The Journal of the Arkansas Medical Society Med Journal June 2019 Final - Page 6

by CASEY L. PENN The Good with the Bad Looking Back on a Difficult Legislative Session “ T his was probably the most challenging legislative session faced by the Arkansas Medical Society, at least in my 35-year career,” began AMS Executive Director David Wroten, from the conference room of the Society’s Little Rock office. Having come from months of daily work at the Capitol, Wroten and AMS Govern- mental Affairs Director Scott Smith sat down to reflect on the high and low points of the 92nd Arkansas General Assembly. CP: Before we get into the bills themselves, talk to me about what made this such a dif- ficult session. DW: As for the why, I think there were several factors. Some of it had to do with a shakeup in committees – particularly in the House, where leg- islators didn’t know what committees they would be on until the first day of the session. In the Sen- ate, six members of the Senate Public Health Com- mittee were replaced. SS: In addition, due to a new rule, you didn’t have to worry about a bill-filing deadline, so you had bills coming in at the last minute. Also, the sheer volume of scope-of-practice bills was higher than normal. We started off with five APRN bills, two CRNA bills, three pharmacy bills, telemedicine bills, and more. CP: Despite notable wins – AMS-initiated legislation being passed into law – there were some disappointing losses – particu- larly in the realm of scope-of-practice. Could you provide a summary of what took place on that front? DW: Let’s start with the bad news first. The op- tometry bill (HB 1251/Act 579/Jon Banks-R, David Wallace-R) was a hard-fought battle that we lost. Highly publicized, this legislation will allow optom- etrists to perform certain surgical procedures. SS: The opposition presented the bill as if it would only allow optometrists to perform a few basic procedures. In fact, the way it was written, it could allow over 100 procedures including the one most publicized, laser eye surgery. DW: It’s worth noting that the optometrists had been working on the bill for more than a year. They made massive campaign contribu- tions leading up to the session. This was part of a nationwide effort by the American Optometric Association to push this legislation into states. Arkansas was a target because Louisiana, Okla- homa, and Kentucky all allow similar procedures to what was passed in Arkansas. CP: Does the public understand the differ- ence in training between an optometrist and an ophthalmologist? SS: I’m not sure, but we certainly point out that difference to legislators. After college, oph- thalmologists have four years of medical school, one year of internship, and a minimum of three years of in-depth ophthalmology residency. DW: There’s no comparison in the training. Also, during the battle, we commissioned a pub- lic opinion survey and found that an overwhelm- ing majority of the public thought this bill was a bad idea. CP: One of the arguments for the bill had to do with access. Could you speak to that? DW: It’s a common argument. The propo- nents of this type of legislation argue that this will increase access, yet legislation has never required proof. There is no evidence that other states that have adopted these types of scope- of-practice laws have seen an increase in ac- cess. In reality, in states that have done some of these things, the evidence is that they do not increase access. 270 • THE JOURNAL OF THE ARKANSAS MEDICAL SOCIETY CP: What about some of the other scope-of- practice bills? DW: We lost the optometry battle, but we had some wins on the APRN side. This APRN bill (HB 1267/Act 593/Justin Gonzales-R, Kim Hammer- R) will prove helpful to our members who utilize APRNs in their practices. First, this will allow APRNs to provide continuity of care once it has been initiat- ed by a physician for up to six months. For example, a physician has a patient with ADHD and starts him on medication. The APRN working for the physician would be authorized to write follow-up prescrip- tions for up to six months before the patient would need to be seen by the physician again. SS: This allows APRNs also to write a one-time, up-to-a-five-day prescription for opioids. This was a compromise that we offered, and as a result, we were able to pass that bill. CP: What happened on the pharmaceutical front? DW: An oral contraceptive bill (HB 1290/Aaron Pilkington-R, Barton Hester-R) would have allowed pharmacists to dispense oral contraceptives with- out a prescription. AMS opposed the bill because it did not have enough safeguards. That bill failed. SS: The nicotine replacement bill (HB 1263/Act 651/Les Eaves-R) would have allowed some phar- macists to dispense Chantix ® and other smoking- cessation prescription drugs. AMS was successful in amending that bill to limit it to smoking-replace- ment products such as nicotine gum. DW: An immunization bill (HB 1278/Act 652/ Jimmy Gazaway-R) allows pharmacists to give immunizations to 7-to-18-year-olds under a state- wide protocol. Currently, they can give immuniza- tions to this age group under a physician-patient- specific prescription. This only applies to three types of immunizations. AMS opposition to this bill was minimal, due in part to the fact that many phy- sicians’ offices have discontinued providing these immunizations. VOLUME 115