As Scope Defenses Continue, TMA Opposes Treatment Expansion for Midwives
By Joey Berlin

Throughout the 2021 session, troublesome bills to expand nonphysicians’ scope of practice have collectively been a sleeping monster – kept dormant by the House of Medicine’s dogged advocacy efforts, but in constant need of monitoring should the beast awaken.

So far, most of the scope bills the Texas Medical Association has the greatest concerns with have stayed pending in committees. TMA aimed to keep it that way this week with a letter to the Senate Health and Human Services Committee that opposes giving nurse-midwives the authority to treat and diagnose a patient.

Under Senate Bill 735 by Sen. Angela Paxton (R-McKinney), nurse-midwives would be allowed to administer drugs “commonly used in labor or postpartum care,” including antihemorrhaging drugs, intravenous fluids, local anesthetics, and prophylactics.

Also signing onto TMA’s letter were the American College of Obstetricians and Gynecologists, Texas Pediatric Society, Texas Academy of Family Physicians, and Texas chapter of the American College of Physicians Services. The organizations told the committee they’re respectful of the expertise, education, training, and experience of all nurse-midwives, but said SB 735 “allows a nurse-midwife to treat and diagnose a patient” and would compromise patient care.

“Our intent is to ensure that any midwifery-related policy proposal assures safe midwifery care for both the mother and baby,” TMA wrote. “Independent treating and diagnosing IS the practice of medicine, and it must continue to be reserved for those properly trained to do so. We believe that Senate Bill 735 is too broad and is not in the best interest of patients. Our physician members are committed to the existing collaborative approach with the nurse-midwife community to continue to best serve Texas patients, with good communication and plans for unanticipated complications.”

The committee held a hearing on the bill on April 21 but has left it pending thus far. Other ill-advised scope-of-practice bills TMA is working to stop include:

  • House Bill 678 by Rep. Philip Cortez (D-San Antonio) to allow pharmacists to order and administer immunizations or vaccinations to patients at least 3 years old. HB 678 has reached the full House calendar, and TMA is calling on members to help stop it.
  • House Bill 2029 by Rep. Stephanie Klick (R-Fort Worth) to grant advanced practice registered nurses independent prescribing authority and diagnostic authority;
  • House Bill 2049 by Rep. Donna Howard (D-Austin) to allow pharmacists to diagnose and prescribe medications for strep throat and the flu; and
  • Senate Bill 993 by Sen. Kelly Hancock (R-North Richland Hills) to allow optometrists to perform certain surgeries.

 Getting teens off e-cigs

Medicine’s effort to curb youth electronic cigarette use took its latest step late Monday afternoon when Austin pediatrician Maria Monge, MD, testified for TMA in support of a bill to license e-cigarette retailers and establish a framework to regulate vaping.

Senate Bill 248 by Sen. Nathan Johnson (D-Dallas) was heard Monday in the House Ways & Means Committee after passing the Senate last month. It requires e-cigarette retailers to obtain permits and sets up vaping products to be regulated similarly to other cigarette products.

During her testimony, Dr. Monge related a pair of anecdotes regarding patients she saw last week, including a 16-year-old whose use escalated to the point where she was vaping every hour. When her parents found out, they threw away the vaping products – and their daughter became sick for days because of nicotine withdrawal.

“As you quit combustible cigarettes, there’s kind of a way to taper off of it. We know about gums, we know about patches, we know about ways to get people off of those,” Dr. Monge testified. “We actually don’t have the data – there is no published way to get teenagers off of vapes at this point. So it’s us trying to do our best. But instead, we have teenagers who are suffering. Unacceptable – we need to stop it before it starts.”

Dr. Monge also noted during her testimony that Texas physicians “are very concerned about the e-cigarette crisis that we have going on currently. Not only are we concerned about the immediate effects, but we’re also concerned about future effects and things that we don’t even know yet.”

SHAC transparency, again

Meanwhile, TMA continues to pound home the importance of encouraging – rather than discouraging – physician volunteer participation in school health advisory councils (SHACs). In a letter Tuesday to the House Public Education Committee, TMA raised the same concerns with Senate Bill 347 by Senator Paxton that it has with similar legislation.

Under SB 347, SHACs would be considered a “governmental body” and be subject to open records laws. As TMA’s letter notes, volunteer SHAC members may be required to “open their personal communication devices, messages, email, and other correspondence to public view.” As it did last week with a SHAC bill by Representative Klick, TMA recommended instead emulating the current language in Senate Bill 442 by Sen. Bryan Hughes (R-Mineola). That measure still requires transparency from SHACs without subjecting them to open meetings or public information laws, decreasing the chance that volunteers will be apprehensive about joining the councils. SB 442 has passed the Senate and is now pending in House Public Health.

Last Updated On

May 04, 2021

Originally Published On

May 04, 2021

Joey Berlin

Associate Editor

(512) 370-1393
JoeyBerlinSQ

Joey Berlin is associate editor of Texas Medicine. His previous work includes stints as a reporter and editor for various newspapers and publishing companies, and he’s covered everything from hard news to sports to workers’ compensation. Joey grew up in the Kansas City area and attended the University of Kansas. He lives in Austin.

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