Virginia HB 512
HB 512 STATUS- Failed or awaiting action- Continued to next session
HB 512 Lyme disease; allows a licensed physician to prescribe long-term antibiotic therapy.
Delegate Tom Rust introduced H.B. 512, a doctor protection bill relating to antibiotic treatment for Lyme disease.
The bills intent is to allow a physician to prescribe long-term antibiotic therapy to a patient diagnosed with Lyme and other tick borne diseases and not be targeted by the Board of Medicine for doing so.
The National Capital Lyme and Tick-Borne Disease Association endorsed Delegate Rust’s bill and reported they worked closely with his staff.
The bill was not initiated, nor endorsed by national or state groups and they were not asked to participate in the bill process.
Summary as introduced:
Lyme disease; long-term antibiotic therapy allowed. Allows a licensed physician to prescribe, administer, or dispense long-term antibiotic therapy to a patient diagnosed with Lyme disease. Also specifies that the Board of Medicine shall not initiate a disciplinary action against a licensed physician solely for prescribing, administering, or dispensing long-term antibiotic therapy to a patient clinically diagnosed with Lyme disease, provided such clinical diagnosis and treatment has been documented in the patient's medical record by such licensed physician.Full text:
01/12/10 House: Prefiled and ordered printed; offered 01/13/10 10103686D
02/01/10 House: Subcommittee recommends continuing to 2011 by voice vote
02/02/10 House: Continued to 2011 in Health, Welfare and Institutions by voice vote
The bill states- "C. The authority granted in this section to prescribe, administer, and dispense antibiotic therapy shall also apply to other tick-borne infections."
There is little to no evidence/peer-reviewed studies showing other TBD's (RMSF, Babesia, Bart, etc) can not be cured with standard protocols or that they can become chronic and/or require additional treatment. There are no strong references to support limitless therapy for other tick borne diseases. This section will draw opposition from insurance companies and members of the medical field.
The bill refers to "antibiotic" therapy for other TBD's. Technically speaking, not all TBD's require antibiotics; some require the use of anti-parasitic drugs, anti-malarials, anti-microbials, etc. Without clarification, much-needed long-term (expensive) treatment with Mepron for Babesia, for example, may not be addressed in this bill and may leave the physician open for sanctions. Virginia DoH already has a history of targeting doctors for diagnosing Babesia and the health department has warned at least one Lyme treating doctor officially that Babesia is not found in Virginia. Accordingly, doctors are to not test for it, diagnose it or treat it.
NEW HAMPSHIRE- "No licensed physician may be subject to disciplinary action solely for prescribing, administering, or dispensing long-term antibiotic therapy for a patient clinically diagnosed with Lyme disease, if a diagnosis and treatment plan has been documented in the physician’s medical record for that patient."
VIRGINIA- "The Board of Medicine shall not initiate a disciplinary action against a licensed physician and such physician shall not be subject to disciplinary action by the Board of Medicine solely for prescribing, administering, or dispensing long-term antibiotic therapy to a patient clinically diagnosed with Lyme disease, provided such clinical diagnosis and treatment has been documented in the patient's medical record by such licensed physician."
Concern- The Virginia bill states the Medical Board can't "initiate" an action, but it doesn't close the deal by saying others can't initiate an action. The New Hampshire wording could potentially stop others (insurance companies, IDSA, drug companies, disgruntled spouse, etc) from "initiating" an action because they didn't limit it to the Medical Board in their wording.
The Virginia bill also states:
"B. Nothing in this section shall be construed to grant any person immunity from investigation or disciplinary action for any other violation of this title."
There is no mention of this provision in the NH bill. The Maryland Board of Physicians, for example, used that wording in the statement they issued for Maryland doctors in order to protect them.
Nat Cap issued the following press release concerning HB 512.
For Immediate Release:
CONTACT: Monte Skall- 703-821-8822
New Lyme Law Proposed to Protect Virginia Doctors Treating Lyme Disease
U.S. Physicians Fear Losing Medical License for Treating Lyme Aggressively
(Richmond, VA) -
A new bill, introduced in the Virginia House of Delegates by Tom Rust, Delegate, 86th District (R), seeks to protect physicians in Virginia who provide extended antibiotic therapy to patients diagnosed with chronic Lyme and other tick-borne diseases.
Currently doctors treating Lyme disease aggressively with long term antibiotics are targeted by medical boards and insurance companies and face losing their license.
Lyme disease is the fastest growing infectious disease in the United States today. This disease, caused by the bite of a tick, has reached epidemic levels in many counties in Virginia.
Most experts agree that reported cases are likely to represent only a tenth of the actual number of cases.
Delegate Rust introduced this bill to empower physicians to provide effective, desperately needed patient care.
"Doctors should be able to treat patients based on their best medical judgment, without fear of retaliation. "
Delegate Rust added, "If Lyme disease is untreated or not treated aggressively it can have far-reaching implications - not only for patients' health but also for healthcare costs, disability compensation and worker productivity.
These costs far exceed the expense of paying for therapeutic antibiotics to treat the infection and its symptoms."
The National Capital Lyme and Tick-Borne Disease Association, an organization with over 1800 members, including affiliated chapters across the state in Central Virginia, Fairfax, Hampton Roads, and the Shenandoah Valley endorses the bill.
Executive Director Monte Skall said, "House Bill 512 is necessary to improve treatment options for patients.
Our hotline receives dozens of calls every day from patients seeking a doctor knowledgeable in the treatment of tick-borne diseases, often reporting they have had to drive hundreds of miles to receive care, frequently out-of-state.
I am confident that passage of HB 512 will result in many more physicians willing to treat Lyme patients with the standard of care they believe most appropriate. "
Dr. Samuel Shor, an internist in Reston, Virginia who studies, researches and treats Lyme disease said: "physicians are finding, and the literature supports, the need for long term antibiotic therapy when treating certain cases of Lyme disease.
The treatment guideline limited to four weeks of antibiotic treatment is seriously flawed.
In fact, a two year investigation by the Connecticut Attorney General resulted in a reevaluation of that guideline, yet it remains the de facto standard."
"It is interesting, " he noted, "doxycycline often used for the treatment of Lyme disease is commonly used long-term by dermatologists for acne."
When detected early, the disease is considered curable with a limited course of antibiotics, typically 30 days.
Unfortunately, diagnosis and treatment of Lyme disease are often hindered by the limited sensitivity of current tests, and physician lack of awareness of the prevalence of the disease in Virginia.
Early symptoms of Lyme may include: headache, stiff neck, fever, muscle aches, and fatigue.
If left untreated, the disease is thought to become chronic with more serious complications such as:
joint pain and swelling; heart disease; neurological problems such as Bell's Palsy; dizziness; irritability; ADHD-like symptoms; cognitive dysfunction; and muscle weakness.
For more information on HB 512, please contact Monte Skall at 703-821-8822 or visit the NatCapLyme website at www.natcaplyme.org
NAT CAP PRESS RELEASE
February 2010- H.B. 512 was not forwarded to the full committee for action, neither was it defeated. It was rolled over to the 2011 session of the House of Delegates.
In addition, the bill was referred to the Virginia Department of Health (“VDH”), the parent organization of the Board of Medicine, for additional study and to try to resolve the issues without legislation. A brief meeting with representatives of the VDH, who were in attendance, confirmed that they will meet with us and take our cause, and our needs, seriously. If there is no progress by the next session, the bill is still alive and can be acted upon at that time.
Delegate Rust introduced the bill and offered a good description of the Lyme disease problem in the U.S. as well as in Virginia. He cited Governor McDonnell, “As Governor I look forward to working with you and others to improve reporting and education efforts, as well as examine ways to provide our physicians the ability to meet the treatment needs of their patients without undue liability threats.” We had six witnesses ready to testify in support of the bill beginning with Dr. Sam Shor, who delivered a well documented statement about the need for physician protection because of Board of Medicine intimidation in other states and the fear of such intimidation in Virginia.
As soon as Dr. Shor completed his statement, it became clear that several members of the subcommittee had been prepped by the medical society with questions. The committee took at least another 15 minutes with very tough questions that appeared to come directly from the bill’s detractors, including the medical society and the Infectious Disease Society of America (IDSA). Dr. Shor, put up a good defense of the bill and its purposes, but it became clear that the subcommittee members were not prepared to move the bill forward in this session. After Dr. Shor, there was only a small amount of time for the rest of the witnesses to speak. Much of the questioning related to why Lyme disease should be addressed by legislation when Virginia has an expert agency charged with the responsibility to consider these matters.
The respondents included Dr. Donald Poretz, the former president of the IDSA and a local pediatric rheumatologist. They warned that the use of long-term antibiotics have dangerous side-effects and create antibiotic resistant “super bugs.” Unfortunately, there was no opportunity for rebuttal.
While many of the members were skeptical, they all recognized the problem presented by the exponential growth of Lyme disease in Virginia. In response to opposing testimony from doctors, Delegate Spurill, of the cities of Chesapeake and Suffolk, became passionate for the Lyme patients in the room. In response to the motion to hold the bill over to 2011, Spruill said,” Is this all that we are we going to offer these people who have come here tonight?”
In the end, we did achieve a good result. It is extremely difficult to get a bill like H.B. 512 passed the first time out. It took several legislative sessions in Connecticut to get that bill passed. The New Hampshire effort this year met similar opposition and also was referred to the medical expert agency. Further, in a highly specialized area of expertise, such as medicine, it is customary to refer to the expert agency first, before turning to legislation.
Here are the main points:
- The bill was not killed, it is not dead; it is tabled.
- The bill was referred to the Virginia Department of Health, the parent organization of the Board of Medicine, for study and evaluation. Implicit in this referral is the need to report back to the committee. Lyme advocates can make sure that happens by continuing to impress their delegates and senators of the need for accountability and a report.
- The Virginia Department of Health representatives will meet with us which opens the dialogue we have been striving for. * While this bill is alive, the Board of Medicine is not likely to bring charges against any Virginia physician solely for the use of long-term antibiotics, which was the precise purpose of HB 512. If they do, they will be demonstrating the need for the legislature to take control and pass the bill.
What saved the bill in the face of obvious heavy lobbying by the IDSA and the Virginia Medical Society was the overwhelming number of Lyme patients that filled the hearing room. Very few issues get that kind of a turn out and it was impressive without a doubt. In the face of so many patients, it was impossible to kill the bill.
So this was not a loss, it is a bump in the road. Some may consider that spin, but it is also the truth. We need to keep moving forward. We have the ear of the Virginia Department of Health. We will meet with them and we will educate them. They have a mandate from the committee to offer all Virginia doctors a CME course on Lyme disease this year. Following the hearing it was agreed with the VDH representative that the CME course would not be one-sided. If they do not fulfill our needs, we’ll be back in the 2011 session to tell the legislature where the Department of Health failed.
And, we’ll be back with H.B. 512 again in the next session. It took several attempts to pass legislation in Connecticut. We should not expect any less in Virginia, a state where Lyme wasn’t even acknowledged as a problem until a few years ago.
State of Board of Health
January 29, 2010 – 9:00 a.m.
Perimeter Center, 9960 Mayland Drive
Richmond, Virginia 23233
Members present: Dr. Craig Reed, Vice Chairman; Dr. Julie Beales; Scott Burnette; Paul Clements; Jim Edmondson; Bruce Edwards; Dr. Anna Jeng; Dr. Charles Johnson; Willis Logan; Dr. Bennie Marshall; Dr. Bhushan Pandya; and David Summers.
Members absent: Barbara Favola, Fred Hannett, and Ed Spearbeck.
VDH staff present: Dr. Karen Remley, State Health Commissioner; Jeff Lake, Deputy Commissioner for Community Health Services; Joan Martin, Deputy Commissioner for Administration; Joe Hilbert, Executive Advisor; Martha Pulley, Policy Advisor; Catherine West, Administrative Assistant; Dr. Joanne Wakeham, Director of Public Health Nursing; Gary Brown, Director of the Office of Emergency Medical Services; Paul Sharpe, Trauma & Critical Care Manager, Office of Emergency Medical Services; Michael McMahon, Deputy Director, Office of Financial Management; Dr. Michael Royster, Director, Office of Minority Health and Public Health Policy; Dr. Keri Hall, Director of the Office of Epidemiology; and Nevena Skoro and Janet Mulligan, guests of the Commissioner
Others Present: Robin Kurz, Attorney General’s Office.
Page 3 Quote-
This was provided by Joe Hilbert. There was a brief discussion concerning the intent of SB540 and what this bill is trying to accomplish. Mr. Hilbert stated that VDH would examine this bill more closely.
There was a discussion of the impact of the increasing deer population in Northern Virginia with regard to bills that were introduced pertaining to Lyme disease."