Health Care Highlights Is Published Weekly During Legislative Sessions and Monthly During

MONDAY, FEBRUARY 22, 2010 VOLUME 22 ISSUE 6

Welcome to the sixth issue of Health Care Highlights in 2010. This marks the 22nd anniversary of our unique health care publication. Our newsletter reaches more than 2,500 health professionals and health policymakers. We are glad to have you in our subscriber communications network! Subscription information and rates for non-subscribers are available by calling 304-344-8466 or by e-mail to . Please respect the publication’s privacy rights as other use of the newsletter’s material is protected by copyright and requires written permission from the editor.

Health Care Highlights is published weekly during legislative sessions and monthly during the periods in between sessions. In addition, we will provide news coverage on any additional special legislative sessions, should they be called, and should health care issues be discussed.

Health Care Highlights provides a special focus on health topics of interest, legislative health deliberations, and a special section featuring the history and status of all health care bills introduced in the West Virginia State Senate and the House of Delegates throughout legislative sessions and during interim periods. As in past years, we follow issues relating to patient advocacy; hospice services and end-of-life decisions; organ and tissue donation and education; diabetes health treatment; medical practice issues; behavioral health initiatives; child health care services; hospital topics; health care delivery systems; pharmaceutical availability; insurance; health care management; preventive health and wellness programs; and public safety. These are the issues represented by the firm Government Relations Specialists, LLC, the publisher of Health Care Highlights.

Today is the 41st day of the 60-day second regular session of the 79th Legislature. Currently there are 1,301 House bills introduced, including 591 new bills and 710 carry-over bills from last session. The Senate is considering 630 bills. Of the 1,931 total bills introduced so far this session about 379 (20%) are health care related. Inside Health Care Highlights this week we provide a complete status listing of all health related bills. In addition, we report actions taken by legislative committees and other health care news items of general interest.

Key Legislative Dates

February 22 – Last day to introduce bills; does not apply to originating or supplementary appropriation bills or to resolutions.

(Senate Rule 14), (House Rule 91a)

February 28 – Bills due out of committees in house of origin to ensure three full days for reading.

March 3 – Last day to consider bill on 3rd reading in house of origin (except for budget or supplementary appropriation bills)

(Joint Rule 5b)

March 13 – Adjournment at midnight. (WV Const. Art. VI, §22)

Please feel free to contact us with any comments, suggestions or matters of interest.

OPINION:

ONLY EYE SURGEONS SHOULD PERFORM EYE SURGERY

Sunday Gazette-Mail

February 21, 2010
Stephen R. Powell, M.D.
CHARLESTON, W.Va.

Some of you may have seen the recent newspaper, radio and TV coverage of the "dispute" between optometrists and medical organizations at the Capitol.

The question for you is simple as well: Do you want someone who is not a licensed medical doctor and surgeon performing surgery on your eyes?

That's the issue. That's what this disagreement is all about. That's what's being considered in legislation (SB230).

Ophthalmologists across the state receive referrals from optometrists every day. The two professions work well together to provide a comprehensive range of care. Optometrists earn a bachelor's degree and then a doctorate in optometry. They examine eyes, prescribe glasses and have good general training. Optometrists refer patients to ophthalmologists for complicated medical procedures, surgeries and treatments.

Medical doctors trained in the practice of medicine and surgery earn a bachelor's degree and a doctorate, too. But then these physicians go on to internship and residency for another four years or 12,000 hours of supervised medical and surgical training. This includes the study of the human body and surgery, and how the body reacts to different medications and diseases, many of which affect the eyes. Then, and only then, have ophthalmologists earned the privilege of performing medical procedures on your eyes.

The bill now moving through the Legislature has certainly taken a twisted route. It started out dealing with rules for the Board of Optometry and -- at least as of this writing -- will permit optometrists to perform some eyelid surgeries, laser surgery in the eye, do injections around the eye, and order laboratory tests. These are not permitted in West Virginia now, and laser surgeries by optometrists are not permitted in 49 states.

So, what if something goes wrong? Are optometrists trained to prescribe medications that may affect blood pressure, or interfere with diabetes treatment?

Are optometrists trained to know how and when to adjust medications for patients with impaired kidney function? Have optometrists performed hundreds of surgeries under the watchful eye of experienced surgeons before being granted the privilege to cut on patients without supervision?

If laser surgery by optometrists is such a good idea, why did the Veterans Administration, after a five-year study, adopt a policy that only physicians trained in the practice of medicine and surgery of the eye can perform laser surgery on our nation's veterans and prohibit optometrists from doing so?

If this is such a good idea, why does the state chapter of AARP oppose it? And why do 20 medical organizations -- including the West Virginia Board of Medicine, the Hospital Association and the Medical Association -- oppose it?

Many senators and delegates are well-intentioned and approachable and have looked at these issues. They hear talk from all sides and are subjected to lots of political pressure. What we need now is for the public to tell them patient safety should come first.

It is the opinion of your medical doctors and surgeons that it's important for your own patient safety that you contact your legislators immediately and ask them to vote against SB 230, the "optometry surgery bill."

Simply put, it is bad medicine.

This OPINION was printed in the February 21, 2010 edition of the Sunday Gazette-Mail and authored by Stephen R. Powell, M.D., a Morgantown ophthalmologist and Past President of the West Virginia Academy of Ophthalmology. SB 230 is now a Committee Substitute as reported last week from the Senate Government Organization Committee. The bill was not referred to the Senate Health and Human Resources Committee as desired by many members of the Senate, including Chairman Roman Prezioso and Vice Chair Ron Stollings. The controversial bill is on amendment stage in the Senate today and will be up for passage or defeat on Tuesday.

Readers desiring to express an opinion on this bill may call the Legislature toll free: 1-877-565-3447

House Treads Gently Into Possibility of Hiking Cigarette Tax

If they can come up with a way to make it budget-neutral, it’s possible a bipartisan effort would tackle the high unhealthy smoking rate in West Virginia by moving the state’s cigarette tax closer to the national average. While no bill is yet before it (HB 2746 has been introduced but not taken up), the House and Health Human Resources Committee held an informal discussion about the possibility of increasing the West Virginia 55 cents-a-pack tax up to $1.34, the national average. Chuck Hamsher, speaking for the Coalition for a Tobacco Free West Virginia, says raising the price of cigarettes “is one of the most effective public health tools. Smokers are very responsive to price change,” he said, noting that young people often won’t start smoking if the price is too high. West Virginia has the second highest rate of smokers in the country, he said. The Select Interim Committee on Health recommended an increase in the tax as a way to reduce smoking and improve health. Some proposals would go as high as $1.50. Delegate Mitch Carmichael agreed “the overwhelming evidence is in single pack purchases,” and said he, and many of his fellow Republicans would consider supporting some increase if it should prove to be revenue neutral. That would require the increase in revenue from smokers who continue smoking and pay a higher tax to offset the reduction in revenue from those who quit smoking. Members agreed to continue their informal discussions and try to come to some consensus on what precisely constitutes “revenue neutral.”

Monday Hearing Set on Beer Tax That Would Fund Substance Abuse Programs

The House Health and Human Resources Committee has scheduled a public hearing for 5 p.m. this evening (Monday) in the House of Delegates Chamber to hear opinions on a proposed increase in West Virginia’s beer tax. The Healing Place, a planned substance abuse treatment facility in Huntington, plans to speak in favor of the bill in order to be able to apply for grants under the estimated $20+ million beer tax fund revenues. The tax, which has not been increased in nearly half-a-century – since 1966 – currently is 2 cents per can or bottle. One proposal (HB 2100) calls for increasing the tax to 5 cents per 12-ounce can or bottle. Technically, the tax would be assessed on barrels of beer, it was said during a wide-ranging discussion of the proposal last Wednesday. The tax proposal would be included in a “strike and insert” amendment that deals with creating the Prevention and Intervention Recovery Fund, which would fund programs relating to prevention, intervention, treatment and recovery from drug and alcohol abuse. A disbursement board would consider and award grants under supervision of the West Virginia State Supreme Court of Appeals, as drafted.

Steve Canterbury, administrator for the Supreme Court, said a major goal is to keep people from being sentenced to jail or prison for drug/alcohol abuse, and instead offer local prevention and treatment programs. The recidivism rate for persons incarcerated because of drug or alcohol abuse is 81%, he said, while the recidivism rate for those who use treatment centers is only 18%. If successful, this would represent a considerable cost savings for the state because of the high cost of incarcerating prisoners, he noted, while saying the Court had not taken an official position on the legislative proposals.

‘Stroke Center,’ Consent, Caseload Bills Advance in House

A bill that would help hospitals with grant-writing and planning for the treatment of stroke victims has been approved by the House Health and Human Resources Committee. HB 4415 next will be reviewed by the House Judiciary Committee. Chuck Hamsher, speaking for the American Heart Association, said, “The treatment of stroke has been spotty in the past and technology has changed; we want to develop an entire system of care statewide.” Stroke centers would be certified and would have to meet certain emergency, treatment, census and clinical practice standards. There are now three hospitals so designated in West Virginia. According to Hamsher, more could be added.

The Committee also advanced to the House Judiciary Committee HB 4499. The bill would change the age of consent for refusal of mental health treatment from 12 to 18. The bill also clarifies that the state is not obligated to pay for voluntary hospitalizations. The bill was amended to deal with “emancipated minors.”

HB 4419, which develops caseload standards for DHHR program areas, was approved by the committee as well, and now goes to the House Government Organization Committee. It requires the Secretary of the Department of Health and Human Resources to propose rules for legislative approval on or before June 30, 2010, to establish caseload standards for the program areas within the department. All caseload standards developed shall establish at a minimum the maximum level of staff to patient caseloads and the maximum level of staff to client caseloads. Caseload standards may use any professional caseload standard guidelines established by professional organizations as they are applicable to a program area if it does not exceed a maximum average threshold of the recognized applicable professional caseload standards for any program area.

West Virginia Keeps Watch on Nursing Shortage

The Martinsburg Journal is reporting that while WVU Hospitals-East will soon undergo a $28 million expansion which will allow it to handle 20,000 more patient visits a year, they are also paying attention to projections that the nation will face a shortage of registered nurses. The paper says West Virginia hasn’t been hit hard yet, but could experience an increased demand over the next decade. Teresa McCabe, vice president for marketing and development, said the hospital is looking to hire 20 to 25 new staff once the expansion is complete. “We’re always actively recruiting registered nurses for the positions because we would prefer having our own

staff versus using an agency staff that is usually more expensive, and they’re not always familiar with the facility,” she told The Journal. Duane Napier, executive director of the West Virginia Center for Nursing, is quoted as saying the average age for West Virginia RNs is around 45.

Nurses’ Board Would Launch Pilot Study on Medication Administration in Nursing Homes

Provisions of HB 4425 would authorize the Board of Registered Professional Nurses to develop a pilot program for unlicensed personnel to administer medications in a nursing home. The bill, the result of an interim study, was approved by the House Health and Human Resources Committee last week. It envisions a year-long study into whether unlicensed personnel, such as CNAs, could – under the supervision of registered nurses or LPNs – administer medications to patients in nursing homes. The development of a training program would be carried out in cooperation with the West Virginia Board of Practical Nurses and the West Virginia Health Care Association. The committee was told the board wanted authorization before proceeding with the study. Other states have implemented such programs, arguing that if medications are administered under the direction of professionals, it frees nurses up to perform other duties. Delegate Barbara “Bobbie” Hatfield noted some states have done this with limited medications. “This is just to study if it can be done safely in a limited way,” she said. Prior to implementation, the board would have to provide its plan to the Select Committee on Health for its consideration prior to the 2011 legislative session. The bill now goes to the Judiciary Committee.

‘End-of-Life,’ Diabetes Program Budget Cuts Continue to Cause Concerns

Delegate Linda Goode Phillips remains concerned about proposed DHHR budget cuts that would zero out the state’s End-of-Life program and reduce funding for diabetes programs and others. She questioned DHHR Cabinet Secretary Patsy Hardy during a courtesy appearance by Hardy before the House Health and Human Resources Committee last week. Phillips asked if the department was re-thinking the cuts since serious concerns had been expressed during a budget hearing before the House Finance Committee. Hardy repeated what she had said earlier – that the department saw the programs as duplicative. “We have not made any decisions to re-fund any of those,” she said. Delegate Barbara “Bobbie” Hatfield disagreed that the programs are duplicative. “They do a lot more; they are trying to educate the public. They have a program and this interrupts their plans. This will jeopardize a lot they are trying to do,” she said. The matter will eventually be addressed in the extended budget session which follows expiration of the Regular Session on March 13.