As president of the Idaho Medical Association, I feel compelled to comment regarding two bills pending in the Idaho Senate, HB 191 and HB 195. I urge you to become familiar with each. Both bills passed the House and cleared the Senate Health and Welfare Committee. Only the Senate needs to approve before submission to Gov. Butch Otter.
HB 191 grants broad medication prescribing powers (as opposed to traditional dispensing powers) to pharmacists. Other states have granted pharmacists prescribing power, but HB 191 appears to be the broadest and most liberal in the U.S.
HB 195 authorizes chiropractors to treat patients with “substances” through intra-muscular and IV routes. Included are minerals such as potassium, iodine, copper, zinc and drugs including epinephrine. Concerning to physicians is that more than half of substances in HB 195 can cause sudden cardiac death.
The future of health care delivery in the U.S. is focused around Patient Centered Medical Homes. “PCMH” is a team-based health care model led by a health care provider (usually a primary care provider, or “PCP”) intended to provide comprehensive and continuous medical care to patients with the goal of maximized health outcomes. The PCP is the “quarterback,” in essence the “hub” of the health care delivery wheel. Neither bill integrates care into the PCMH model. In fact, the “care” authorized by these bills flies in the face of the entire design of the PCMH as it is not coordinated through or under the direction of the PCP.
While possibly well intentioned, the risk that accompanies these proposed bills substantially outweighs any possible benefit. The referenced professions have appropriate training in their respective discipline, which can be involved in delivery of care through a PCMH. However, neither profession has training or the experience to provide the care as identified in these bills.
Utilization of medications critically requires an accurate diagnosis. Pharmacists have extensive training, but not in diagnosing medical conditions. HB 191 anticipates the Board of Pharmacy in conjunction with the Legislature may provide limitations in terms of such medications. However, as written HB 191 does not contain limitations. Based upon some legislator responses to physicians, it is clear that not all legislators understand the complexity of prescribing medications, many of which require close or periodic monitoring.
HB 195 recognizes that chiropractors are inherently deficient in use of the identified substances as HB 195 requires a “pre-cursor” nutrition course of approximately 40 hours. Compared to medical school and residency, 40 hours is extremely deficient for administration of potentially life-threatening substances via IV routes and appropriate monitoring of the same.
If you have concerns regarding these bills, I urge you to contact your respective senator immediately. Our Legislature has the responsibility to serve the public. To quote President Donald Trump recently, “nobody knew that health care could be so complicated.” In fact it is complicated — physicians know and appreciate that fact and are faced with it every day. Consequently, the Idaho Medical Association mission includes the following statement: “the protection of the public health.”
Bruce Belzer, MD, is a WWAMI and Family Medicine Residency of Idaho graduate. He is president of the Idaho Medical Association, a statewide organization providing representation and advocacy for over 2,700 physicians, residents, medical students, physician assistants and nurse practitioners. He is also a graduate of the University of Notre Dame School of Law, and states he looks at issues with his entire education and life experience in mind.