|| Amy Young-Governmental Consultant
Dr. Yelverton, incoming chair for our new ACOG District XII, and I returned in September from another weekend of camaraderie and roundtable discussions in Washington, DC with ACOG. This year there were almost seventy staff members, state legislative chairs, and lobbyists from throughout the country present. This was the largest attendance we have experienced in the several decades that ACOG has hosted this exciting event. ACOG’s long-term state legislative director, Kathryn Moore, continues to provide extensive educational materials in preparation of this high intensity and lively roundtable conference.
This year we discussed issues involving environmental health, maternal mortality surveillance and prevention, nurse and certified midwife scope of practice, tort reform, abortion rights as well as the impact of the federal Affordable Health Care Act on state reforms.
This event is always an education for us and an opportunity to share our successes in Florida—not only with our legislative agenda, but with our robust and exemplary grass-roots and fundraising efforts. Year after year, Florida remains the state that is the bellwether and model for others throughout our country with our FOGS PAC Leadership funds and our ability to effectively elect state leaders who are supportive of our issues. We are also the model that many states look to in their efforts to create their own birth injury funds. Unfortunately, so many states have unsuccessfully attempted to pass similar “No-tort” funds, but we continue to provide guidance and support to those who continue these efforts on an annual basis.
As you know, FOGS continues to be very active in the election process, but we can only continue to experience our success with your dedication to fund the Florida OB/GYN PAC. The Florida OB/GYN PAC is your specialty political action committee that works on your behalf to support candidates running for office that are pro-medicine and supportive of women’s health rights and issues, as well as supportive of our overall legislative agenda. Please be on the lookout for your Florida OB/GYN PAC renewal form that should arrive in the mail soon.
We were quite successful during the primary elections this August. We are thrilled to report that we had a 93% success rate, winning 30 out of 32 House primaries and 8 out of 9 Senate races. Unfortunately, you can’t win them all, but we came very close. The General Election proved even more successful with our choices, even in the many open seats that we took some risk in participating and supporting candidates based on their position on issues.
With the elections over, we are gearing up for the 2013 Legislative Session. The Organizational Session in Tallahassee is scheduled for Tuesday, November 20th and committee hearings start the week of December 3rd. Much of our agenda hinges on who will be House and Senate Committee chairmen and committee members, which should be decided in a few weeks.
Thank you in advance for your generous contributions!!
Calendar of Important Upcoming Dates:
November 20, 2012 State Legislative Organizational Session
INTERIM COMMITTEE SCHEDULE:
December 3-7, 2012
January 14-18, 2013
January 21-25, 2013
February 4-8, 2013
February 11-15, 2013
February 18-22, 2013
March 5, 2013 Regular Session convenes
May 3, 2013 60th day—last day of Regular Session
2012 Legislation Session Recap-Successes
The Florida Legislature finally adjourned “Sine Die” a few moments past midnight on Friday, March 9, 2012. Hands down, this was the most active Session we have had in a very long time. Unfortunately, I believe we can expect the future to bring on continued assaults on NICA, abortion, reimbursement rates, price transparency as well as many other issues.
SUMMARY OF LEGISLATION
One piece of legislation particularly affecting FOGS members was ultimately passed. This legislation was never heard in a House committee (HB 1371), however it was amended on to a comprehensive Department of Health bill at the very end of Session. The new law contains the following provisions regarding prenatal testing:
383.141 Prenatally diagnosed conditions; patient to be provided information; definitions; information clearinghouse; advisory council.—
(1) As used in this section, the term:
(a) "Down syndrome" means a chromosomal disorder caused by an error in cell division which results in the presence of an extra whole or partial copy of chromosome 21.
(b) "Developmental disability" includes Down syndrome and other developmental disabilities defined by s. 393.063(9).
(c) "Health care provider" means a physician licensed under chapter 458 or chapter 459.
(d) "Prenatally diagnosed condition" means an adverse fetal health condition identified by prenatal testing.
(e) "Prenatal test" or "prenatal testing" means a diagnostic procedure or screening procedure performed on a pregnant woman or her unborn offspring to obtain information about her offspring's health or development.
(2) When a developmental disability is diagnosed based on the results of a prenatal test, the health care provider who ordered the prenatal test, or his or her designee, shall provide the patient with current information about the nature of the developmental disability, the accuracy of the prenatal test, and resources for obtaining relevant support services, including hotlines, resource centers, and information clearinghouses related to Down syndrome or other prenatally diagnosed developmental disabilities; support programs for parents and families; and developmental evaluation and intervention services under s. 391.303. 2986
(3) The Department of Health shall establish on its Internet website, a clearinghouse of information related to developmental disabilities concerning providers of supportive services, information hotlines specific to Down syndrome and other prenatally diagnosed developmental disabilities, resource centers, educational programs, other support programs for parents and families, and developmental evaluation and intervention services under s. 391.303. Such information shall be made available to health care providers for use in counseling pregnant women whose unborn children have been prenatally diagnosed with developmental disabilities.
(a) There is established an advisory council within the Department of Health which consists of health care providers and caregivers who perform health care services for persons who have developmental disabilities, including Down syndrome and autism.
We will be working closely with the DOH on their efforts to implement this provision over the summer months. The bill becomes effective upon “becoming law.” (As soon as the Governor signs the bill.)
Of utmost importance were two bills that put our valuable NICA program at risk. The first piece of legislation, HB 4127, was filed by Representative Mat Gaetz (R-Shallimar), who is the son of Senate President-elect Don Gaetz (R- Destin). This legislation would have repealed the general physician assessment of $250 annually which is currently tied to licensure. As all of you realize, this funding source is essential to the success of NICA solvency and would completely gut the program. I met with Representative Gaetz as soon as the bill was filed and he committed to work with us over the summer months to allay some of his concerns regarding the funding of the NICA program. We were successful in defeating attempts to hear this bill in any committee this Session.
Another adversarial bill was filed by Senator Rhonda Storms (R-Brandon). SB 1582 would have changed the membership of the NICA Board and, among other things, include a member of the Florida Bar. We were adamantly opposed to this legislation and convinced the Chair of the Senate Health Regulation committee to refuse to hold a hearing on the bill.
I also met with CFO Jeff Atwater, who oversees NICA, and he continues to assure us that he is in full support of the Program. Dr. Yelverton and NICA Executive Director Kenney Shipley and I also took some time to educate the CFO’s chief of staff on the effectiveness of the program at a meeting in Tallahassee in February.
We will undoubtedly be facing these issues again during the 2013 Legislative Session and will continue to educate new and veteran legislators regarding the importance of NICA throughout the campaign season!
Republican legislators pushed all Session for an omnibus anti-abortion measure that revived some of the most controversial portions of proposals left out of a package of anti-abortion bills passed last year and signed into law by Governor Rick Scott.
As expected, the House overwhelmingly passed the measure that would have, among other things, imposed a 24-hour wait period before women can receive abortions, require that clinics be wholly owned and operated by doctors whose residency was in abortion procedures, bar clinics from advertising that they perform abortions, and make it even more difficult for women to get already-banned and extremely rare third-trimester abortions.
The bill would have also required abortion doctors to take three hours of ethics courses each year.
The Senate ultimately killed the measure on a procedural vote prohibiting it from being withdrawn from the remaining committees of reference on a 26 to 13 vote. (The Senate rules require a 2/3rds vote to withdraw legislation from committee.)
Of special interest was the House analysis of the issue of fetal pain as published in the legal comments:
The concept of fetal pain and the capacity of the fetus to recognize pain are the subjects of both ongoing research and significant debate. There are studies that suggest that a fetus may have the physical structures to be capable to feel pain by the gestational age of between 20-24 weeks. This research crystallizes around the connection of nociceptors (the central nervous system’s pain messengers) in the extremities of the fetal body to the central nervous system. In support of these claims, researchers have made the following observations:
That the fetus reacts to noxious stimuli in the womb with what would appear to be a recoil response in an adult or child,
There is an increase in stress hormones in the fetus in response to noxious stimuli, and
Fetal anesthesia may be administered to a fetus that is undergoing surgery in the womb, which may result in a decrease in fetal stress hormones.
However, there is also research to suggest that despite the presence of such a physical structure within the fetus, it still lacks the capacity to recognize pain. In a 2005 review of the evidence, the American Medical Association concluded that: pain is an emotional and psychological response that requires conscious recognition of a stimulus. Consequently, the capacity for conscious perception of pain can only arise after the thalamocortical pathways begin to function, which may occur in the third trimester around 29-30 weeks gestational age.”
In a 2010 review of research and recommendations for practice, the Royal College of Obstetricians and Gynecologists of the United Kingdom, noted the following in relation to fetal awareness: Connections from the periphery to the cortex are not intact before 24 weeks of gestation. Most pain neuroscientists believe that the cortex is necessary for pain perception; cortical activation correlates strongly with pain experience and an absence of cortical activity generally indicate an absence of pain experience. The lack of cortical connections before 24 weeks, therefore, implies that pain is not possible until after 24 weeks. Even after 24 weeks, there is continuing development and elaboration of intracortical networks.
We defeated the proposal which would have mandated signage with a menu of prices for your services as well as a prohibition on balance billing! As you recall, this legislation was passed last year. However, we were able to explicitly exempt Ob/Gyns. We know that this will be an annual battle to kill this legislation which would mandate a fifteen foot sign in your office lobby listing the cost of the top fifty procedures that you provide.
Newborn Task Force
Dr. Yelverton was appointed to a Newborn Task Force to study Prescription Drug Abuse and the impact on neonatal withdrawal syndrome. The legislation passed this Session requires the Task Force to report the findings to the Florida Legislature by January 15, 2012.
We fully supported the efforts of Senator Detert (R-Venice) to pass SB 598 which would mandate contraceptive coverage. Unfortunately, there was no House companion to this legislation, and therefore the bill was ultimately withdrawn from further consideration.
HB 1051 by Representative VanZant (R-Palatka) would have required the Department of Health to adopt rules adding HPV to the list of communicable diseases for which immunizations are recommended. Unfortunately, this bill had four committee references in the House and never had a hearing. Senator Thad Altman R-Melbourne) had the companion bill (SB 1116) which only received one committee hearing.
Members will be kept apprised of legislative news throughout the 2013 session here on the District XII website, via email and through the District newsletter-ACOG District XII Florida Update.