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Dr. Regina Benjamin: A Trailblazer in Medicine Honored with the Samuel Buford Word Award

Dr. Regina Benjamin: A Trailblazer in Medicine Honored with the Samuel Buford Word Award

In the realm of healthcare, the name Dr. Regina Benjamin resonates as a beacon of inspiration and change. As the first African American President of the Medical Association of the State of Alabama and the 18th Surgeon General of the United States, Dr. Benjamin’s illustrious career is marked by a profound commitment to service, advocacy, and addressing healthcare disparities. This year, she is set to be presented with the esteemed Samuel Buford Word Award at the Medical Association’s Annual Meeting.

Trailblazing Leadership

Dr. Regina Benjamin’s journey to becoming a trailblazer in the medical field began in Mobile, Alabama, where she was raised in an environment that valued community service and compassion. Her early exposure to the healthcare profession, through the stories of her grandfather’s dedicated service as a country doctor, ignited a passion that would shape her illustrious career.

After earning her medical degree from the University of Alabama at Birmingham, Dr. Benjamin returned to her hometown, establishing a clinic that catered to the needs of underserved communities. Her dedication to addressing healthcare disparities at the grassroots level earned her widespread recognition and paved the way for her ascent into leadership roles.

Surgeon General of the United States

In 2009, Dr. Regina Benjamin made history as the 18th Surgeon General of the United States, breaking barriers as the first African American woman to hold this prestigious position. During her tenure, Dr. Benjamin focused not only on traditional public health issues but also on the social determinants of health. Recognizing that health outcomes are influenced by factors beyond clinical care, she advocated for holistic approaches that addressed the root causes of disparities, including poverty, education, and access to essential resources.

Her leadership in the face of challenges, such as the H1N1 pandemic and the Deepwater Horizon oil spill, showcased her resilience and commitment to public health. Dr. Benjamin’s tenure as Surgeon General left an indelible mark, emphasizing the importance of preventive care, health promotion, and community engagement.

Samuel Buford Word Award: A Legacy of Service

This year, Dr. Regina Benjamin will be honored with the Samuel Buford Word Award at the Medical Association’s Annual Meeting. Established in 1971, the award is named in memory of Samuel Buford Word, M.D., a distinguished physician and former president of the Medical Association of the State of Alabama. The award recognizes individuals who have demonstrated exceptional service to humanity beyond the typical scope of medical practice, often at personal sacrifice.

As the highest honor presented by the Medical Association, the Word Award symbolizes a commitment to the values upheld by its namesake. Dr. Benjamin’s receipt of this award not only acknowledges her outstanding achievements in medicine but also underscores her profound dedication to service and the betterment of human health.

A Legacy of Service and Inspiration

Dr. Regina Benjamin’s journey from a community clinic in Mobile to the highest echelons of medical leadership is a testament to her unwavering commitment to service and advocacy. Her groundbreaking achievements have not only paved the way for future generations but have also significantly impacted the trajectory of healthcare in the United States.

As she prepares to receive the Samuel Buford Word Award, Dr. Benjamin’s legacy serves as a reminder that true leadership in medicine extends beyond clinical expertise—it encompasses a passion for equity, a commitment to service, and a tireless pursuit of a healthier and more just society. In honoring Dr. Regina Benjamin, the Medical Association celebrates not only an individual but a legacy that continues to inspire and shape the future of healthcare.

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The Potential Dangers of Semaglutide for Prescribers

The Potential Dangers of Semaglutide for Prescribers

By Angie C. Smith, Burr & Forman

Semagludtide, the drug contained in medications such as Wegovy, Ozempic, and Rybelsus, has received significant attention over the past few months as those medications have grown in popularity for weight loss.  Although most publicity and warnings of potential side effects are directed to those taking the medications, prescribers, and providers should also be mindful of the practitioner pitfalls associated with the drug. In fact, we are already seeing lawsuits being filed by patients claiming they were not properly warned about harsh side effects.

In September 2023, the Alabama Board of Medical Examiners (ABME) issued a press release titled “Concerns with Semaglutide and other GLP-1 Receptor Agonists.”  The press release states that there is mounting concern related to the prescribing and compounding of semaglutide and other glucagon-like peptide-1 receptor agonists.  With greater concerns typically comes greater scrutiny.  In the release, the ABME reminds providers that Wegovy is the only FDA-approved drug for obesity whereas the other medications are approved only for Type 2 Diabetes.  However, these drugs have seen increased off-label use for weight loss.   

Because of the potential for off-label use, the ABME also noted that prescribers should be mindful of the potential for “improper evaluation for and prescribing” of the drug.  Although off-label use may be appropriate, a practitioner must ensure that he/she has properly documented the medical necessity of the drug for a particular patient as well as obtaining informed consent from the patient.    Providers should also avoid accepting any type of remuneration or anything of value for prescribing these medications, regardless of whether the provider is billing a third party for services.    

Other concerns cited by ABME include the availability of semaglutide resulting in increased compounding of the drug.  Specifically, the ABME cautioned practitioners against improperly compounding drugs in physician offices or using “semaglutide salts” in compounding that do not meet federal requirements.  Not only did the ABME cite this as a concern, but the Alabama Pharmacy Association noted that the Alabama Board of Pharmacy (ALBOP) had received numerous inquiries related to compounding semaglutide, prompting the ABOP to comment on the appropriateness of such compounding.  According to the ABME press release, the ALBOP notified all pharmacies and pharmacists that if compounding, when permitted by law, “the use of semaglutide salts, the use of any non-pharmaceutical grade active pharmaceutical ingredient (API) or one not produced by an FDA-registered establishment, is prohibited.”  At the time of the press release, there were no compounding pharmacies in Alabama receiving pharmaceutical-grade API to compound semaglutide.   

In addition to state agencies weighing in, the FDA has also published information related to compounding semaglutide.  The Federal Food Drug and Cosmetic Act prohibits pharmacies from compounding drug products that are “essentially copies of a commercially available drug product.”  Additionally, compounded drugs are not FDA-approved.  However, when a drug is in shortage, compounders may be able to prepare a compounded version of the drug if the compounding pharmacy can meet certain requirements.  In May 2023, Ozempic and Wegovy were both listed on the FDA’s Drug Shortage list, and as of the writing of this article, some presentations of both drugs remained on the list as “limited availability” due to “demand increase for the drug.”  But just because the drug is listed on the shortage list does not give compounding pharmacies carte blanche.  The FDA noted that some compounding pharmacies were using salt forms of semaglutide, which have different active ingredients than those in the approved drugs, and it warned health care professionals that it is “not aware of any basis for compounding a drug using semaglutide salts that would meet federal requirements.”  The FDA also warned of potential counterfeit drugs.


As highlighted above, the prescribing and use of semaglutide has gained increased scrutiny from both state agencies and regulatory authorities, and health care professionals should be mindful of how this scrutiny may impact their practice.      

Angie Smith is a Partner at Burr & Forman LLP practicing exclusively in the firm’s Health Care Practice Group. Angie may be reached at (205) 458-5209 or

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2024 Advocacy Agenda

As the professional association for some 7,000 physicians of all specialties in Alabama, the
Medical Association of the State of Alabama exists to serve, lead, and unite physicians in
promoting the highest quality of healthcare for the people of Alabama through advocacy,
information, and education

General Policies Supported

The Medical Association supports the physician-led health team model and maintaining the highest standards for medical care delivery across all specialties of medicine.  The Association  supports prohibiting deceptive healthcare advertising and requiring health professionals identify their license to patients.

The Association supports physician autonomy in patient care and medical practice decisions, fair reimbursement for services and reducing the volume of administrative tasks required by insurers which increase annual health spending and negatively impact patient health.     

Further, the Association supports increasing health insurance options for Alabamians, including expanding Medicaid.  The Association supports increasing access to quality mental health care and continued state funding for the Maternal Mortality Review Committee and the Infant Mortality Review Committee.  Recognizing the long-term effects of social determinants of health on individuals, families and ultimately communities, the Association supports comprehensive solutions to addressing these challenges, with emphasis on pipeline programs, tax credits and loan forgiveness proposals benefitting rural and underserved areas.

Finally, by ensuring medical liability environment stability and pursuing further civil justice reforms, the Association believes Alabama can continue to attract highly-qualified physicians.

Specific Policies Supported

For 2024, the Association specifically supports:

  • Streamlining the prior authorization process for physicians and patients
  • Initiatives to grow and support Alabama’s physician workforce
  • Increasing access to physician-led care in rural and underserved communities
  • The ability of medical practices to set patient practice policies
  • Increasing physician representation on state healthcare boards, task forces and committees

General Policies Opposed

The Medical Association opposes any scope of practice expansion for non-physicians that would fracture the physician-led health team model, lower quality of care and/or increase costs.  The Association also opposes any interference with the physician-patient relationship and attempts to reduce a physician’s autonomy in patient care or medical practice decisions.

The Association opposes legislation or other initiatives that could increase lawsuit opportunities against physicians, including the establishment of statutory standards of care or any statutory dictums for medical care delivery.  The Association also opposes any state-level increase of requirements for Maintenance of Certification.  Finally, the Medical Association opposes tax increases disproportionately affecting physicians.

Specific Policies Opposed

For 2024, the Association specifically opposes:

  • New lawsuit opportunities against physician employers and medical practices over employment policies
  • Efforts to reduce and/or politicize physician involvement in health regulatory affairs
  • Expanding Prescription Drug Monitoring Program (PDMP) access for law enforcement
  • Statutory requirements for mandatory Prescription Drug Monitoring Program (PDMP) checks

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Discussions with Decision Makers: Justice Greg Cook

Justice Gregory Carl Cook (“Greg”) was elected to the Supreme Court in 2022. Justice Cook is the son of Gene and Dottie Cook and is from Florence, Alabama. From an early age, his parents instilled in him faith, the value of hard work, and the importance of public service.

Justice Cook attended Duke University on an Air Force ROTC scholarship, graduated in 1984 magna cum laude, and was elected to Phi Beta Kappa. He then served our country in the United States Air Force, reaching the rank of Captain. Justice Cook received his law degree from Harvard Law School in 1991, magna cum laude, where he served as an Executive Editor of the Federalist Society’s Journal of Law and Public Policy.

After finishing law school, Justice Cook moved back to Alabama and practiced law at Balch & Bingham for over 31 years. He handled a wide variety of matters in over 40 of Alabama’s 67 counties and in over 15 different states, including jury trials, bench trials, and arbitrations. A large part of his practice involved complex commercial litigation including a number of class actions.

Can you tell us a bit about your early life and upbringing? Where were you born and raised?

My Dad was a member of the Air Force, so we spent a good deal of time moving from place to place.  But his home – and mine – has always really been Florence, Alabama.

What motivated you to pursue a career in law and ultimately run for office?

I love the law.  It is how our society avoids chaos and fights in the street; it is how we resolve disputes peacefully; it is how people can own property and build businesses.  I believe God has ordained the law as a gift to us.  The challenge to represent clients vigorously but with civility and ethics has always appealed to me.  Having the opportunity now to be on the bench is the realization of a lifelong dream.  I am still excited every day when I go to the office.

Where did you go to law school and what did you do before serving on the bench? 

I attended Duke University on an Air Force ROTC scholarship; so, I had the honor to serve in the United States Air Force for four years at the Pentagon.  I met my wife in church while in the Air Force.  After my tour of duty, I attended Harvard Law School and was blessed to be able to come home to Alabama to practice.  I spent almost 32 years at the law firm of Balch & Bingham. 

Could you share some highlights from your legal career before becoming a judge? What type of law did you practice?

Initially my practice covered all types of lawsuits and included cases all over Alabama.  I tried jury trials and bench trials, including insurance and workers compensation disputes among other things.  Over the years, my practice grew towards complex commercial litigation, including very large actions involving banking, energy, and class actions.  These cases were all over the country (many in federal court) and I appeared in courts in more than 10 states and took depositions in Canada and Germany. 

Could you walk us through your approach to analyzing a complex legal case?

My job is to know the details.  This means I (or my staff) need to read everything.  One of the important assets of my job is that I have the time to do reading and research with few interruptions.  The facts can often dictate the result.  At the end of the detailed analysis, it is time to take a step back and see whether the result makes sense and whether it fits with the original meaning of the law and whether it is a predictable result.  I promised the voters that I would be “boring and predictable,” and I try very hard to render results that do not surprise anyone. 

In medicine, physicians go through residency training after medical school and often cite mentors that impacted and made him or her the doctor they are today.  Have there been individuals who’ve had a significant impact on your legal career or your life in general?

Yes.  There were lots of lawyers at Balch & Bingham who were mentors and influenced me.  One of them was Mike Edwards. Mike was the chair of our litigation section when I joined the firm and had a prior military career like I did.  Mike was also a member of the American College of Trial Lawyers.  He taught me almost everything I knew as a litigator, and he always emphasized truthfulness and a complete devotion to the client.  Another mentor is Justice Champ Lyons.  Justice Lyons was the chief drafter in 1973 of our Rules of Civil Procedure, which govern the courts day-to-day process.  Afterwards, he wrote a treatise explaining the rules and was then appointed (and later elected) to the Supreme Court.  I assumed the authorship of his two-volume treatise and wrote the Fifth Edition.  He is a hero to me and has been an invaluable sounding board and example for me. 

What is the most rewarding aspect of serving on the Alabama Supreme Court for you personally?

The opportunity to provide justice to the citizens of Alabama is a great privilege.  I want every party who comes before our Court to feel that we have heard and considered everything they had to say.  I want our citizens to feel that, even if they lose, we are trying our best to get the answer correct.  I love the opportunity to have oral arguments and have the lawyers explain their arguments.  Then, the lawyers and their clients know we heard them, and I hope they can tell from our questions that we are very interested in their cases.

What is the one thing you would like to say to physicians in Alabama?

Trust our system.  Even if you may not agree with every decision (and I don’t), I believe that all of the Justices on our Court are trying to get the answer right.  If you believe our Court has gotten the answer wrong, I encourage you to go to the Legislature with your arguments to change the law.  I can promise all your physicians that we are grateful for the important services they provide, and we value their efforts to contribute to our health.  We know that they care deeply about every patient.  Thank you for what you do.

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Discussions with Decision Makers: Justice Will Sellers

Justice William B. Sellers was appointed by Governor Kay Ivey in May 2017 to fill a vacancy on the Supreme Court of Alabama.

Justice Sellers received a Bachelor of Arts degree from Hillsdale College in 1985, a Juris Doctorate from the University of Alabama in 1988, and a Masters of Laws in Taxation from New York University in 1989. Justice Sellers practiced law in Montgomery for 28 years. He maintained a general business practice with emphasis on taxation, business organizations and finance. A major part of Justice Sellers’s practice involved tax litigation.

Justice Sellers and his wife, Lee, have been married for 35 years. They are members of Trinity Presbyterian Church and have three adult children.

Can you tell us a bit about your early life and upbringing? Where were you born and raised?

I was born in Montgomery and still live in the same neighborhood; Thirty-five years ago, I married the girl down the street. My father was an investment banker and, before she had 4 children, my mother was a history professor. My parents were a devoted couple, very active in the civic life of our community and provided our family with a wonderful nurturing environment.

What motivated you to pursue a career in law and ultimately run for office?

I was the last of 4 children and when my sister left to go off to college, I was virtually an only child, so I spent a lot of time with my parents and I saw in particular from my father’s standpoint how complicated the law was and how difficult it was for businesses to prosper in that environment. I observed how his lawyers solved regulatory and other legal problems and I thought a career in law would be challenging for me.

In 2017 after Gov. Ivey became governor there was an opening on the court and she appointed me. I was elected in 2018 without any opposition.

Where did you go to law school and what did you do before serving on the bench? 

I received by undergraduate degree from Hillsdale College with the BA in History and Political Economy. I received a JD from the University of Alabama and then I went to NYU where I received an LL.M in taxation.

Could you share some highlights from your legal career before becoming a judge? What type of law did you practice?

For 28 years I practiced tax law in Montgomery. While I primarily had an office practice, I also handled tax controversies and successfully litigated cases against the Alabama Department of Revenue and Internal Revenue Service.

Could you walk us through your approach to analyzing a complex legal case?

When cases are assigned to me, I review the order or motion that is being appealed so I can understand what the real issues are that the parties are disputing. I then review the briefs to make sure I understand the material facts and then I look at the law to understand the basis for the lower court’s decision. Based on my review of the law, I decide whether we should affirm the trial court’s decision or reverse it. Then, I write an opinion explaining my reasoning for the action I think the court should take with the appeal.

In medicine, physicians go through residency training after medical school and often cite mentors that impacted and made him or her the doctor they are today.  Have there been individuals who’ve had a significant impact on your legal career or your life in general?

Absolutely! I had great professors in college. Dr. Jim Juroe taught me how to write with precision, Dr. John Willson made me love the founding of America, Dr. Rodler Morris engaged my thinking about the history of science and Dr. Tom Burke challenged me to think critically about the Protestant Reformation. In law school, Don Turlington gave me an appreciation of the complexities of partnership taxation and Richard Pomp opened the world of state and local taxation to me. 

What is the most rewarding aspect of serving on the Alabama Supreme Court for you personally?

By the time cases get to us, they are usually complicated and have the potential to be very significant. To decide these important cases and know that our decisions have a wide impact is personally fulfilling.

What is the one thing you would like to say to physicians in Alabama?

Thank you for what you do. I hope you will view Alabama’s judicial system favorably and find that our system provides consistency and certainty so that professionals can conduct business in Alabama knowing that the court system provides a fair and stable environment to efficiently resolve disputes.

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Discussions with Decision Makers: Justice Jay Mitchell

Justice James L. “Jay” Mitchell was elected to the Alabama Supreme Court in 2018.

Before serving on the Supreme Court, Justice Mitchell was an accomplished litigation attorney with Maynard, Cooper & Gale (now Maynard Nexsen). During his time in private practice, he tried a number of complex cases to verdict, successfully handled appeals, and obtained favorable settlements for clients. He was rated as one of the top litigators in the United States and Alabama, and received the highest possible rating for professional ethics. He also served on Maynard, Cooper & Gale’s executive committee, helping to lead strategic and growth initiatives for the firm.

Can you tell us a bit about your early life and upbringing? Where were you born and raised?

I was born in Mobile and did my early growing up in the Wiregrass, where my parents are from.  My father was a salesman and my mother was a teacher and stay-at-home mom.

When I was 10, my dad took a new sales job that moved us to Homewood.  Like my two younger siblings, I went to middle school and high school in Homewood.  We attended Covenant Presbyterian Church (PCA), where my dad played the piano each Sunday.

I’m thankful that I was raised in a home with strong values and a lot of love and encouragement (though my brother and I did get into our fair share of scrapes as kids!).  

What motivated you to pursue a career in law and ultimately run for office?

I had no lawyers on either side of my family and did not know much about law beyond what I read in John Grisham novels and saw in “A Few Good Men” back in the 90s.

But in the January term of my sophomore year at Birmingham-Southern, I interned at the law firm of Maynard, Cooper & Gale in Birmingham.  I would go to their offices in the morning, then head back to campus in the afternoon for basketball practice.  I thought what the lawyers at Maynard did seemed interesting – but more importantly, I just really liked the people there and was impressed with how much the lawyers seemed to enjoy working with each other and their clients.

The firm was kind enough to let me keep coming back to work in the summer and on holiday breaks when I was in college.  I would summarize depositions, do basic research, and run documents to the courthouse.  Eventually, I decided to go to law school – and they hired me to work there as a summer associate both of my summers.  It wasn’t difficult for me to decide to go practice law there after law school!    

Where did you go to law school and what did you do before serving on the bench? 

I graduated from the University of Virginia School of Law, where I met my wife Elizabeth, a proud Auburn graduate.  We got married before our third year of law school and both graduated in 2002.

Not long after passing the bar, I began practicing law at Maynard in Birmingham.  I practiced there for 16 years and became a shareholder.  I also served on the management committee of the firm during a time of rapid growth.  

I thoroughly enjoyed my time as a lawyer – working with clients and being in the trenches with my law partners and colleagues gave me great professional satisfaction.

Could you share some highlights from your legal career before becoming a judge? What type of law did you practice?

I handled all kinds of cases.  My specialty was commercial litigation, where a business would be sued for money damages based on a contract or some other type of claim.  But I also handled construction, environmental, securities, real estate, products liability, and other types of cases – which prepared me well for serving on the Supreme Court, because we decide a wide variety of cases and are constantly having to toggle between different areas of the law.

Probably my most vivid memory as a lawyer was serving as lead counsel for a national radio company during the “sports talk radio wars” in Birmingham.  As radio listeners may recall, other suitors did their best to get Paul Finebaum to leave WJOX while he was under contract and take his renowned call-in show elsewhere.  We engaged quickly on behalf of the company, got embroiled in some fast-moving litigation, and ultimately kept Finebaum and his right-hand people at home.  Of course, once Finebaum’s contract expired, he moved on to help launch the SEC Network, where his brand has become bigger than ever.  Some great stories from those days!

Could you walk us through your approach to analyzing a complex legal case?

I believe it’s our job on the Supreme Court to get the law right in the cases that come before us.  When it comes to analyzing a complex case, that means digging in on the law, understanding the procedural nuances of the case, reviewing and digesting the factual record, and announcing our Court’s ruling in a way that is clear to the parties and the public.  That takes time, energy, and occasionally some robust discussion with my colleagues.  But I believe it’s absolutely critical that we commit ourselves to finding the correct answers under the law and expressing those answers well.

In medicine, physicians go through residency training after medical school and often cite mentors that impacted and made him or her the doctor they are today.  Have there been individuals who’ve had a significant impact on your legal career or your life in general? 

Absolutely.  The lawyers at Maynard who trained me in how to practice law – Tony Miller, George Lynn, and Jim Priester – had a big impact on me and shaped how I approach thorny legal questions.  As did Boots Gale, who has a remarkable ability to size up tough situations and provide wise counsel.  And Kirby Sevier and Drayton Nabers are longtime personal mentors of mine who taught me how to be a professional in a way that honors God and people.  

As far as being a judge, Justices Antonin Scalia and Clarence Thomas have had a huge influence on me.  Both of them exemplify what it means to uphold the Constitution and the rule of law, while holding the line against judges who try to subvert the law by interjecting their own policy preferences into rulings.

What is the most rewarding aspect of serving on the Alabama Supreme Court for you personally?

Working with my law clerks.  These are sharp, young attorneys – many of whom are fresh out of law school – who come and work with me for a year before launching their legal careers.  They include the best and brightest students from Alabama and Cumberland, as well as graduates of Harvard, Chicago, Virginia, NYU, and other great law schools across the country.  My law clerks keep me in teaching mode and sharpen me as a judge.  

I’m pleased to say that Justice Clarence Thomas has hired three of my clerks to work for him at the United States Supreme Court – which is a huge honor for them and I believe is a testament to the quality of work that we’re doing together at the Alabama Supreme Court.

What is the one thing you would like to say to physicians in Alabama?

The courts really matter and have a big impact on your profession – how you practice medicine; the legal exposure that you face as you do your job and manage your office; and how much you pay in insurance premiums.

I would encourage you to get engaged and support judges and judicial candidates who are committed to doing two things.  First, when it comes to legal texts – whether a public text like a constitutional provision or a statute or a private document like a contract – a judge should be committed to interpreting and applying the words on the page faithfully as they’re written.  This promotes fair notice to those who are impacted by the law and should minimize surprises for the public.

Second, a judge should have the right outlook when it comes to common-law issues.  A number of areas of law fall into the category of “Alabama common law” – which means they aren’t written down in a constitution or a code book, but are developed entirely by the courts.  This includes key areas for doctors like torts and property; it also includes the Alabama Supreme Court’s process for reviewing punitive damages.  When it comes to common-law issues, you want judges who will be appropriately attuned to how their rulings may impact industry and the overall legal landscape. 

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2023 Legislative Recap

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.

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Mobile Physician Becomes New President of Medical Association of the State of Alabama

Mobile Physician Becomes New President of Medical Association of the State of Alabama

Dr. George Koulianos sworn in during Association’s annual meeting

George Koulianos, M.D., F.A.C.O.G., of Mobile was sworn in as the new President of the Medical Association of the State of Alabama during the Association’s annual meeting on Saturday, April 29th in Huntsville.

Dr. Koulianos is the founder and medical director of The Center for Reproductive Medicine in Mobile. He is board certified in Obstetrics and Gynecology. Prior to founding The Center in 1993, he served as assistant professor of Obstetrics and Gynecology at the University of South Alabama.

“It is a privilege to serve the Medical Association as President during this pivotal time for healthcare in Alabama. Our goals are to address the physician shortage, expand access to quality care for all Alabamians, prioritize patient safety by supporting physician-led team-based care, and to support physicians and the patients they serve during some of the most significant moments of their lives,” said Dr. Koulianos.

Mark Jackson, Executive Director of the Medical Association, said Dr. Koulianos has “not only impressive medical experience but also a true passion for helping people. It’s why he became a doctor in the first place.”

Dr. Koulianos served the past year as President-elect of the Medical Association under President Julia Boothe, M.D., of Reform, whose term has expired.

Dr. Koulianos completed a fellowship in Reproductive Endocrinology and Infertility at Tulane Medical School and the University of South Alabama. He did his residency in Obstetrics and Gynecology at Texas Tech Regional Academic Center in Amarillo. He graduated from the University of Texas Medical School at Houston. His professional accomplishments include winning the ACOG/CIBA (American College of Obstetricians and Gynecologists) Fellowship for Endocrinology of the Postreproductive Woman, authoring several book chapters and articles with original research for peer review and presenting original research at numerous national and international meetings.

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OIG Unveils Telehealth Toolkit to Analyze Program Integrity Risks

OIG Unveils Telehealth Toolkit to Analyze Program Integrity Risks

By: Jim Hoover, Burr & Forman, LLP

Over the course of the last year, audits of telehealth services and the associated claims data has continued to increase.  As a result, it may be useful for physician practices to conduct a compliance review of the telehealth claims they submitted since the beginning of the COVID-19 pandemic.  Of course with any compliance audit, healthcare providers should think carefully about the manner and procedures used in an audit.

A useful source of information related to telehealth claims is the OIG’s telehealth toolkit.  On April 20, 2023, the Office of Inspector General (OIG) unveiled a new telehealth toolkit designed to help identify program integrity risks associated with telehealth services.  A copy of the toolkit is located here. The toolkit provides detailed information on methods to analyze telehealth claims to identify program integrity risks. While the OIG created the toolkit to assist public and private sector partners such as Medicare Advantage plan sponsors, private health plans, State Medicaid Fraud Control Units, and other Federal health care agencies with analyzing their telehealth claims data, it can also be used by physician practices to review their telehealth claims.

The OIG created the toolkit because the COVID-19 pandemic changed how patients visit and interact with their health care providers. The use of telehealth services grew dramatically during the first year of the pandemic and is now an important part of the health care system. For example, Medicare beneficiaries used 88 times more telehealth services during the first year of the pandemic than in the year prior, with more than 2 in 5 Medicare beneficiaries using telehealth services in that year. Medicaid and private health plans also experienced exponential growth in the use of telehealth. With the dramatic increase of telehealth visits, came concerns about fraud, waste and abuse associated with the use of telehealth.  

The toolkit includes detailed descriptions of seven data analysis measures providers can apply to their own data.  The toolkit also includes steps for analyzing telehealth claims such as (1) reviewing program policies, (2) collecting claims data, (3) conducting quality assurance checks, (4) analyzing data to identify program integrity risks, and (5) interpreting the results of the analysis. When beginning the analysis process, it is important to be familiar with payment and coverage policies of the particular program being reviewed, such as traditional Medicare or a commercial payor.  The toolkit is based on Medicare fee-for-service payment and coverage policies for telehealth services during the first year of the COVID-19 pandemic (March 2020 through February 2021).  Be aware that Medicare telehealth policies changed over time and different programs may have different policies.  As a result, the analysis of the telehealth claims will vary according to the coverage and billing policies of a particular program and for the particular time period.  During the COVID-19 pandemic, Medicare claims for telehealth services used a modifier of 95, GQ, or G0 or a place of service code of 02 to indicate that the service was delivered via telehealth.  The Centers for Medicare & Medicaid Service’s website also maintains a complete list of services that may be provided using telehealth under Medicare.

The measures in the toolkit are intended to be a starting point for the analysis of telehealth claims and are based on patterns in the Medicare claims data during the first year of the COVID-19 pandemic. Billing patterns in other data may be different from those in Medicare data, so it may be necessary to adjust the analysis accordingly. For example, the OIG considered providers who billed telehealth services for 2,000 or more Medicare beneficiaries during a year to be high risk. This number is far higher than the median of 21 Medicare beneficiaries. 

The toolkit contains seven measures the OIG developed to focus on different types of billing for telehealth services.  Some the measures include billing telehealth services at the highest most expensive level for a high proportion of the services billed, billing a high average number of hours of telehealth services per visit and billing telehealth services for a high number of days in a year or a high number of patients.  

Although the OIG designed the toolkit to analyze program integrity risks, it is a useful resource for physician practices to help them understand the particular areas of concern of the OIG.  It provides easy to understand analysis of claims and thresholds the OIG considers to indicate a high risk of fraud, waste or abuse.   

Jim Hoover is a Partner at Burr & Forman LLP practicing exclusively in the firm’s healthcare group. Jim may be reached at (205) 458-5111 or

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Physician Workforce Act Addresses Alabama’s Doctor Shortage So Patients Get the Care They Need

By Julia M. Boothe, M.D.

If it seems you are having to to wait longer to get a doctor appointment than you used to, it’s not your imagination. Alabama is experiencing a physician shortage, and the results can be far worse than a mere inconvenience for your schedule.

The physician shortage means patients are experiencing delays in access to medical care for a range of prevention, wellness and treatment options. When patients have difficulty accessing care, their health problems worsen. Most eventually end up in already crowded hospital emergency departments. This puts extra strain on overworked hospital staff and ends up increasing health care costs for everyone.

Fortunately, there is legislation before the Alabama Legislature that would help address the physician shortage of today and build the physician workforce we need for tomorrow.

This legislation is the Physician Workforce Act – House Bill 243 sponsored by Rep. Paul Lee and Senate Bill 155 sponsored by Sen. April Weaver. Patients and physicians across the state can be grateful these two leaders are proactively dealing with this looming health care crisis.

The Physician Workforce Act focuses on three key areas: cutting red tape to boost physician recruitment, better utilizing our existing physician workforce, and establishing an apprenticeship-like program for future physicians.

Alabama does a great job recruiting industries to our state with incentives. But when it comes to recruiting doctors, we throw up unnecessary barriers and red tape. Physicians licensed to practice medicine in other states can’t relocate to Alabama and practice medicine unless they take an additional test. And we make this test even more burdensome by requiring that it be taken in-person. So, a fully licensed physician from Georgia, Florida or any other state who is thinking of moving to Alabama must physically show up to take this test.

This requirement is unnecessary, outdated and a barrier to better health care. The Physician Workforce Act repeals this red tape. Doing so won’t lessen standards because all other medical licensure requirements will stay the same. But removing this bureaucratic barrier will make Alabama more competitive when it comes to recruiting physicians.

As Sen. Weaver has said, if we want more doctors in Alabama, we need to make Alabama more welcoming to doctors. With this important change, the Physician Workforce Act does that.

In addition to recruiting physicians, we need to do a better job utilizing the physician workforce we already have. International Medical Graduates (IMGs) currently make up 20 percent of Alabama’s physician workforce. They are required to complete three years of training in a residency program to become eligible for an initial medical license. By contrast, U.S. and Canadian medical graduates must complete only one year of residency to become licensed.

IMGs are subject to the same rigorous credentialing standards as any other U.S. physician and are held to the same demanding educational standards as students attending medical schools in the U.S. and Canada. Alabama’s licensing requirements need to reflect that.

Therefore, the Physician Workforce Act would allow IMGs to apply for an initial medical license after two years of residency. This would enable IMGs to begin working more quickly in Alabama and allow our busy clinics and hospitals to utilize these highly trained medical professionals for hard-to-staff overnight shifts in emergency departments.

If a medical graduate is looking to apply for a residency, they will go to states where they can work as soon as possible. And if these physicians are allowed to work sooner in Alabama, the higher the chances they will stay in Alabama when their residency training is over.

Twenty other states already follow this accelerated route toward a medical license for IMGs. Alabama should join them.

Lastly, the Physician Workforce Act would create an apprenticeship-like program to help bolster the physician workforce of tomorrow. If this were to become law, Alabama would join nearly 10 other states that allow medical graduates who do not match into residency programs to increase their knowledge and skills under the supervision of licensed physicians as they prepare to reapply for residency.

With physicians serving as their mentors, these medical graduates would receive additional training that will benefit them tremendously in the future and help to ease pressure on our health care system today.

Legislators should make passage of the Physician Workforce Act a priority. It would significantly expand the pool of trained physicians practicing in our state, it would increase the number of patients getting the medical care they need and it would improve health outcomes for Alabama’s sick and injured. For these reasons, it has earned the support of the Medical Association of the State of Alabama, the University of Alabama at Birmingham (UAB), the University of South Alabama, Federally Qualified Health Centers, and numerous medical specialty groups.

The sooner the Physician Workforce Act becomes law, the sooner we’ll put Alabama on the path toward a healthier future.

Dr. Boothe is a primary care physician caring for patients in Reform, Alabama. She serves as Immediate Past President of the Medical Association of the State of Alabama.

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