UAB Synopsis, Vol. 24, No. 28, July 25, 2005
UAB Faculty Help Shape State Laws
Eighty-five bills with potential impact on health care were introduced in the Alabama Legislature this year, touching on a wide range of issues from the highly controversial, such as a human cloning ban and legalized medical marijuana, to more routine but important "housekeeping" concerns like allowing electronic renewal of some professional licenses.
Lawmakers passed few bills of any kind during a session marked by a senate leadership struggle that University of Alabama System lobbyist Christopher Porter Banister, Jr., called "especially contentious," but he noted, "We successfully headed off all bills that could negatively effect the way the Health System conducts business and the one critical issue — — received a record increase, more than 15%."
Former UAB Health System Chief Planning and Strategy Officer Martin Nowak, who retired from UAB July 13, reviewed every health care related bill and sent selected legislation to faculty and staff most directly involved in the issue for a recommendation to support, oppose, or take a neutral position. Nowak used those expert opinions to develop an official UAB position that Banister promoted in Montgomery.
"Once legislation becomes law, it can have a profound effect on health care. A campus-wide approach to the political process lets us actively represent the interests of our employees, patients, and all the citizens of Alabama," Bannister said. "Expert input helps us present the most informed, substantive standpoint. UAB's position can influence other state health care organizations, which often choose to support us. We can also back other hospitals on issues of particular importance to them. This kind of reciprocal support helps us in subtle ways; for example, we have never had a contested Certificate of Need submitted to the State Health Planning and Development Agency.
"Faculty input is critical to the process," Nowak added. "As always, in 2005 we got a good response from faculty, but not quite the 100% participation of past years. Our faculty can wield considerable influence — their input helps shape future law."
Expert review can reveal hidden agendas, ambiguities, and long-term consequences. Sometimes, well-intended legislation is weighed down by unclear language, such as a proposed bill mandating public reporting of hospital data, an important piece of legislation UAB opposed during the last session.
"UAB generally supports data reporting because of confidence in our high-quality medical care, but this particular bill was poorly written and lacked elements of protection," Nowak said.
"A collaborative effort among UAB, the Alabama Hospital Association, and the Business Council of Alabama created strong opposition, and we defeated the bill," continued Nowak, who predicted data reporting legislation will be reintroduced in the next session. Alabama is 1 of only 4 states in the U.S. that does not have some form of data reporting — this type of legislation is desirable and inevitable; we just wanted to make sure the language of the law is clear and fair.
UAB Opinion Makers
This year, Nowak sent 22 bills to UAB experts for review. After wading through complex legal language, faculty responded with clear-cut, influential opinions.
Vice President and Dean of the School of Medicine Robert Rich, MD, strongly opposed a bill that would ban some cloning technologies. "All responsible scientists oppose human reproductive cloning, which involves use of cloning technologies that result in uterine implantation with the intent of producing a human being. But I opposed this legislation because it would have also prohibited use of similar technology — so-called therapeutic cloning — that would never result in cloning of a human being but has potential to provide new approaches to many important diseases, such as type 1 diabetes, Parkinson disease, spinal cord injury, and others."
"As UAB physicians, we are dedicated to prevention and treatment of illness in our patients. Although much more research must be done, therapeutic cloning has that potential. I would not want Alabama patients denied opportunities that are likely to become available through the work of researchers elsewhere in the United States and around the world."
The proposed cloning ban died early in the session without generating much controversy, Banister said, noting that bills can get derailed at any point in the legislative process — on introduction, in committee, during a full vote of the house and senate, or through gubernatorial veto.
Dean of the School of Optometry John Amos, OD, reviewed several bills for UAB and recommended support for all of them. "I appreciated the opportunity to review proposed legislation related to the optometric profession. All three of the bills, which covered license renewal, the continuation of the Alabama Board of Optometry, and identification and treatment of impaired practitioners, were probably proposed by the Alabama Optometric Association, but I had not seen them until they came to me.
"Review allowed me to delve a little deeper and consider how the legislation would impact the school and the profession — I enjoyed being involved."
Dean of the School of Dentistry Huw Thomas, PhD, strongly supported a bill that proposed regulating dental use of oral conscious sedation.
"Oral conscious sedation, which in dental care is most often used for anxious children, requires initial training and continuing education. The proposed legislation is a great idea — it ensures the safety of these young patients by mandating adequate training for individuals delivering care, but the requirements are not so burdensome as to make the process impractical." The bill was indefinitely postponed, but will likely be reintroduced in the next session, Banister said.
Sometimes, proposed health care legislation is in conflict with medical literature. Neonatologist Wally Carlo, MD, reviewed just such a bill during the last session and took a strong stance against it. The legislation required health care providers to inform parents of newborns about availability of sleep apnea monitors for prevention of sudden infant death syndrome (SIDS).
In his response, Dr. Carlo said, "The monitoring aspect of the bill is ill-conceived, as there is no evidence SIDS can be prevented with apnea monitoring. In fact, a large National Institutes of Health study concluded that apnea and obstructive breathing events are quite common, even in term infants, but the timing of such events suggest they are not likely to be precursory to SIDS."
He went on to note that American Academy of Pediatrics guidelines say home cardiorespiratory monitoring should not be prescribed for SIDS prevention and that inappropriate use of such monitoring would result in large increases in health care costs. Dr. Carlo contacted other Alabama neonatologists to rally opposition to the bill, which died after being reviewed in committee.
"Dr. Carlo's expertise was noted, and he was asked to design the neonatal services section of the state health plan," Nowak said. "Strong faculty responses lead to strong positions in Montgomery, increasing UAB's impact on the lawmaking process and extending our influence into other arenas."
Banister agreed, noting, "There's no higher comfort level than having UAB faculty, who are among the world's foremost experts, give their opinion on legislation. This input gives UAB's positions a degree of credibility other interest groups do not enjoy. On a related note, another election year has begun, and I hope our faculty, staff, and friends will consider a timely contribution to UASPAC, our political action group, to help ensure our continued success in Montgomery."