Volume 16, No. 2, Spring 2008
By Senate President Therese Murray
Together with my colleagues in the Senate, I have been proud to announce major health care legislation that will make Massachusetts a national leader in the statewide adoption of electronic medical records and the first in the country to impose an outright ban on pharmaceutical marketing gifts of any value.
The Senate bill, An Act to Promote Cost Containment, Transparency and Efficiency in the Delivery of Quality Health Care, also addresses the critical areas of primary care access, transparency and efficient use of resources and technology to drive down escalating costs in our health care system.
This legislation represents a defining moment for the Commonwealth and our efforts are crucial to the future vitality of our health care system and our economy. This bill makes good on the promise I made in October to propose bold measures to ensure the success of health care reform in Massachusetts.
If we expect to realize the full promise of the state's landmark health reform law–to achieve universal health coverage with safe, high quality and affordable care for all–this bill is vital. We must expand access to care, ensure a transparent system of quality improvement and cost containment, and improve the overall health of the people of Massachusetts.
The Senate bill mandates statewide adoption and compatibility of electronic medical records by 2015, backed by a public commitment of $25 million a year to accelerate the program. Physicians would have to show competency in the technology for medical board registration. The bill also sets a deadline of 2012 for statewide adoption of Computerized Physician Order Entry systems (CPOE). After this date, the use of CPOE would be required for hospital licensure.
These initiatives will modernize the health care system, reduce waste and inefficiencies, and improve health care quality for every citizen of the Commonwealth.
The gift-ban measure prohibits pharmaceutical agents from offering gifts and physicians from accepting gifts of any kind. The ban extends to physicians’ staff and family members. The legislation allows distribution of drug samples to doctors for the exclusive use of their patients.
This bill is truly a collaborative effort and I want to congratulate Senators Richard Moore, Mark Montigny, Karen Spilka, Robert O’Leary, Susan Fargo, Steven Baddour, Stephen Buoniconti, Gale Candaras, Steven Tolman and others who made this bill possible. I’m proud of the Senate’s work to make this a meaningful and comprehensive piece of legislation.
Other highlights of the bill include:
(Senator Murray, D-Plymouth/Upper Cape, is the first female President of the Senate in Massachusetts history.)
By Senator Rob O’Leary
I want to commend the Senate President, Therese Murray, on filing a thoughtful and comprehensive piece of legislation to continue the Commonwealth’s efforts at health care reform. Increasing access to primary care is essential to completing our goal of universal health care, especially for underserved regions of the Commonwealth. We must do more to control the growing cost of health care for our first-in-the nation approach to work. I would like to speak to a few specific aspects of the bill that are of interest to me.
As the Senate Chairman of the Joint Committee on Higher Education, I am particularly interested in the expansion of UMass Medical School.
Under the current legislation the Medical School was originally tasked with producing primary care physicians for Massachusetts, but today very few students choose primary care as their specialty. The medical school is solely for Massachusetts residents with each class capped at 100 students. Currently, there is a doctor shortage in Massachusetts; expanding the medical school and creating incentives to encourage students to go into primary care are important steps to begin to alleviate this crisis.
There is an ongoing nationwide movement, encouraged by the Association of American Medical Colleges, to expand medical schools and produce more doctors. This bill authorizes an expansion of the medical school, it directs the board of trustees to determine the appropriate size of the increase and create more opportunities in primary care instruction.
Money to support this expansion will be included in the Higher Education Capital Bond Bill. The legislation creates an Enhanced Learning Contract for students at UMass Medical going into primary care. Participation in the program garners the student full waiver of tuition and fees; in return a student owes a payback service of at least four years as a primary care physician in an underserved area of the state. If students do not perform the payback service directly after completion of training they shall pay back the financial grants they received two-fold. The Commonwealth will bear the cost of this incentive program.
This and other reforms proposed by the bill are important first steps towards increasing access to care and reducing system-wide costs.
However, I think that we can do more, especially in the area of malpractice reform. The legislation as filed authorizes a Medical Malpractice Study, directing the Division of Insurance to conduct an investigation into the high costs of medical malpractice coverage for health care providers and the possibility of prorating premiums for providers who practice less than full time.
We must do more to improve the medical malpractice liability climate in Massachusetts. Today’s process for resolving medical injury cases takes too long, is inefficient and does little to promote system-wide enhancements in patient safety.
Doctors no longer can afford the skyrocketing premiums for this insurance and many are refusing to practice certain specialties, such as obstetrics, or are leaving the state altogether.
The practice of defensive medicine, in which doctors order unnecessary tests to protect themselves from malpractice claims, further inflates health care costs. Moreover, our costly court system fails the patients. Studies suggest that fewer than five percent of injured patients ever seek claims. And cases are kept quiet, so doctors never learn from mistakes.
Caps on damages or other avenues of tort reform have often been suggested as means of addressing the liability crisis. But while these caps may slow the growth of insurance rates, they do not address the underlying problems with our adversarial tort system and do nothing to improve patient safety. We must find a better option for reform.
An alternative approach could help to correct these failings, while potentially reducing adversarialism in the system–benefiting both patients and health care providers.
(Senator O’Leary, D-Cummaquid, represents the Mid and Lower Cape and Islands and is a member of the Legislature’s Joint Public Health Committee.)
By Representative Cleon H. Turner
As any parent of a teenager can tell you, drug abuse is a constant concern, creating negative affects to the individual, the family, and the community. Naturally, this combination inspires legislators to take the matter very seriously.
Adding to parental fears, those who wish to perpetuate drug abuse and its culture continually find non-regulated material to push onto the public. Law enforcement and the legislature must remain constantly vigilant to keep regulations up to date regarding drugs that can be abused.
For these reasons, a bill has been recently introduced by two Republican representatives, Vinny deMacedo of Plymouth and Daniel Webster of Pembroke, to outlaw two more new drugs that have similar properties to currently illegal drugs, but have only recently become more popular in the United States.
On March 18, the Joint Committee on Public Health heard testimony from law enforcement personnel and legislators regarding House Bill 4434, An Act Relative to Controlled Substances. The bill seeks to amend Chapter 94C of the Massachusetts General Laws to add newly recognized drugs kratom and these salvia derivatives, Salvia Divinorum, Salvinorin A, and Catha Edulis as controlled substances.
Virtually unknown to many Americans, kratom is obtained from a tree native to Southeast Asia while salvia is a plant native to Oaxaca, Mexico where it has been used for meditation and enlightenment by the natives of the area.
Salvia derivatives produce hallucinations much like LSD, even in small doses. With more use, “flashbacks,” depression, and schizophrenia may also ensue. In spite of this, salvia is legal in almost every state and anyone can buy it in stores or online. This mind-altering drug, which can be smoked, chewed, ingested as tea, or vaporized and inhaled, has been outlawed only in Louisiana, Missouri, Tennessee, Oklahoma, and Delaware. Because salvia is not included in drug surveys and only in a few studies, little is know about the rates of use or even who is using it.
Kratom produces euphoria and acts as a stimulant in low doses and a depressant at higher doses.
If passed, Bill 4434 would outlaw manufacturing, distributing, dispensing, or possessing these drugs. Kratom would be listed as a class B drug (drugs with opiate qualities) and Salvia would be listed as a class C drug (drugs having depressant effects on the nervous system). Penalties for violations would be the same as existing penalties under the respective controlled substances classes.
The bill has been reported favorably by the Joint Committee on Public Health and was referred to the House Committee on Steering, Policy, and Scheduling.
(Representative Turner, D-Dennis, is a member of the Legislature’s Joint Public Health committee.)