeat a bill than to pass one. Ensuring that inefficiency are the chubs and the POOs. Since the easiest way to kill a bill is to prevent it from ever coming up for a vote, lawmakers who don’t like one or more bills sitting in the maybe-we’ll-get-to-it part of the calendar purposefully slow the whole train down with chubs and POOs. 

If you’re watching the session in person or via the streaming feed and you notice a lot of questions being asked about seemingly minor bills … and you notice that the questioners are taking lots of time asking and explaining their questions and then questioning the answers … and you notice the same representatives showing up over and over again to ask those questions … that’s chubbing. 

Per House rules, questioners each have 10 minutes to engage in debate with a bill’s authors or supporters. Expert chubbers know how to use every one of those minutes, all 600 seconds, asking and re-asking until the speaker slams the gavel and intones, “The gentleman’s (or gentlelady’s) time has expired.” A good tag-team chub can last a half hour or longer, sending more and more bills at the end of the calendar to the legislative graveyard. 

And then there’s a POO – or point of order. Any member of the House can “call” a point of order on a bill. Basically a POO challenges that bill’s legitimacy. A POO alleges that the bill’s route from filing to committee hearing to the calendar somehow violated a House rule. 

Quite frequently, a lawmaker will call a POO in order to kill the bill that’s actually up for debate on the House floor. Since it takes quite a bit of time from when the assassin says, “Point of order!” until the speaker and his team evaluate the claim amid the arcana of House rules and the speaker declares, “Point of order is well taken and sustained,” or “Point of order is overruled,” a well-timed and well-argued POO can turn into a champion chub. 

If all of this sounds fascinating to you, and you tune in to the House feed all the wy until midnight and then you feel as empty as when you’ve binge-watched every available episode of some nasty Netflix series, fear not.

The whole process gets a reprise on Tuesday, May 21. That’s the 134th day of the session, and every legislative junkie knows that midnight on day 134 is the very last minute for a Senate bill to win preliminary approval on the House floor. 

More chubbing. More POOs. Another nauseating visit to the Jimmy Dean processing plant.