House 'Train Bill' Groups Trauma, Telemedicine And Nursing In Hopes Of Wooing Senate

Apr 10, 2014

Credit Didier Lahousse / flickr/creative commons

The Florida House is cobbling together several different health-related bills in the hope the combined proposal will sway the Senate to vote for them. But the new, combined proposal still doesn’t sway some in the originating chamber.

Florida lawmakers started off this legislative session with attempts to lay out ground rules for telemedicine, trauma centers and what has become an annual turf battle between different groups of health practitioners. But the House and Senate have different perspectives on all these issues, so the House is combining them into a single piece of legislation. In legislative terms, the bundling of related bills is sometimes called a train.

The goal of a train bill is to make it harder to reject part of the proposal without the rest collapsing. But there’s always the danger the train runs off the rails, taking its new passengers with it.  As Hallandale Beach Democratic Representative Joe Gibbons argued in the House Health Regulatory Affairs Committee Thursday, it becomes a judgment call.

“This approach is a good approach," said Gibbons. "Now, when I looked at this bill initially, I said, man, they took some good stuff and put in some bad stuff and mixed it with some good stuff, and then you say, well does the good outweigh the bad? And in this case, the good does outweigh the bad.”  

Not everyone likes the medicine they're being fed.

“I have to say, I think the bad outweighs the good on this bill," said  Stuart Republican Representative Gayle Harrell (R-Stuart).

Take the issue of telemedicine, one of the dominant back-and-forth topics so far this session. The House plan would let out-of-state doctors see Florida patients if those physicians first register with the state. The Senate wants those out-of-state doctors to have a license to practice in Florida.  Harrell wanted that provision added into the House bill, but it failed. 

“For those that say we have too much in this bill that isn’t good over what is good, you know what? I’m sorry ,but it’s time to evolve a little bit and recognize the internet is not a fad, and 49 other states aren’t wrong,"  said Rep. Matt Hudson (R-Naples) taking a swipe at Harrell and Rep. "Doc" Renuart (R-Ponte Vedra Beach) who voted against the omnibus bill. 

When it comes to trauma centers, the House is seeking to protect three privately-owned facilities in  Pasco, Marion and Bay Counties. Those centers are in the middle of a fight with large, non-profit hospitals which say the trauma centers drain resources and staff, rather than improve access to care. The House placed a moratorium on new facilities in a bid to win support from the Senate—which is also considering a trauma center moratorium proposal.

However, the chambers remain divided over a bid by advanced registered nurse practitioners who want the ability to prescribe basic medications and see patients without the supervision of doctors. This plan has so far been a no-go in the Senate, and it’s a non-starter for some in the House, Harrell and Doc Renuart.

Talking to reporters prior to the bills being combined, House Speaker Will Weatherford said the goal is to give all the measures a boost in the Senate.

“Some of these issues are related to each other and sometimes it’s easier to send one omnibus package over to the Senate as opposed to a bunch of individual bills," he said.

In the Senate, the proposals remain separated. But before the House train bill can switch tracks and head to the Senate, it must first pass the full House—and not everyone is prepared to lay down and be run over by the health care express.