Two doctors in the House clash openly over health care policy
Disagreement between two doctors in the Florida House over health policy flared up Tuesday, derailing a bill that would expand pharmacists’ role in health care.
The House Health Quality subcommittee was considering a proposal (H.B. 527) by Rep. Ed Narain, D-Tampa, to let pharmacists inject prescribed medications if instructed by a doctor. It had been put on the agenda by the committee’s chairman, Rep. Cary Pigman, R-Avon Park, an emergency room doctor who serves rural patients.
Rep. Julio Gonzalez, R-Venice, an orthopedic surgeon, is not much of a fan.
Gonzalez started asking pointed questions of Narain — incidentally, not a doctor — about what kinds of injections he believed pharmacists should be allowed to give patients. Other issues cropped up: what the nature of a pharmacist’s relationship with a doctor should be, whether the bill was appropriate at all.
Several times, Pigman stopped the meeting so lawmakers could quickly write proposed amendments and discuss them with one another, an unusual scene in the state Capitol, where lawmakers’ votes are courted by advocates and lobbyists and where few bills are offered up for a hearing without a majority of committee members ready to vote in favor.
After about an hour, the committee was ready to vote, and Pigman sounded exasperated as he made a plea.
“If we had physicians to see patients, we wouldn’t be here today,” he said. “We wouldn’t be talking about legislation.”
But Gonzalez prevailed, at least in preventing a vote Tuesday, and the bill has been postponed. Pigman later tweeted that "we'll bring it back," a sign that behind-the-scenes negotiations will likely take place to make the bill something a majority of committee members will support.
It’s not the first sign of disagreement between Gonzalez and Pigman, two of just three doctors in the Florida House. Gonzalez and Rep. Fred Costello, R-Ormond Beach, laid out a health care plan in October, which Gonzalez described to the Times/Herald as an eight-year road map for what he would like to see accomplished in the world of health policy during his time in the House.
The plan would in part have adopted some of the free-market proposals being pushed by Republican leadership, some of which Pigman has sponsored. But Gonzalez and Costello proposed to do so in a way that would protect doctors, for example by limiting telemedicine to only physicians licensed in Florida or permitting advanced registered nurse practitioners to prescribe medicine but only allow it under the direct supervision of a doctor.
At the time, here’s what Pigman — who had only started reading the 29-page missive — said: “It just too much sounds like an effort to protect one professional class. I would submit to you that physicians are doing perfectly fine.”
By the end of Tuesday’s Health Quality subcommittee, the physicians may have been doing fine, but they were terse.
Pigman seemed frustrated as he defended a separate bill (H.B. 423), which he sponsored, to allow advanced registered nurse practitioners and physician’s assistants to prescribe medications.
“We are the only state, we are the only state in the United States of America that does not have controlled substance prescriptive authority for those professionals,” he said. “We’ve got to ask ourselves why is that? Why? We’ve got to be honest with ourselves.”
Gonzalez had taken him to task, asking if Pigman had any plans to expand the full ability to practice medicine to ARNPs and PAs. Pigman said he didn’t believe it was germane to the proposal they were considering, that he was “certainly anxious to consider anything like that” and that he didn’t think “this is the venue to discuss proposed bills with you that are not published at this time.”
Pigman got his prescription bill through — and Gonzalez voted for it.