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Texas Medical Association

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Emergency: Liberty Right Infringement

Texas Right to Life General Counsel Emily Cook is attacking Texas Medical Association on Facebook, even though virtually every other pro-life, medical, nursing, hospital, and disability group in Texas oppose SB 2089 by Hughes, that would change the “Texas Advance Directive Act, “TADA” will harm patients and attack the right of doctors to refuse to act against our conscience.

Here’s a partial list of organizations opposing SB 2089: Texas Medical Association, Texas Baptist Christian Life Commission Ethics, Texas Catholic Bishops, Texas Nurses Association, Texas Society for Anethesiology, Texas Osteopathic Association, Catholic Health Association, Texas Hospital Association, Baylor Scott and White, Texas Teaching Hospitals, Texas Alliance for Life, Coalition of Texans With Disabilities.
The central question isn’t “10 days” or the actions of a “Committee.” Doctors start the process, and under the law, the Committee can only affirm that his decision is medically appropriate or not.
The question is whether a patient can demand that a doctor be forced against her conscience to indefinitely write orders and provide treatment she believes is not in the best interest of the patient because the patient or family wants it?
The patient is near death and in the hospital, so the doctor can’t morally just “fire” him if there’s a disagreement. We all agree that 10 days isn’t enough time for families, and have tried since 2005 to add days to the process – we had a Bill that would expand the time to a month in 2007. (CSSB 439)
But Texas Right to Life would/will accept nothing but indefinite “treatment until transfer.” They keep demanding lawyers, courts and trials for medical decisions.
This is the issue that caused the break between TRTL and the Catholic Bishops.
It would force Drs to violate our conscience, without compromising with a set, limited time frame.

We’ve worked to fix other problems: Artificially administered food and water, even full IV feedings, can‘t be removed. Texas law didn’t even mention DNRs, but last session, we passed an amendment with explicit procedures and informed consent language.

SB 2089 ends the ability for a doctor to “refuse” medically inappropriate treatment, only allows “recommending,” (while being legally required to act against her conscience, harming the patient, prolonging death and increasing side effects, requiring more treatments.)

There’s no leeway, at all, in the new Bill.

SB 2089 specifically says anyone can file a lawsuit in any Court in the County, the Court can’t charge the patient (or surrogates) any fees, and the judge is required to rule in 5 days.

More doctors will limit the number of older or sicker patients to keep from falling under the dispute process and the Court battle.
Even tertiary hospitals – teaching hospitals and big City referral hospitals – will find that their doctors don’t want to accept patients from outlying hospitals.
It will kill tort reform, because it’s designed to get all these cases into Court.
It’s like the Masterpiece Cakeshop case, only bigger, in my opinion, because if doctors lose here, we lose the right to conscience in everything.

If you believe that even doctors have the right of Conscience, and that infringement of the right not to be forced to act against your will is wrong, please contact your Texas Senator and Lieutenant Governor Dan Patrick and respectfully ask that SB2089 not be brought up.

You can let me know if you disagree on my Facebook page.

Death Politics

Someone named Rich DeOtte has written a Facebook piece attacking friends of mine. Rich mocks Dr. Joe Pojman as “a rocket scientist” and “knucklehead” (needless to say, that’s not popular in the Nuckols household) and takes a slap at Kyleen Wright, of Texans for Life Coalition and the Texas Medical Association.

Dr. Joe Pojman, Ph.D., is indeed a “rocket scientist,” who gave up his original career path of aerospace engineering to sacrifice as founder and Executive Director of Texas Alliance for Life, an organization I’m proud to support and serve as a Board member.

Joe wrote the op-ed that Rich attacks in direct response to the “misrepresentations” in another, political op-ed piece by Emily Kebedeaux Cook on the Texas Right to Life Website. Joe only wrote about issues, and did not engage in name calling or derision. The only reason Emily and TRTL are mentioned is because she’s the author of the political opinion piece about the “decline in the Texas Legislature’s efforts to protect human Life.”

As Joe points out, the very document to which Emily refers refutes her position: Texas was named one of three “Life List All-Stars” for 2016 by the Americans United for Life.

Joe laid out the case that our Texas Legislature’s pro-life laws are most definitely not at a standstill: we are ahead of the Nation. Joe’s position that Texas leaders gave us many successes in the 2015 84th Legislature is supported by the similar list of “Wins” reported by the Texas Catholic Conference, representing the Bishops of Texas. In an earlier letter, TCC notes that many of the criticisms Emily makes in her February 8th blog post were not previously scored “equitably” by TRTL. For instance, Senator Bob Deuell received no credit for authoring much of what became HB2.

In fact, Texas’ Legislative leadership in passing pro-life laws is why many of us are going to Washington, DC on March 2nd to bear witness when the Supreme Court hears testimony on the abortion facility regulations in HB2.

Emily and Rich focus most of their criticism on the efforts of pro-life groups, including doctors like me, to reform end of life care and the Texas Advance Directive Act (TADA). Session after session since it was passed, we in the pro-life community have had our efforts repeatedly blocked by the “death panel” accusations Rich makes and the demands in Emily’s op-ed.

I was one of the doctors appointed to the Texas Medical Association ad hoc committee that evaluated last sessions’ end of life Bills for TMA approval. Our group of doctors agreed to and helped fine tune HB 3074, what Emily called a “modest protection”: prohibiting the removal of Artificially Administered Nutrition and Hydration, including food and water by invasive medical methods like IV’s and “Total Parenteral Nutrition.” We were called anti-life and pro-“death panel” (Rich’s words) for including medical exceptions for the rare circumstances when the patient can’t process the AANH and/or when it actually caused harm.

Those “three strongest Pro-Life bills” that Emily mentioned were included in the “Wins” listed by the TCC. The Bills not only would have forced doctors to continue to indefinitely perform acts that we believe are not medically appropriate as long as a patient or his family demands it. They would have forced all disputes between the doctors practicing medicine and patients or their families into court and add “liability”(civil and criminal penalties) for the doctor.

Forget if you can, that if all disputes go to court judges would be required to determine medical care – to practice medicine – probably based on the testimony of dueling, paid medical expert doctors. Malpractice rates will go up for doctors taking on the most vulnerable patients – the elderly, the trauma victims and the victims of cancer. Those doctors will spend more time in courts, rather than in the ICU. And so will more grieving families.

We found out what happens when malpractice goes up in Texas, before tort reform was passed. Because of the malpractice crisis, there were no neurosurgeons west and south of San Antonio and Houston – none at all in El Paso or all of South Texas. We were losing obstetricians and family doctors willing to deliver babies and offer prenatal care, all over the State.

I don’t know how to translate past physician shortages directly into the possible shortage of doctors providing end of life care. However, I will predict that fewer family doctors, internists, pulmonologists and the ICU intensivists will be able to afford to practice in the ICU. Just as a patient had to be flown to Dallas, San Antonio or Houston from most of Texas for a head injury, only the tertiary medical centers in those cities will be able to staff their ICU’s properly.

Physicians, not hospitals – and certainly not courts – practice medicine in Texas. Doctors must be allowed to practice medicine according to our medical judgment, which is a combination of education and experience, under the watchful eye of the community; not “death panels,” but fellow physicians, nurses, ethicists, lawyers (who may be any of the former) and lay people. In the end, if you force the hands and minds of doctors against their judgment, you will end up with doctors practicing without judgment, and humans with inalienable rights forced to act against our will and in violation of our conscience.

And, now, back to Rich’s Facebook post. Think twice when you read political posts full of  personal attacks and name calling. We should be able to discuss politics without, as Emily said in her blog post, “unnecessary, vicious, and vindictive fights inside the Republican Party.”

Edited to fix a name glitch – BBN

Untested Waters (TMA on ObamaCare)

From the Texas Medical Association website:

Both Texas Oncology and ARC, for example, already participated in most major health plans in Texas before the launch of the exchange. Because not all of those insurers explicitly invited Texas Oncology to join their new marketplace networks, the group was combing through its contracts and contacting carriers to find out how to opt out of the exchange plans. All of ARC\’s existing contracts require insurers to renegotiate with the group before including it in any new products or networks. Some payers never approached the group; others came back with lower fee schedules, which ARC declined. On the other hand, 27 percent of respondents in the MGMA survey said they are participating in the exchange because their existing contract terms required them to participate in all of an insurers\’ products under so-called \”all products\” clauses.

Because a number of Dr. Buckingham\’s contracts include such clauses, the six-physician practice, Eye Physicians of Austin, faces the prospect of renegotiation in order to opt out of certain exchange plans.

\”To me, my hands are tied, and they are making me jump off of a plank I don\’t want to jump off of. And it\’s an expensive process, and it interrupts patient care,\” she said.

via Untested Waters.

Texas Medical Association @TexMed “Friendly Incumbent” rule

A fellow Texas Medical Association member asked me today how I felt about TexPAC – was it even worth giving them money and “what about their endorsements for judges?” He had been surprised to notice the TMA’s endorsement of some Democrat candidates after the Judicial endorsements caught his eye. (He even asked whether the list was just a pet of some of the more wealthy docs in the TMA.)

I explained that, while the TMA generally opposes ObamaCare, the Association unfortunately has what they call the “friendly incumbent” rule.  I also agreed that the policy doesn’t explain all of the choices on the TexPAC list. But for the most part, It’s virtually a given that the PAC endorses the incumbent in a race, even if the candidate doesn’t agree with the TMA on such vital issues as ObamaCare and the (Un-) Sustainable Growth Rate (“SGR”) or even the “RAC audits.” (“Recovery Audit Contractors” – *private* contractors who audit Medicare “providers” – doctors and hospitals, and earn more for finding more “fraudandabuse.”)

The policy – along with the heavy-handedness of some of the leaders of the PAC –  leads to such debacles as their mistaken endorsement of Jeff Wentworth, who opposed tort reform, over  Dr. Donna Campbell, the eventual winner (by a 2 to 1 vote!) of the Texas Senate District 25 Republican Primary,

I suggested that he include a note about his disagreements with the PAC in any check he writes in the future. As for this election, I advised my friend – who is very opposed to ObamaCare – to ignore any recommendation that didn’t have an “R” for “Republican” in front of the candidate’s name – especially when it comes to the candidates for our Third Court of Appeals: Scott Fields is a much better choice for conservative voters than the incumbent. (I could say the same about Congressional District 35, where I hope my neighbors will vote for Susan Narvaiz, rather than Layoff Lloyd Doggett.)

Texas Whooping Cough (Pertussis) Kills 5 Kids, Sickens 1,000 @texmed

 

Please consider getting your Whooping Cough vaccine.

By the time you start coughing, we can’t change your course – you will probably cough for the next month or more. The new pertussis vaccine in the “D-TaP” or “T-DaP” is “acellular,” not the old one that so many worried about in the past. http://www.immunize.org/catg.d/p4212.pdf

From the Texas Medical Association’s “Me and My Doctor:”

FRIDAY, SEPTEMBER 7, 201

Texas Department of State Health Services Commissioner David Lakey, MD, issued an advisory yesterday urging Texans to protect themselves and their loved ones from pertussis (whooping cough) by getting vaccinated. An increase in cases this year claimed the lives of six children — two of whom were infants — and sickened more than 1,000. That’s the highest number of pertussis victims since 2005. Texas doctors urge families to avoid tragedy by vaccinating their children and themselves from this deadly disease. Read More:

Texas Medical Association wants you to pay for elective abortions @texmed @texasallianceforlife #pro-life #tcot

Not all of the members of Texas Medical Association agree with the TMA on this.

The San Antonio Express News published an editorial August 9th, by O. Ricardo Pimentel, entitled, “Texas tries to get between you, your doctor:”

For them, the issue isn’t abortion; it’s about the doctor-patient relationship, patient health and the ability to put everything on the table that needs to be discussed. Even if it’s abortion.

In a recent letter to the state, the Texas Medical Association, joined by other medical groups, said Texas is about to embark on a plan for providing medical care to low-income women that will impose a “gag order” on discussing abortion even on doctors working with patients not in the program.

Other groups, weighing in during the public comment period on proposed state rules, have similar concerns.

It’s a plan, they say, that will ensure not enough doctors for this program willing to provide care, including family planning services. And this, they say, will guarantee more unintended pregnancies, more abortions and more illness that might have been prevented for low-income women.

Among those also commenting on the rules were the Center for Public Policy Priorities, and leaders of Planned Parenthood entities in the state, South Texas groups among them.

Trust me, for everyone who is mentioned above, it’s about abortion. The law doesn’t stop anyone from discussing or even promoting true contraception that doesn’t end the life of our youngest children of tomorrow.

And it is about “elective abortions:” those that are performed on health babies in healthy mothers. We’re not talking about the more controversial abortions in cases of rape and incest, much less in the cases of congenital disorders that are “not compatible with life outside the womb and certainly not in cases where the mother’s life is in danger. Since when do elective abortions “need to be discussed?

How difficult is it to understand that Texas taxpayers should not pay for “promotion” of abortion? Or that we most certainly do not want our State tax funds to go to doctors who perform elective abortions on healthy babies and healthy mothers?

While I don’t speak for the Society, I am an elected delegate for my County Medical Society to the TMA House of Delegates and I believe that most of our members would agree with me on this. I am very much in favor of restricting payment from our limited State funds to only those doctors and organizations that provide comprehensive and continuing medical care for the whole woman and her whole family. With Texas Family Doctors, Internal Medicine Docs, Pediatricians and OB/Gyns reeling from the lack of increasing fees from Medicare and decreases in Medicaid funding, why not help keep them in business by adding the availability of billing the State for screening tests like pap smears, exams for breast masses, diabetes and high blood pressure?

In fact, that’s what the Legislature decided: that money would be prioritized. First come the comprehensive care docs, hospitals, and county and city clinics. Planned Parenthood is never mentioned, although there is a section of the law that absolutely prohibits the State from contracting with anyone who “promotes” abortion *if there are other qualified providers available.*

Texas DHS has already identified more than enough doctors and clinics that qualify under the law. These doctors can actually treat the diseases for which the Texas Women’s Health Plan screens. Our Texas Legislature made a wise decision when they agreed that it doesn’t make sense to send our few dollars to a clinic that treats a very narrow medical spectrum in an intermittent manner.

And the law has already saved human lives: Austin city and Travis County taxes once paid for 400 elective abortions each year. A year ago, the law achieved what the taxpayers who protested this use of their money couldn’t do: Austin and Travis County health clinics were forced to stop funding those abortions.
If you have a family doctor, consider a polite call to his or her front desk asking them to let the TMA know their views on using Texas’ tax funds to support Planned Parenthood and other abortion providers.

You might also consider contacting Texas Alliance for Life and/or you local Crisis Pregnancy Center to let them know that you support their efforts to keep your State (and federal) tax funds from paying for the ending of lives of our Texans of tomorrow.

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