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LEGISLATIVE
INTRODUCTION

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tion in the 2019 session. that our core principle has remained the same: Independent diagno-
Improving funding for the Texas Department of State Health sis and prescribing is the practice of medicine. Physicians can dele-
Services (DSHS) is at the top of the list, he says. DSHS’ budget will gate, but must supervise, because ultimately, they’re accountable.”
determine the state’s ability to handle public health priorities such As always, the House of Medicine will take a stand against any
as disease control and disaster response. That includes support for bill that seeks to grant medical practice authority to nonphysicians
bolstering the statewide child immunization program Texas Vac- of any profession.
cines for Children, and maintaining the state’s current vaccine ex-
emption requirements in schools and other facilities. Sunset and TMB (again)
On vaccine exemptions, Dr. Lakey said, “It will be controver- Political wrangling left renewal of the Texas Medical Board
sial, but there will be conversations there. And I think there will (TMB) and the state’s Medical Practice Act up in the air at the end
be efforts [by anti-vaccine groups] to require child care centers of the 2017 regular session, prompting Gov. Greg Abbott to call a
to accept children who are not immunized, and I think there will special session. Fortunately, lawmakers averted medical anarchy in
be pushback.” Texas by reauthorizing TMB and the state’s medical law — but for
Aside from the DSHS budget, Dr. Lakey says, four key areas offer just two years, instead of the customary 12 that would’ve kept TMB
openings to improve public health: reducing maternal illness and on the standard cycle for Sunset Advisory Commission review.
death; increasing the age for purchasing tobacco to 21; reducing the That means it’s already time to renew TMB and keep the prac-
rate of obesity; and improving mental health services. tice of medicine properly regulated past its current expiration
One measure to watch will be Senate Bill 63 authored by Sen. date of Sept. 1, 2019. Medicine is hoping for a 10-year extension
Jane Nelson (R-Flower Mound), which is designed to expand mental this time to get the medical board’s review back on the standard
health care by creating a consortium of 12 of the state’s medical Sunset schedule.
schools and health science centers. As it has in recent years, medicine is asking for this year’s TMB
“It will better utilize the regional academic centers in solving the sunset bill to improve transparency and due process for physicians
mental health issues,” Dr. Lakey said. “As the chair of the Senate implicated in the board’s disciplinary process, which TMA believes
Finance [Committee], [Senator Nelson will] be in good position to has become less fair over time. TMA supports eliminating the
make sure that bill gets the funding it needs to get implemented.” board’s one-per-lifetime limit on remedial plans for physicians, as
In the TMA-supported drive to rebuild state hospitals, modern- well as making remedial plans more available for minor administra-
ization will be important, says Ms. Romero. tive violations.
“When they’re going to rebuild the state hospitals, they need to Also, TMA will again advocate for a TMB complaint process for
be built and planned where it’s not just the mental health that pa- physicians employed by 501(a) nonprofit health care organizations
tients are being treated for — that it’s also their physical health,” who want to fight back against improper corporate interference in
the TMA lobbyist said. For example, “We’ve heard Rusk [State Hos- the practice of medicine. A 2017 bill to that effect, SB 833, passed
pital] is … not meeting the needs of patients today. It was planned the Senate but died in the House.
100 years ago, and so we need to look at how do you treat patients
in the modern hospital, give them modern care.” Making the PMP work
A mandate for physicians to check the state’s prescription drug
Scope of practice: They’ll be back monitoring program (PMP) looms later this year. TMA’s legislative
This is one fight that never stops. aim will be to make that mandate as burden-free as possible for
Every two years without fail, nonmedical professionals back bills physicians.
that would allow them to play doctor — that is, expanding their As things stand now, starting on Sept. 1, prescribers will be re-
scope of practice beyond their training and expertise. quired to check the PMP before writing any prescription for opioids,
One reliable source of such legislation: Advance practice regis- benzodiazepines, barbiturates, or carisoprodol. But at TexMed 2018,
tered nurses (APRNs), who have consistently but unsuccessfully TMA’s House of Delegates adopted policy to advocate for initially
pressed for independent prescribing authority in recent sessions. limiting the mandate to Schedule II drugs. TMA will work to con-
TMA lobbyist Dan Finch expects this year to be no different. vince lawmakers that’s a more sensible approach.
“The nurse practitioners will be back,” he said. “We’ve told them Medicine also is stressing the importance of integrating the state’s

14 San Antonio Medicine • February 2019