TALLAHASSEE, Fla. – House Speaker Jose Oliva, who last year shepherded several contentious health-care measures through the Legislature, lashed out Tuesday at the health-care industry as modern-day "robber barons."
Oliva’s aggressive remarks on the opening day of the 2020 legislative session painted a bleak picture of the industry as putting profits over patients. The Miami Lakes Republican outlined what he considers to be a fix, including allowing advanced practice registered nurses to provide care independently from physicians.
It’s not clear, though, that Gov. Ron DeSantis or the Senate see things the same way, setting the stage for a potentially contentious back-and-forth over the next 60 days.
Oliva dedicated a large part of his 18-minute opening day speech in the House to the need to revamp medical professional licensure regulations, which he called “archaic and backward.”
And to a near-standing ovation, Oliva encouraged lawmakers to allow “health-care professionals to practice to the extent of their training.” Such so-called “scope of practice” expansions have long drawn fierce opposition.
As an example, physicians have fought proposals to allow advanced practice registered nurses to work independently, raising issues such patient safety and not enough training for nurses.
‘It is a stain upon a state that prides itself on leading to even humor talk of patient safety coming from interest groups when we now know beyond a shadow of a doubt of its safety and efficacy. Or worse, to use phrases like, ‘If you want to be a doctor, study to be a doctor,’” said Oliva, a reference to arguments by the powerful Florida Medical Association physicians group. “Thirty states have outgrown this backwards policy. Thirty. It is high-time we allow health-care professionals to practice to the extent of their training.”
The Health Quality Subcommittee has already has approved a measure (HB 607) that would carry out Oliva’s proposal on advanced practice registered nurses. The bill is on the Care Appropriations Subcommittee agenda for Wednesday.
At the Capitol on Tuesday, dozens of medical professionals donned their white coats. Retired Army Col. John McDonough, who is also an educator at the University of North Florida in Jacksonville and an expert, and his colleagues answered a call from Oliva to show up and show out on a bill about nurse practitioners.
“I’m a certified registered nurse anesthetist. I happened to be, with the permission of the Board of Nursing, a certified registered nurse anesthesiologist,” McDonough said. “There’s currently a bill before the House that would grant practice to advanced practice nurses the ability to practice unsupervised by physicians because, as we all know in the health care business, physician supervision is really a loser. It doesn’t exist.”
Support for the bill outside the House, however, remains unclear.
Opponents believe a patient expects and deserves that a physician will at least be part of the patient’s health care team. Some believe it would lower the quality of health care if a physician was not.
McDonough said prices would be lower, but his military experience shows the quality can still be great.
“I can tell you after 30 years in the Army, treating some of the most severely injured and sickest people that you’re ever going to find, there are no anesthesiologists in Army combat support hospitals. That’s a role taken by nurse anesthetists. It has been since prior to World War II, and continues to be that way today,” he said.
Chris Nuland, a Jacksonville attorney who represents doctors, said the American College of Physicians opposes the bill.
When asked whether he supports the measure, DeSantis said that the “devil is in the details on some of this stuff.”
“We’ll look to see what’s going on,” DeSantis told reporters following his State of the State address Tuesday, adding, “I want people to be able to earn a living and do well. At the same time, there’s no easy solution for something if someone is practicing outside their education. I’m willing to look to see what they are proposing and go from there.”
Senate President Bill Galvano, R-Bradenton, has been lukewarm to the issue, as has Senate Health Policy Chairwoman Gayle Harrell, R-Stuart.
“I think we are very concerned that we have well-trained people taking care of patients, and there’s a real difference between nurse practitioner training and physician training,” said Harrell, whose late husband was a physician.
Oliva has made revamping the health-care industry a top priority of his two years as speaker, calling for a more free-market approach.
Among other things, Oliva last year helped lead efforts to pass a bill that authorized the state to establish two international drug importation programs, an issue that DeSantis touched upon in his opening State of the State speech. Florida is working with the Trump administration to try to move forward with the programs.
Oliva also used his considerable influence last year to help pass a bill authorizing telehealth, which allows out-of-state physicians who register with the state Department of Health to treat Florida patients remotely. The House speaker also spearheaded an effort to abolish the “certificate of need” regulatory program for hospitals. That program required hospitals to get state approval before adding new facilities or tertiary services, such as organ transplant programs.
Nevertheless, Oliva on Tuesday continued to take aim at hospitals, pharmaceutical companies and durable medical equipment providers.
“Now, I am not given to hyperbole, I use these words with precision. The health-care industrial complex -- made up of hospitals, medical device manufacturers and pharmaceutical companies -- are the great robber barons of our time,” Oliva said. “The term robber baron is defined by government manipulation, monopolizing industry and price gouging. Check, check and check.”
Oliva also specifically chided Florida hospitals and a proliferation of free-standing emergency rooms, which can be built off hospitals’ main campuses.
“These facilities are primary care substitutes at emergency room prices. They are highly profitable because they can charge significantly higher rates. How do I know this? I have actually had hospital executives boast of their stand-alone ER’s and their effects on the bottom line,” Oliva said. “The audacity is such that they advertise them openly on billboards listing the wait times. Clearly, this isn’t intended for anyone in an actual emergency as I can’t imagine one would have time to shop. This is done to lure us into their facilities for far less emergent conditions.”
Justin Senior, chief executive officer of the Safety Net Hospital Alliance of Florida, pointed after Oliva’s speech to quality care provided by hospitals. Senior’s organization represents public, children’s and teaching hospitals.
“We support the speaker’s goals to increase transparency and efficiency in health care while helping people get the best health care at the right place at the right time,” Senior said. “Our members proudly serve our citizens at their ‘most powerless and exposed moments’ as the speaker said. Our institutions also have some of the best patient outcomes in the nation -- as ranked by U.S. News and World Report and CMS (Federal Centers for Medicare & Medicaid Services) Five Star awards. It is important to note that in addition to high quality services, our members stand out as partners of local and state government to provide the most affordable care, or even free care, to Floridians who struggle financially.”