The Commonwealth of Virginia has a duty to assure that professional standards are met in the delivery of health care for all citizens. For those who cannot provide for their own basic needs, state government actions should enhance the delivery of services; focus on developing maximum abilities that may lead to independence; and not add cost or delay to private, charitable, or local government providers.
One reason I enjoy serving at the state level is that we are still close enough to really see what works. One type of service in one area of Virginia is best delivered by the private sector; in another area, non-profits know community needs best; while in some areas government has to step-in to fill service needs. The challenge is to find the right balance and to assure that government oversight of taxpayer funded programs is well-focused accountability and not simply red-tape.
Often when I cast a vote in the legislature, I see the faces of someone I've met in an Alzheimer Center, a kid I went to school with in rural Michigan, a parent who must have help to keep their retarded child at home, or a volunteer whose passion leaves them frustrated with lack of professional support. I believe that the common good has to embrace the "least" among us. We must never lose sight of the individual human being, whose increased level of functioning will make us all stronger.
ASSISTED LIVING FACILITIES
The Washington Post's series on shocking conditions in Assisted Living Facilities put a face on bills I carried since 2000. In 2005, I worked with key legislators and responsible assisted living operators to create much-needed protection for over 30,000 people who cannot live on their own and are in assisted living throughout Virginia. Our 2005 legislation creates
oversight for dispensing medications,
better mental health screening,
licensure of operators so that the bad apples can't just close one home and open another, and
emergency help for residents in unsafe homes.
Fines were substantially increased from just $500 to up to $10,000 (the maximum fine currently possible for veterinarians), but we also provided that fines could be used to remedy conditions. We also increased the number of inspectors and their training. Finally, we modestly increased state funding for needy residents by $50 per month, but the total is still far below actual costs.
NURSING HOME STAFFING
See discussion on this issue under Seniors
The cost of medical malpractice insurance is becoming prohibitive, especially for emergency and obstetrical physicians. However, legislation to cap lawsuits did not pass because Virginia's cap is already the 3rd lowest in the nation. This should drive Virginia insurance rates down and a 2005 study will determine if Virginia doctors are in fact subsidizing the cost of lawsuits in other states.
In 2003, a series of news articles about doctors who continued to practice after numerous, serious incidents affecting patients, led to comprehensive reform. The disciplinary standard was lowered from gross negligence to simple negligence and 3 years must now lapse before a doctor who's lost his license can be re-instated. In addition, reporting requirements for institutions and healthcare professionals who witness questionable actions were significantly strengthened.
If an HMO denies you a medical procedure that is later found to be necessary, you cannot recover the damages you suffer -- even if the decision results in death or disability. For the second year, an attempt to correct this major lack of accountability, which also severely limits patient and doctor choice, was killed by a party vote in 2000.
Policies issued on or after July 1, 2000 by health insurers, HMO's, and health care subscription contracts must cover
* childhood immunizations (subject to co-payment provisions);
* hospitalization or out-patient costs for anesthesia required for major dental work on a child under age 5, a severely retarded or mentally disturbed person, or a person with a limiting medical condition; and
* specific, medically necessary prescription drugs without additional cost sharing. Insurers, after reasonable consultation with the prescribing doctor, must act on requests within one business day.
In 2001, I got a bill passed (HB2704) to require insurance and HMO coverage when pharmacists provide services, such as diabetes training, which otherwise would be performed in a doctor's office.
Also in 2001, we extended Medicaid coverage to breast and cervical cancer treatments. This captures $2 of federal funds for every $1 in state funds.
In 1996 through 1999, we passed bills requiring insurance policies to include contraceptives if they cover outpatient prescriptions; an annual OB/GYN visit, as well as mammograms and pap smears; annual prostate cancer screening; hospice care; and diabetes equipment, supplies and outpatient self-management training. Policies must also cover treatment of biologically-based mental illnesses, including depressions and drug and alcohol addiction, at the same level that physical illnesses are covered.
In 2005, in response to arrests made for purchasing bear gall bladders, I was pleased with the state's immediate response to my call for an education program on all such laws.
In 1999, I changed state regulation of acupuncture so that patients can go directly to an acupuncturist without being referred by a physician and the acupuncturist is not barred from dispensing herbal preparations and nutritional supplements (HB2061). Further reform resulted recognition of acupuncture through establishing its own board under the Board of Medicine.
MENTAL HEALTH AND PHYSICAL DISABILITIES
Long before the inconceivable tragedy of Virginia Tech, informed members knew Virginia lagged far behind in providing mental health services. Access to help and accountability vary tremendously statewide. Reluctance and shame still stifle discussion. Several General Assembly members have significant experience in mental health. Mine includes 30 hours of college courses focused on scientific research on brain functioning. I also headed a non-profit that worked with the mental trauma of child abuse and neglect.
Before the 2008 Session, commissions and legislative committees spent countless hours looking at what Virginia Tech revealed about our mental health system. During the Session, I was part of numerous long meetings trying to truly understand the ramifications of reform proposals. We passed laws to change the commitment standard to respond better to potential danger. We spelled out oversight responsibility for out-patient tracking. I particularly focused on better information sharing. Despite a tight budget, we added funding for 40 mental health service providers. We also funded the Wounded Warrior initiative to provide mental health services to veterans, guardsmen, and reservists.
The challenge will be to preserve this progress as we grapple with Budget shortfalls in the 2010 Session. Autism services and insurance coverage is another very significant challenge that died in committee in the 2009 Session.
Since 2004, each year, we have funded new mental retardation slots for individuals on the urgent waiting list, more slots for at home services, and slots for developmentally disabled. This funding is especially important to aging parents concerned about transitioning an adult child into alternative care.
Since erratic behavior could be related to a serious physical condition, in 2002, I introduced legislation to require a medical screening before a person is admitted to a mental health facility. While having ready access to a doctor in rural areas is a problem, the underlying issue really is who will pay for medical care. It's often easier to get a poor person admitted to a mental health facility than to a medical hospital.
In 2002 Virginia finally joined 39 other states by having an independent ombudsman to investigate complaints of abuse or physical conditions in facilities. It was a 3-year battle against administration objections to this safeguard. Legislation to establish an Ombudsman office was driven by tragedies revealed in a federal investigation of deaths in Virginia facilities. One woman who had spent 558 hours in restraints in the two months before she died. A letter, responding to her attempts to get help, arrived 19 days after her death: "... Since we have not heard from you in over 90 days ... assume you have no new concerns ... we will close your case with us."
CHILDREN'S HEALTH INSURANCE
In 2001, only half of children of working poor were covered by a health insurance program launched 2 years earlier. Virginia was the only state that required mothers to give information about an absent father and, in Fairfax, lack of information about the father was the biggest reason for denial of coverage. My bill (HB1982) made disclosure voluntary. Under the Warner administration, Virginia became a national leader in enrolling uninsured children by simplifying the application process, removing barriers to enrollment, making application sites more widely available, and promoting the program aggressively statewide.
WHEN LIFE BEGINS
I believe the very complex decision of when life begins should be a personal choice. I will continue to defend that position in all of the challenging and complex ways that it comes before the Virginia General Assembly, including birth control; in vitro fertilization; a women's right to chose to have an abortion under Roe v. Wade; the right of a person to have an advanced medical directive carried out that bars heroic efforts; and the advancement of stem cell research in the treatment of disease and disabilities.
If a fertilized egg is defined as a fetus throughout Virginia's law as it was in a 2009 biotech research amendment, 40% of commonly used birth control would be outlawed as an abortion, because the pill can operate to prevent a fertilized egg from implanting in the uterus. Bills are repeatedly killed in the House that would ensure that using any such contraceptive would not be termed an abortion.
In 2005, the federal court struck down a law passed in the 2003 session, which I voted against, that barred most abortions after the 15th week, because it had no provision for medical decisions to protect the life of the mother. The 2000 Supreme Court ruling in Nebraska v. Carhart was based on a thorough review of medical testimony regarding the rare need to end a pregnancy after the 14th week but before viability outside the womb. Abortions in this this time frame are typically forced by the woman's dangerously deteriorating health related to diabetes or poor kidney functioning.
In 2003, I voted against a bill requiring parents who consent to their daughter having an abortion to do so before a notary, which I thought was an invasion of privacy especially in a rural setting. Since 1979, Virginia law has required written informed consent before an abortion, which I support. In 2001, I voted against requiring women to wait 24 hours after receiving required information because of the burden in placed on women in remote rural areas.
I support educational efforts to prevent un-wanted pregnancies and sexually transmitted diseases.