Prescribing Bill Log Jamed will not progress this year

Some bills on death watch at midpoint

By Jim Saunders

3/31/2010 © Health News Florida

The 2010 legislative session is halfway done. But for many lawmakers, health groups and lobbyists, that just highlights this painful point: Their favorite bills are in neverland.

As in, they never will make it through committees. And never make it into law.

The bills stuck in legislative limbo --- or, in some cases, on legislative death watches --- include controversial proposals such as giving new drug-prescribing powers to optometrists and advanced registered nurse practitioners. But they also include lower-profile bills aimed at preventing health problems or improving care, such as requiring bars and other businesses to post signs about fetal-alcohol syndrome.

House or Senate committees have not heard the bills, which is the crucial first step in getting legislation passed. That can spell doom at this point in the session, particularly as the House finishes many of its committee meetings.

"If a bill hasn't been heard by now, it's dead,'' said Republican Rep. Ed Homan, a Tampa orthopedic surgeon who is watching some of his bills die. "It's not stuck.''

As an example, Anna Small, a lobbyist for the Florida Nurses Association, said she doesn't think the nurse-practitioner prescribing bill will pass this year. The proposal, which is opposed by the Florida Medical Association, has not been heard in any House or Senate committees.

"I think it's too late in the session for it to move,'' Small said.

But another group backing the bill, the Florida Nurse Practitioner Network, isn't giving up. Its Internet site this week implored members to put pressure on House Health Care Regulation Policy Committee Chairman Nick Thompson, R-Fort Myers, to take up the bill, which would allow nurse practitioners to prescribe controlled substances.

"Gather your patients who have chronic medical issues, who have been unable to be successfully treated by a physician and have them contact Mr. Thompson's office IMMEDIATELY!!!'' a message on the Internet site said.

Hundreds of bills --- health or otherwise --- die at the end of each legislative session, with many never getting heard in committees. But with the 60-day session at its midpoint today, bills that have gone unheard in House committees especially are in jeopardy.

The House has a two-tier process for taking up most bills, with "policy" committees initially voting on issues and then passing them up to broader panels known as "councils.'' The policy committees largely stopped meeting last week.

The Senate has a different structure that allows its committees to continue hearing bills later in the legislative session. But even with that, some bills will never get taken up in Senate committees --- and those that do ultimately would need approval from the full House and Senate.

Thompson's Health Care Regulation Policy Committee has a logjam of bills. He pointed to time constraints and said he even had to pull one of his own bills off a committee agenda.

"We've used up every minute that was allotted to our committee on the bills we've had,'' Thompson said. "And there's always more bills that are filed than actually are able to be heard in the time that we have.''

But Richard Polangin, health-care policy director for the consumer group Florida PIRG, said a lack of time isn't the only issue holding back bills. He said House Republican leaders help decide which bills will be heard, which often leads to Democratic-sponsored bills not being considered. Also, he said special-interest groups can lobby to stop bills.

House leaders scheduled an extra meeting of Thompson's committee today, but only allotted 45 minutes to consider four bills.

Homan is sponsoring one of those bills, which would require insurance benefits for mental illnesses to be on par with benefits for physical illnesses. But even with the bill scheduled for the committee meeting, Homan said he didn't think it has a chance of going to the full House.

"They were throwing me a crumb (by adding it to the committee agenda),'' said Homan, chairman of the House Health & Family Services Policy Council.

A sample of the bills that have not been heard in committees reflects a wide range of issues.

For instance, the American Heart Association has supported a bill that would require local emergency-medical services agencies and hospitals to develop plans for treating heart-attack victims who suffer from blocked coronary arteries. The bill is aimed at getting patients to hospitals that are best equipped to care for such conditions.

Two other unheard bills, meanwhile, would lead to new nurse-staffing plans or requirements for hospitals, while another would create a statewide program targeting chronic obstructive pulmonary disease, which is often a result of smoking.

Homan and Sen. Mike Bennett, R-Bradenton, also have sponsored a proposal that would require businesses that sell alcohol to post signs warning about the dangers of fetal alcohol syndrome if pregnant women drink.

"That's probably not going to play,'' Bennett said.

Two of the most-controversial bills that appear in danger of dying are the proposals to give new prescribing powers to optometrists and advanced registered nurse practitioners. The optometrists bill passed a Senate committee but has not been heard in the House.

Bennett, who is sponsoring both bills, argues that taking steps such as allowing nurse practitioners to prescribe controlled substances would reduce Medicaid and health-insurance costs. But he said the Florida Medical Association, which represents physicians, is fighting to kill the bills.

"It's strictly a turf war,'' Bennett said.

But FMA leaders, during an interview earlier this month, said the proposals are patient-safety issues. As an example, they contrasted the training of opthalmologists and optometrists, who, under one of the bills, would be allowed to start prescribing some oral medications.

"If you want to practice medicine, you should go to medical school,'' said Tim Stapleton, the FMA's executive vice president.

--Capital Bureau Chief Jim Saunders can be reached at 850-228-0963 or by e-mail at jim.saunders@healthnewsflorida.org.