Workplace violence, scope of practice protections, mental health: 3 weeks into 45 days in Richmond.

By Jeff Kelley, VACEP Communications

• Note: This article was originally published on January 21, then updated on January 28 to reflect recent updates to various bills. Our thanks to VACEP government affairs lead Aimee Perron Seibert for the overview of the various bills.

Emergency physicians came to Richmond last week for EM Advocacy Day and met with a number of Virginia lawmakers and their aides. We lobbied for three bills, focusing mostly on the VACEP-backed Senate Bill 827, which would require hospitals to have either off-duty police officers or security personnel in the ED 24/7/365. They would have training in conflict resolution and de-escalation, and the training to physically restrain unruly individuals.

This bill will be heard in the week of January 30.

VACEP President Todd Parker, MD, FACEP, who resides in Virginia Beach, with newly elected Senator Aaron Rouse of Virginia Beach. The two met at EM Advocacy Day in Richmond on January 25.

Beyond ER security, there are dozens of pieces of legislation pertaining to healthcare, with a select few that rise to the level of “priority” in the world of emergency medicine. Our our focus has been on bills covering workplace issues, scope of practice for healthcare providers, and mental health. You can find more about the issues on our Issues page.

Workplace

In addition to the trained security bill, Senate Bill 1103 would make it a Class 3 felony for someone to commit violence at places of employment, including a hospital.

House Bill 1835 also extends protections to health care providers who work outside the hospital setting, such as physician offices, urgent care centers, and ambulatory surgery center. These providers are not covered under current law.

Scope of Practice

The priority bill emergency medicine opposed, House Bill 2183, would have removed the current five years/9,000 hours of supervised training before a Nurse Practitioner could apply for independent practice, and allowed them to practice independently upon licensure. The bill is defeated for the year.

The bill was initially amended in committee to two years, but was still killed early in the session on a 3-3 vote. More than 75 VACEP members sent letters to their Delegate this week encouraging their leaders to vote against the bill, and Roanoke emergency physician and VACEP Board member Caroline Cox, MD testified against it.

Emergency physicians (L-R) Gina Siddiqui, Todd Parker, Randall Myers, Benjamin Blackwood, Lawrence Leslie, Mary McCarthy and Jessica Cartoski met with Virginia Sen. Mark Peake of Lynchburg.

We have grave concerns about House Bill 2274 that, among other tests, would allow pharmacists to initiate treatment (and dispense medication) for urinary tract infections (UTIs). VACEP President Todd Parker, MD, FACEP testified against this component of the bill in subcommittee and it was reported out on a close 5-4 vote and last week was narrowly reported from the House’s Health, Welfare and Institutions committee 11-10.

House Bill 1764 would eliminate the 6:1 physician assistant-to-doctor practice ratio, except in the emergency department, as we asked for a carveout. A second part of the bill also eliminated practice agreements for PAs who work in hospitals. The bill failed to report out of a subcommittee.

Mental health

Several bills focus on mental health — both for patient, and provider.

Senate Bill 808 was incorporated into Senate Bill 1302. They help physicians get a medical TDO for intoxicated patients by allowing them to call magistrates without having to call courts first. This is a bill we are working on collaboratively with the Virginia Sheriff’s Association. (There is also an identical House Bill 1792).

Virginia is also considering a new mechanism to release a patient under a TDO when they are in the ER and waiting for a bed, but, in waiting, no longer meet the criteria of being a danger to themselves or others. This is a complicated topic and we are working on amendments to ensure patient safety. The bills are House Bill 1796 and Senate Bill 1299, and will be heard this week.

House Bill 1573 and Senate Bill 970 are identical and are critically important bills that direct the Department of Health Professions to amend its licensure, certification, and registration applications to remove any existing questions pertaining to mental health conditions and impairment. These bills are being spearheaded by Dr. Lorna Breen’s family and the foundation they started in her honor. We are happy to support these bills and remove more barriers to emergency physicians’ ability to seek mental health treatment when they need it. Both bills have passed out of their respective committees and will be voted on this week.