The 2023 Regular Session was the first regular session of the quadrennium (four-year election cycle) that
commenced new leadership in the House and also brought in 36 newly elected freshmen to the Legislator. With all the new faces in the Legislature, a new set of challenges presented itself to the Medical Association while the Association again saw roughly 20 percent of bills and resolutions filed during the 2023 Regular Session relating to health care.
Without the Medical Association’s work during the 2023 Session, none of the progress seen in medicine
this year would have occurred and many problematic bills for physicians and bills dangerous to patients
could have become law.
Moving Medicine Forward in 2023
While preventing dangerous and problematic proposals from becoming law consumes much of the Association’s advocacy efforts, at the same time the Association is trying to move medicine forward each session. The Association set out in the 2023 Session to address the physician shortage in Alabama and was successful with the passage of the Physician Workforce Act as well as securing funding for residency slots in Alabama. This was the first step in building back the physician workforce in Alabama and the Association will continue to focus on legislation and secure funding to increase the number of physicians that practice in Alabama.
Without the Medical Association . . . addressing the physician shortage with the passage of the Physician Workforce Act would not have become law. With “initiatives to grow Alabama’s workforce” as one of the Medical Association’s top priorities as outlined in its 2023 Advocacy Agenda, the Association passed legislation to help address the growing physician shortage in Alabama. Sponsored by Rep. Paul Lee in the House and Sen. April Weaver in the Senate, the “Physician Workforce Act” (PWA) is a multi-stakeholder proactive effort to help confront today’s physician shortage and build tomorrow’s physician workforce. The Physician Workforce Act will cut red tape and remove unnecessary barriers by eliminating the SPEX exam that some out of state physicians are required to take before becoming licensed to practice in Alabama; better utilize Alabama’s existing physician workforce by allowing IMG’s to gain full medical licensure after 2 years of residency and passage of the final licensure step instead of 3 years; and establishes an apprenticeship style program for medical school graduates who did not match in to residency that allows Medical School graduates to work under the direct supervision of a physicians under a 1-year permit as they reapply for residency the next year.
Without the Medical Association . . . state funded residency slots would not have been a reality. Championed by Sen. Tim Melson, M.D. (R-Florence) and supported by the Association, for the first time ever, the legislature funded medical residency slots to recruit and retain more physicians to Alabama – particularly to rural parts of the state. $800,000 will go toward five additional primary care residency slots with an emphasis on rural health care.
Without the Medical Association . . . student athletes would not have needed physician clearance to return to play after suspicion of cardiac issues. Championed by Rep. Jeremy Gray (D-Auburn) and supported by the Medical Association, the Alabama Chapter, American College of Cardiology, and the Alabama Chapter, American Academy of Pediatrics, the Sudden Cardiac Arrest Prevention Act requires the State Board of Education to adopt certain guidelines to inform and educate student athletes, parents, and coaches about the signs and symptoms of sudden cardiac arrest. The Association worked with Rep. Gray and others to revise the bill to make it more in line with Alabama’s highly-successful concussion law. A specific provision requested by the Association and included in the amended bill prohibits a student athlete from returning to play without being examined and okayed by a licensed physician.
Without the Medical Association . . . the Maternal Mortality Review Committee (MMRC) may not have received vital funding for the third year in a row. In 2019, the Association spearheaded a coalition of stakeholders – which included March of Dimes, the American College of Obstetricians and Gynecologists, the American Academy of Pediatrics, and Johnson & Johnson – to bring awareness to the issue of increasing maternal mortality rates in Alabama and spotlight the impact this committee could have to reverse that trend if properly staffed and resourced. As she did in 2022, Gov. Ivey again supported funding for the MMRC in her initial 2023 budget request and legislators maintained that funding in the final budget. Continued funding for this committee is critical to identifying causes for high maternal mortality and crafting solutions.
Without the Medical Association . . . extending postpartum coverage for women on Medicaid from 60 days to 12 months postpartum may not have continued. One of the Association’s top priorities from the previous year, MASA worked closely with the Ivey Administration, legislators, the Alabama Medicaid Agency, and the Cover Alabama Coalition to secure funding for the 12-month Medicaid postpartum program. The Association partnered with a coalition of stakeholders – including March of Dimes, the American College of Obstetricians and Gynecologists, and the American Academy of Pediatrics – and highlighted the findings from the Maternal Mortality Review Committee (MMRC) that funds allocated to extend postpartum coverage could positively impact 30,000 women and improve maternal health outcomes in Alabama.
Without the Medical Association . . . the Board of Medical Scholarship Awards may not have maintained its funding. Gov. Ivey again recommended maintaining the additional $500,000 increase for the BMSA initially put in place in 2021. The Legislature agreed, and the total amount for physician student-loans for 2024 remains at $1.9 million, allowing roughly 10 medical school tuition loans to be granted annually to physicians willing to set up practice in medically underserved areas of Alabama. This program remains one of the best mechanisms for expanding access to quality, physician-led care.
Without the Medical Association . . . an agreed upon bill with the Board of Social Workers that expanded social workers’ scope of practice would not have become law. The Association worked with Rep. Frances Holk-Jones (R-Foley) and social work advocates to provide for an appropriate and needed update to the scope of practice of licensed clinical social workers to include the authority to diagnose and develop treatment plans, with certain and appropriate limitations. The law will not allow social workers to administer and interpret tests, admit individuals to hospitals, treat any individual in a hospital setting without medical supervision, prescribe medication, authorize clinical laboratory procedures or radiology procedures, and use of electroconvulsive therapy.
Without the Medical Association . . . a preceptor income tax for medical students that train in rural and underserved areas may not have passed. Championed by Rep. Neil Rafferty (D-Birmingham) and supported by the Association, the bill – which passed on the last day of Session – would allow, beginning in the 2024 tax year, a community-based physician shall be allowed a credit of $500 per rotation and up to an annual maximum of $6,000 for each medical, advanced practice nurse or physician or anesthesia assistance assistant he or she percepts.
Without the Medical Association . . . momentum to update the rural physician tax credit would not have passed in Committee for the first time. Although the rural physician tax credit – sponsored by Rep. Ed Oliver (R-Dadeville) and Sen. Robert Stewart (D-Selma) – did not get updated in the 2023 Regular Session, conversations with key stakeholders continue to take shape. Much has changed since 1993 and updating the $5000 tax credit will make it more readily accessible to rural physicians by redefining what is considered rural in Alabama and also eliminating the need for hospital admitting privileges language from the current law. This bill did not pass, but the Association will file the rural physician tax credit legislation again in 2024.
Fighting “Scope Creep” (The Replacing of Education with Legislation)
Many would like to be a physician, but few are willing to endure medical school, residency, and all the other various education and training requirements to become an M.D. or D.O. Instead of pursuing higher education, some non-physician organizations pursue legislative changes as an end-around-means to practice medicine, endangering quality care for patients.
Without the Medical Association . . . optometrists could have begun performing eye surgeries using scalpels and lasers on and around the eye. The legislation would have allowed optometrists, who are not trained surgeons, to perform eye and surrounding tissue surgeries. In the House, the bill passed out of the body, but ultimately failed in the Senate Health Committee. The Association partnered with the Alabama Academy of Eye Physicians and Surgeons, the Alabama Dermatology Society, the Alabama Society of Plastic & Reconstructive Surgery, and others on the issue.
Without the Medical Association . . . pharmacists could have been granted the ability to begin prescribing. Under current law, pharmacists may administer any vaccinations, but may not prescribe them. The proposed legislation would have allowed pharmacists to prescribe essentially any vaccine, clearly a slippery slope that blurs the lines between medicine and pharmacy. The Association worked with the Alabama Chapter of the American Academy of Pediatrics, the Alabama Academy of Family Physicians, and the Alabama Chapter of the American College of Physicians on the legislation. Pharmacy interests bringing the bill stated the goal of the legislation was to increase access to vaccines. Working toward that goal, medicine offered several alternatives to the original bill language which would have met that goal but all of those were rejected by pharmacy interests. The bill passed out of the House Health Committee but stalled thereafter.
Without the Medical Association . . . a diagnosis would not be needed before a physical therapist could begin treatment on a patient. Keeping in place the need for a diagnosis ensures patients receive therapy when appropriate but not unnecessarily. Collaboration and coordinated care between a physician and physical therapists are best for the patient in developing comprehensive treatment plans. Language from the bill that was filed this past session would have ensured this and was an agreed upon bill from 2021. However, physical therapists rejected the compromised legislation this year and the Association expects to see a more expansive PT scope creep bill in the future. The Association partnered with the Alabama Orthopaedic Society and others on the bill. This bill did not pass.
Without the Medical Association . . . lay midwives could have become de facto pediatricians via legislation to allow them to care for newborns for 6 weeks postpartum. This bill did not pass.
Without the Medical Association . . . the podiatric ankle surgery bill which passed would have allowed podiatrists to perform total ankle replacements and administer general anesthesia. The new law allows a podiatrist with 3 years of podiatric residency training (now podiatry’s national standard) to perform surgery on the ankle, in addition to the aforementioned items, it also limits podiatrists’ amputations to below the Chopart joint.
Beating Back the Lawsuit Industry
Plaintiff lawyers are constantly seeking new opportunities to sue physicians. As well as stopping growth of frivolous medical liability suits, the Association must also be vigilant regarding physicians’ inadvertent exposure to new criminal laws, especially with regard to controlled substances.
Without the Medical Association . . . physician and physician offices would have been held liable for more specific regulations with regards to discrimination against a disabled individual from being considered on an organ transplant list because of the disability. Legislation that the Medical Association did not have issue with on its face, created a dynamic where punitive monetary damages could be pursued in Alabama courts if a “covered entity” did not provide “reasonable accommodations” to people with disabilities. The Association worked with the bill’s sponsor and removed the ability of trial to pursue frivolous lawsuits opportunities and added expedited injunctive relief language to the bill for a person that has been discriminated against. This bill became law.
Without the Medical Association . . . physicians could have been held liable in various proposed new causes of action, including related to employer issues, practice organization and staffing, vaccinations, various patient care scenarios, etc. The Association was able to resolve all of these issues.
Without the Medical Association . . . administration of anesthesia to a first responder for a medical procedure could have unintentionally been made a crime. The legislation was aimed at criminalizing the act of exposing a first responder to fentanyl, but as plainly written, it would have created issues for physicians caring for first responders as their patients. Once medicine’s issue was explained, thankfully, the bill sponsor – Rep. Matt Simpson (R-Spanish Fort) worked with the Association to ensure physicians caring for first responders were protected in the version of the bill that became law.
Without the Medical Association . . . a physician could have unintentionally been held liable for manslaughter if his or her patient overdosed on a controlled substance. The legislation was first filed several years ago targeting illegal drug sales and the Association worked with bill sponsor Rep. Chris Pringle (R-Springhill) at that point to ensure physicians were protected for any lawfully prescribed controlled substances. The Association’s proposed language has been included in each version of Rep. Pringle’s bill since, and the Association appreciates Rep. Pringle for working with medicine on that issue. The bill passed this year, but an inadvertent technical computer error will need addressing via future amendment at some point.
Other Health Related Legislation of Interest
Hospital Visitation Bill. Ensures visitation rights for hospital and nursing home patients designated “essential caregivers.” The bill was created in response to the restrictions on visitation during the COVID19 pandemic. It would repeal existing law on hospital visitation policies and require hospitals and other health care facilities to adopt new visitation policies. The bill allows the essential caregiver designated by the patient to visit at least two hours a day in addition to any other visitation policies allowed by the facility. The patient could also pick one different essential caregiver for each day. If a patient is unable to appoint an essential caregiver due to their condition, a family member could appoint one for them. This legislation has become law.
Vaccine-related lawsuits. Targeting employers including physician and medical practices, the bill could have created lawsuit opportunities over the COVID-19 vaccine. The bill did not pass.
State Health Officer. Would have allowed the Governor to appoint the State Health Officer and remove any ability for medicine to vet the State Health Officer. This bill would prohibit an emergency rule, or order issued by the State Health Officer that would restrict the conduct of private citizens or businesses from taking effect unless approved by the Governor and a copy filed with the Office of the Secretary of State. A floor substitute was adopted on the Senate floor that would allow the Governor to appoint the State Health Officer from a list of names provided by the State Committee of Public Health. This bill did not pass.
Scope of Practice Review Commission. Establishes the Health Professional Scope of Practice Review Commission to review and make recommendations to the Legislature regarding legislation revising or creating scope of practice laws for health professions. The Association opposes the legislation as currently drafted. This bill did not pass.