Once again, expertise prevailed in this year’s legislative session. So did good sense.
The 2021 roster of anti-medicine ideas put forth in legislation at the Capitol may have looked familiar. For instance, nonphysician practitioners put forth their usual patient-endangering attempts to expand their scope of practice into medicine: independent prescribing for nurse practitioners, optometrists performing surgeries, psychologists prescribing drugs, and more. But the Texas Medical Association helped stop each of those scope proposals well short of becoming law, once again convincing lawmakers that physicians should be the leaders in a collaborative care team effort with other practitioners.
The House of Medicine also helped kill several pieces of anti-vaccination legislation and bad ideas on advance directives and end-of-life care, among others.
Productive comprom-eyes
As for an optometry bill that turned out to be the biggest scope threat, medicine successfully mitigated its dangers through a mutually beneficial compromise.
As originally filed, Senate Bill 993 by Sen. Kelly Hancock (R-North Richland Hills) would have allowed optometrists to perform a number of different kinds of eye surgeries.
The curriculum in Texas’ optometry schools “have some anatomy and physiology of the eye, not the rest of the body. They have minimal pharmacology training,” says Mark Mazow, MD, president of the Texas Ophthalmological Association (TOA) and a testifier against the bill on TOA’s behalf during this session. “Using medicines and interacting with the rest of the body is not nearly at the level in any way, shape, or form as a medical doctor or [osteopathic doctor]. And they have no surgical training. … The rest of their education does not prepare them for the complications or risks that accompany all surgical procedures.”
As part of a substitute for the original bill, the compromise between TOA and organized optometry stripped out the surgery language, instead creating an ophthalmologist-involved peer review process for glaucoma complaints lodged with the Texas Optometry Board. In exchange, optometrists gained authority to manage mild-to-moderate glaucoma without having to co-manage the condition with an ophthalmologist, and expansion of their ability to administer topical and oral medications for the eye. After the deal was struck, SB 993 suddenly became a measure TMA could support, and it passed without issue.
Sen. Dawn Buckingham, MD (R-Lakeway), an ophthalmologist and an instrumental player in the compromise legislation, said the key was its collaborative peer-review panel that involves both ophthalmologists and optometrists.
“The whole goal is that when a patient [receives] care, they should expect that same standard of care regardless of the provider that they seek,” Senator Buckingham said. “That way, optometrists and ophthalmologists will be held to the same standard.”
Dangerous prescriptive authority
Meanwhile, no compromise was needed to bury other bad scope measures.
House Bill 2029 by Rep. Stephanie Klick (R-Fort Worth), which would have granted advanced practice registered nurses independent prescribing authority and other haphazard autonomy, didn’t pass. Neither did House Bill 1462 by Rep. Vikki Goodwin (D-Austin), which would have allowed psychologists to prescribe drugs.
Fort Worth child and adolescent psychiatrist Debra Atkisson, MD, has personal experience illustrating why psychologists aren’t qualified to prescribe.
She told Texas Medicine she examined a boy referred by a psychologist who “knew” the boy had ADHD and needed Ritalin. But she noticed “some things with his eye movement, and I also noticed that in some ways, his motor skills on one side were a little different. And I thought, ‘I think this could be neurological,’” Dr. Atkisson said.
“To make a long story short, he had a brain tumor. What the child neurologist said to me was, ‘If you had prescribed the Ritalin, he would’ve probably had a seizure on that. Then we would’ve found the brain tumor after he fell on his head, which probably wouldn’t have been good,’” she said. “The child actually did all right. But the bottom line is, it’s because I was trained as a medical doctor that I was able to determine, ‘This is probably not just ADHD.’”
Also on the medication front, medicine’s advocates stopped Senate Bill 735 by Sen. Angela Paxton (R-McKinney), which would have allowed midwives to administer drugs “commonly used in labor or postpartum care” without a physician’s involvement.
Recently retired Austin obstetrician-gynecologist Diana Weihs, MD, believes the drug midwives probably had most in mind was oxytocin, known by the brand name Pitocin. She says the drug, used to help the uterus contract and decrease bleeding, has a reputation for being one of the most dangerous drugs in obstetrics. Dr. Weihs testified against the bill during this session on behalf of the Texas Association of Obstetricians and Gynecologists, as well as the American College of Obstetricians and Gynecologists.
“There were no stipulations about where they would be using it – in a birthing center, or at home. There would be no physician aware of the patient or prescribing the drug,” Dr. Weihs said. “Postpartum hemorrhage is one of the leading causes of maternal mortality. It is crucial to have physician backup in those situations.”
Pharmacists also tried to advance into the practice of medicine but without success. Other defeated scope-of-practice bills included House Bill 678 by Rep. Philip Cortez (D-San Antonio) to allow pharmacists to order immunizations and vaccinations on patients aged 3 and up, and House Bill 2049 by Rep. Donna Howard (D-Austin) to allow pharmacists to test and treat strep throat and the flu.
Anti-vax, end-of-life bills defeated
Anti-vaccination bills were also as prevalent as ever during this session, but medicine worked tirelessly and successfully to defeat them all, along with other bad legislation. Those measures included Senate bills 1310, 1313, and 1669, all by Sen. Bob Hall (R-Edgewood):
- SB 1669, billed as a measure to bar anyone from discriminating against someone based on vaccine status, would have removed all existing Texas vaccination requirements.
- SB 1310 would have required physicians to give parents information on vaccine excipients to obtain informed consent to immunize their child.
- SB 1313 would have allowed people to not participate in a host of infection control measures and created barriers to implementing those measures when needed.
On the end-of-life front:
- House Bill 2180 by Rep. Joe Moody (D-El Paso) would have allowed for multiple people to simultaneously become “co-agents” with medical power of attorney on another person’s behalf.
- Senate Bill 917 by Sen. Bryan Hughes (R-Tyler) would have forced physicians to treat an end-of-life patient indefinitely until a transfer facility could be found, even if the physician believed the treatment was medically inappropriate and the facility’s ethics committee agreed.