Improve Texas' Emergency Response

TMA Testimony by  Donald K. Murphey, MD

Senate Health and Human Services
CSSB 538 by Sen. Charles Schwertner

March 5, 2015

Good afternoon, chair and members of the committee. I want to thank you for the opportunity to testify in support of the Committee Substitute for Senate Bill 538 by Senator Schwertner on behalf of the Texas Medical Association, the Texas Pediatric Society, and the Texas Academy of Family Physicians. I am Donald Murphey, MD, the medical director of infectious diseases at Cook Children’s Health Care System in Fort Worth and president of medical staff at Cook Children’s Medical Center. I serve on the infectious disease committees of both TMA and TPS. I am here to speak on the substitute as presented today. 

Last fall many of my colleagues responded to the Ebola emergency in Dallas. Today, we are still continuing to assess the lessons learned from this experience and to identify the strengths and weaknesses in our medical and public health preparedness and response system.

But first I want to applaud Dr. Schwertner and this committee for taking the challenge to improve our ability to plan for and respond to infectious disease emergencies. Dr. Schwertner has been attentive and responsive to questions we asked about this legislation. Texas physicians support for CSSB 538. I’m going to outline four areas of the bill most relevant to physicians and our ability to protect our patients from infectious diseases.  

  1. Clarity on infectious disease emergency.  A key measure in CSSB 538 will change the state’s leadership role during a declared state of infectious disease emergency. This is a significant change in the current emergency management structure, so we can’t fully understand the impact of this change will have on our ability to respond to future infectious disease emergencies. We appreciate the clarification provided in CSSB 538 on when an infectious disease event would warrant a declaration of a statewide emergency.  

  2. Physician leadership in an infectious disease emergency. When the first Ebola case was identified in Texas, we were extremely fortunate the former commissioner of health, Dr. David Lakey was an infectious disease expert. CSSB 538 designates the commissioner of health as the leader in future state infectious disease emergencies. While Dr. Lakey is a nationally recognized public health expert and leader, the Texas commissioner of health is not required to be a physician or have expertise in infectious diseases. We believe this expertise is critical for anyone overseeing a statewide infectious disease emergency.

    This bill directs the division to issue specific statewide preparedness guidelines and procedures for local health and emergency management. Our experience in Dallas highlights the great need for state and local public health physician leadership and expertise in infectious diseases. Infectious disease resources are needed throughout the department and to support health departments throughout the state. We strongly encourage you to assess these resources in the department and particularly to expand its physician infectious disease leadership.

    Just as physicians will need public health expertise in their communities, we also need to know about infectious disease occurrences. We encourage you to support funding to improve surveillance and epidemiologic support for timely alerts and communications on infectious diseases. This information helps physicians and public health authorities manage infectious disease emergencies and outbreaks.  

  3. Control orders. This legislation makes changes in the current process for enforcing control orders, some of which address concerns raised by Dallas law enforcement and emergency responders. While we take  no position on the specific changes outlined in the control order process. However, we encourage you to ensure those enforcing control orders are properly trained on infectious diseases including the proper use of personal protective equipment.  We support the department’s proposed exceptional item request for stockpiles and continuing education opportunities for physicians and other first responders. This additional preparedness program funding should complement this component of CSSB 538.

  4. Task Force on Infectious Disease Preparedness and Response. We ask you to consider continuing the task force as a body that reports to the Department of State Health Services. We believe it will ensure more transparency in the deliberations of the task force. We appreciate the language in CSSB 538 to provide more diverse representation on the task force and encourage additional representation of the front-line physicians working in private settings caring for patients who are most vulnerable in an infectious disease emergency. We are the ones who must screen and answer the many patient questions during an emergency. 

Texas physicians were directly involved in the treatment, investigation, and monitoring of Texans residents exposed in the Ebola emergency in Dallas. Our ever-increasing knowledge of how infectious pathogens affect humans and our environment are a cornerstone of public health. Disease surveillance occurs thanks to the strong leadership and cooperation between medicine and public health. This, along with clinical and community-based interventions, has reduced annual communicable disease deaths from the thousands to zero or few. We must not only maintain but also further build our state’s preparedness and response system to work with medicine and the public to address emerging and re-emerging diseases like measles. Working with medicine and with many of the provisions in CSSB538, we believe Texas will be better prepared to manage the infectious disease threats present in our environment. 


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TMA Testimony

 Senate Health and Human Services Committee

Texas Medical Association Testimony on Senate Bill 203

March 4, 2015

The Texas Medical Association (TMA) appreciates the work of the Sunset Advisory Commission and staff as they carefully analyzed the work of the Texas Health Services Authority (THSA). Since its inception, THSA has assisted the state in navigating this new and complex health care environment of health data exchange. TMA also appreciates the work of Senator Nelson and her staff as they work to implement the recommendations of the Sunset Commission and staff.  

TMA supports the sunset of the state status of this organization and its full privatization. TMA, however, is concerned with the bill provisions addressing THSA’s post-2021 private, nonprofit organization functions.  

For example, SB 203 would permit THSA, in its fully private post-2021 form, to have a special role in “assisting” in the Health and Human Services Commission’s promulgation/amendment of rules concerning the privacy and security standards for the electronic sharing of protected health information applicable to covered entities.   

Additionally, SB 203 contemplates THSA, in its post-2021 private, nonprofit organization form, continuing to serve as an organization authorized by the Health and Human Services Commission to certify a covered entity’s compliance with the aforementioned privacy and security standards (i.e., those standards that it “assists” in amending).  

TMA is concerned that there may be unintended consequences if a state agency bestows any level of preferred status to a private, nonprofit organization for standard setting and certification. Once THSA’s status changes to a private entity, all state agencies should treat it as any other private stakeholder.  

We strongly agree with Sunset members that it is important that parameters be in place to establish an exit plan to protect the state’s interest and investment.  

Thank you for the opportunity to submit comments on this important process and consideration.  We look forward to working with the author and members on finding the optimal evolution of THSA’s future success.

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April 24, 2018