The Florida House appears poised Friday to pass a massive health-care bill that would ensure three disputed trauma centers remain open and give long-sought powers to nurse practitioners. In legislative parlance, such a mega-bill is called a "train."
The bill (HB 7113) also contains a bunch of other controversial issues, such as expanding the use of telemedicine, allowing pharmacists to supervise additional technicians and stripping the Miami-Dade County Commission of power to approve labor contracts at the massive Jackson Health System.
For months, attention has focused on a fight about whether trauma centers at Blake Medical Center in Manatee County, Regional Medical Center Bayonet Point in Pasco County and Ocala Regional Medical Center in Marion County should be allowed to stay open. Those trauma centers have been challenged by other hospitals, which argue the Florida Department of Health improperly allowed the facilities to open.
But while the House measure would allow those trauma centers to keep their doors open, it became apparent during an initial debate Thursday that much of the controversy about the bill centers on issues such as telemedicine and allowing nurse practitioners to provide care without the supervision of physicians.
Nurse practitioners, technically known as advanced registered nurse practitioners, have more education and training than other nurses. They have long argued they can provide primary care without physician supervision --- an argument that has drawn heavy opposition from physician groups such as the Florida Medical Association.
The bill would grant those expanded powers, with House Republican leaders saying the move would help with a shortage of primary-care doctors in the state. Critics argue that nurse practitioners do not have as much training as physicians and question whether the change could jeopardize patient safety.
But Rep. Cary Pigman, an Avon Park Republican who has helped spearhead the proposal, said studies have shown giving nurse practitioners more authority would be safe. Also, he said the treatment they provide would be relatively limited.
"It does not include brain surgery,'' said Pigman, who is a physician. "It does not include taking your gall bladder out."
Doctor groups also are raising objections about part of the bill that would seek to boost the use of telemedicine, which involves health providers using the Internet and other telecommunications to remotely treat patients.
While all sides say they want to expand telemedicine, critics of the House proposal are concerned that out-of-state doctors would be able to use it to treat Florida patients without being licensed here.
Rep. Janet Cruz, D-Tampa, said lawmakers are about to "open the floodgates" to people practicing medicine in Florida without state licenses. But Rep. Travis Cummings, R-Orange Park, said the bill includes safeguards, such as a registration process that, in part, would require out-of-state physicians to have active licenses in other states.
It remains unclear whether the House and Senate will come to agreement on the issues in the bill. The Senate has a series of bills addressing the issues and takes significantly different positions than the House on telemedicine and nurse practitioners.
But House members Thursday continued adding issues to the bill, which is known in Tallahassee as a legislative "train."
For example, the House approved a controversial amendment that would increase the number of technicians that pharmacists can supervise. That is the subject of another bill that has drawn heavy debate.
Meanwhile, the House voted to keep part of the bill that has opened a debate about the powers of the Miami-Dade County Commission. The bill would take away the power of the commission to approve labor contracts for employees of the massive Jackson hospital system, boosting the authority of the appointed Public Health Trust of Miami-Dade County.
As he introduced the bill Thursday, sponsor Jason Brodeur, R-Sanford, joked about its scope.
"This bill has just a handful of items in it,'' he said.