Director, Legislative Affairs
Deputy Director, Alabama Medical PAC (ALPAC)
Medical Association of the State of Alabama
Grassroots worked, and they can work again.
Alabama’s 2019 legislative session was one for the books. Never before have so many egregious scope of practice expansions been introduced in the same session, with bills to allow optometric surgery, to abolish the need for a medical diagnosis before PT and to abolish the physician oversight of CRNA-administered anesthesia, being but a few of the dangerous bills introduced.
Indeed, 2019 was the year of scope creep, and the Medical Association-led efforts to protect patients prevailed! But it was physician grassroots – doctors taking the time to contact legislators and work the halls of the Alabama State House alongside medicine’s lobbyists – that ultimately stopped these dangerous scope creep bills. Grassroots worked in 2019, and they can work again.
The optometry scope creep bill, SB 114, would have allowed optometrists to perform eye surgeries using scalpels and lasers and also to make injections into the eye. SB114 would also have given the Alabama Board of Optometry the sole power to define the scope of practice of optometry, not the Alabama Legislature as is currently the case. The bill did not come up for a final vote in committee.
The PT scope creep legislation – which would have abolished the physician referral requirement for physical therapy (SB 25/HB 50) – could have led to patients not receiving a proper medical diagnosis before beginning PT, possibly receiving unnecessary care or even delaying the receipt of appropriate care. The House bill wasn’t voted upon and the Senate bill failed on a 2-8 vote in committee.
The CRNA scope creep bill – which would abolished physician oversight of CRNA-administered anesthesia (SB 156) also could have opened the door to CRNA prescribing with no physician oversight. The bill did not come up for a vote in committee. Other scope creep legislation dealing with podiatrists and imaging techs also failed to pass this session due to the work of the Medical Association to prevent lowering standards for care delivery. But most importantly, patients were protected due to the efforts of physicians statewide contacting their legislators in opposition to scope creep legislation.
Unfortunately, these scope creep bills will all return in 2020, but grassroots worked this session, and they can work again. The power of grassroots contacts – when public officials hear directly from their constituents on an issue – is unparalleled in its effectiveness, the reason being public officials have to keep their eyes and ears open to the electorate if they want any hope of being reelected. A voice here and a voice there communicating different messages is not near as impactful as many voices speaking as one – grassroots, when done right, are more influential than any lobbyist or special interest; and that’s exactly what happened this session on the scope creep bills.
Working together, the Medical Association and the entire medical community in Alabama increased the volume so significantly that hearing medicine’s unified, singular message to reject the scope creep bills was unavoidable to lawmakers. This resulted in dangerous bills being stopped, due in large part to the individual outreach efforts of Alabama physicians.
But the fight against lowering standards for care delivery in Alabama isn’t over and to remain successful, physician grassroots will be key. It’s no secret that in the legislative arena, coalitions and consensus get things done, and the Medical Association track record of success, by working with specialties like ALACEP, is proof positive. The scope creep bills will be reintroduced next year, and it’s a safe bet their proponents are at present mobilizing their own grassroots efforts ahead of next year. The time for medicine to prepare is now.
Between now and the start of the 2020 Legislative Session in early February, physicians should speak with their local legislators about these bills, because no one else will. Beyond the Medical Association and its allied specialties, patients have no other advocates working to protect them from harmful legislation in Montgomery.
As well, and contrary to popular belief, most legislators actually do want to hear from their constituents. So with no one else advocating for patients and most legislators eager to hear from constituents, there is no excuse for not engaging in grassroots on these important issues. Remember, while grassroots worked this year, and they can work again, they aren’t a “one and done” effort. Grassroots must continue so lawmakers fully understand the legislation before them and know how their constituents – i.e., the medical community – feels about the issues.
Working together, physicians can continue to protect patients and advocate for sound state health policies that place safety and quality first, so long as the medical community remains involved. Connecting with local legislators is easy, and the Medical Association can help; simply send an email to Nico Corley.