WVSMA Legislative Position Statements 2015
One of the primary purposes of the WVSMA is to promote public health, which we believe is best
accomplished by maintaining the highest standards for the medical profession and supporting
legislation that will allow West Virginians to enjoy the best possible health care. During the 2015
WV Legislative Session, we believe the following issues are of particular concern:
Preventing Scope of Practice Expansion by Non-Physicians
The WVSMA opposes the effort by Advanced Practice Registered Nurses (APRNs) to gain
privileges traditionally reserved for physicians because APRNs have substantially less
education and training compared to physicians. When non-physician practitioners are
permitted to perform services that are not commensurate with their education, training, and
experience, patient safety is threatened and public health is compromised.
APRNs have submitted a proposal to the WV Legislative Auditor’s Performance Evaluation and Research
Division (PERD), requesting that the Legislature enact legislation to remove the collaborative agreement
requirement, expand their prescriptive formulary, and grant them signatory authority equivalent to
physicians.
In nearly perfect concurrence with the report issued by PERD in response to the APRNs’ proposal, the
WVSMA believes that the 2015 WV Legislature should leave current regulations governing APRNs in place.
The only new rules the WVSMA supports are the following, as recommended by PERD:
The Boards of Medicine and Osteopathy should be directed to develop collaborative agreement
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rules, standardizing evaluation and review processes, and limiting the number of agreements that
either a physician or APRN can enter into.
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Oversight for APRNs’ prescriptive authority should shift from the Nursing Board to the Board of
Medicine.
The WVSMA supports a team approach to health care, in which physicians collaborate with other medical
professionals, with physicians leading the team. Through such collaboration, patient access and quality care
can be achieved without threatening patient safety. The WVSMA feels that it is of paramount importance that
current restrictions on prescriptive authority by non-physicians remain in place in an effort to help control the
significant drug abuse problems in our state.
For these reasons, the WVSMA is strongly opposed to SB 21, “Expanding prescriptive authority of advanced nurse
practitioners and certified nurse-midwives.”
Substance Abuse: Balancing Prevention with Treatment
The WVSMA supports policies that facilitate treatment opportunities for individuals suffering
from substance use disorders. Policies that discourage diversion of prescription drugs must be
balanced with policies that promote physicians’ ability to provide comprehensive and
compassionate care, and enable individuals to access appropriate treatment.
Substance use disorders are a significant problem in the United States and in West Virginia. The problem of
prescription drug diversion is an epidemic affecting not only adults but also our children and teens. The WVSMA
recognizes the importance of policies that prevent substance abuse and prescription drug diversion through law
enforcement mechanisms, but we also recognize that physicians have a responsibility to provide appropriate
treatment to patients, and policies should not interfere with their ability to practice good medicine. Policies
should not focus on requiring physicians to be watchdogs for potential drug abusers because this could deter
patients from seeking help or treatment.
With the recognition of the problems associated with prescription drug diversion, misuse, and addiction in
West Virginia and the understanding that it is physicians’ responsibility to help lead the effort to address this
epidemic, the WVSMA supports policies that would:

Allow first responders to possess Naloxone or other opioid antagonists for emergency treatment of
opioid overdose;

Enact a Good Samaritan Law providing immunity for those seeking to help themselves or others
experiencing an overdose; and

Reclassify pseudoephedrine products, with the exception of those which scientific studies have shown
to be tamper-resistant, as Schedule IV controlled substances.
For these reasons, the WVSMA strongly supports SB 9 “Allowing law enforcement and emergency service
personnel possess opioid antagonists;” SB 230 and HB 2045, Creating Overdose Prevention Act; SB 231, Allowing
certain law enforcement and public safety personnel to possess and administer opioid antagonist; and HB 2009,
”Allowing State Police, police, sheriffs and fire and emergency service personnel to possess naloxone or other
approved opioid antagonist.”
Ensuring Medicaid Patients’ Access to Care
The WVSMA supports policies which would ensure that Medicaid patients have access to
quality care by reimbursing physicians at an adequate rate for their services.
The Affordable Care Act has increased the number of Medicaid and CHIP patients in West Virginia by
nearly 50 percent. In order to ensure that these patients have access to care, it is imperative that physicians
be compensated adequately for their services. Data has shown that increasing Medicaid payments to
physicians to a level that is equivalent to Medicare payments (“Medicaid parity”) can result in bettercoordinated, higher quality care for Medicaid patients. In addition, research has shown that Medicaid parity
can result in an overall reduction in health care costs because these patients will be more likely to seek less
costly office-based care, rather than hospital-based care.
Protecting and Strengthening Medical Liability Reform Laws
The WVSMA strongly maintains the need to preserve the integrity of the Medical Professional
Liability Act and to protect against any threats to erode the current statute. At the same time, we
support efforts to strengthen the Act and to clarify certain issues raised by the courts.
Fourteen years ago West Virginia’s healthcare system was spiraling into a severe crisis. The lack of
affordable and available medical liability insurance forced many physicians to either restrict the services they
offer, move their medical practice out of state, or quit practicing altogether. Faced with the reality that West
Virginia’s healthcare system was on the verge of collapse, the Legislature responded by passing two rounds
of medical liability reform legislation.
First, in 2001 the Legislature passed HB 601, which included numerous measures to help put the medical
liability insurance market back on track. In 2003 the Legislature once again addressed the crisis with the
passage of HB 2122, and was the first comprehensive medical liability reform that had passed in West
Virginia in over 20 years and placed West Virginia at the forefront of most states in regard to such reform
laws. The new law included a $250,000 non-economic damages cap, a $500,000 trauma cap, collateral source
offset, elimination of joint liability, creation of a patient injury compensation fund, and more stringent
medical expert witness requirements. Additionally, and critically important, the legislation provided the
revenue and mechanism for the creation of a physicians’ mutual insurance company, a West Virginia-based
insurer which is owned and operated by its policyholders.
Long-term stabilization of the medical liability insurance market has hinged upon whether the WV
Supreme Court of Appeals would uphold the caps on damages as constitutional. In June of 2011 the Court
ruled, in a 4 to 1 decision, to do just that in MacDonald v. City Hospital. This ruling will go far, securing further
stabilization of the market.
The WVSMA supports SB 6 and HB 2006, “Relating to medical professional liability;” specifically, the provisions which
broaden the definitions of health care providers, clarify the collateral source definition, and tighten the expert witness
requirements.
Improving West Virginia’s Perinatal Health
The WVSMA supports initiatives to improve the health of pregnant women and children in
West Virginia.
The health of West Virginia’s babies has a tremendous impact on the state’s economy, workforce development,
and family well being. Because of the declining status of the health of WV mothers and babies, the Perinatal
Partnership was formed to address these needs. The WVSMA has been an active member in the group’s work. The
Partnership and its partner physicians, hospitals, medical schools, nurses, and certified nurse midwives have
begun quality initiatives to improve the state’s poor rates for pre-term birth, low birth weight and very low birth
weight infants, primary C-sections, inductions, vaginal births after cesarean section (VBAC), and access and
availability of obstetrical providers.
The WVSMA, along with the WV Perinatal Partnership, supports and recommends the following policies to
further the efforts on improving perinatal wellness. By working together, we can make sure that the 21,000
babies born each year in West Virginia and their mothers have the best healthcare possible to assure a healthy
beginning:
Offer prevention and treatment interventions for pregnant women who have substance abuse problems.
Pregnant women who are found to use drugs and/or alcohol should be directed to early and regular
prenatal care that incorporates as part of the practice, substance use detection, diagnosis, and referral for
treatment with the goal of delivering a drug free infant. To ensure that women have trusted and confidential
care available to them and that the physician patient relationship is protected, it is essential that the care is
obtained without fear of retribution of any kind.
Expand state education to adequately prepare our young West Virginians for parenthood. West Virginia
women under 20 years of age have worse outcomes for their babies than any other age group of pregnant
women, except for women over 40 years. Advance parenthood preparation of our young students could
help the State significantly reduce low birth weight and preterm birth among women under 20 years of age,
reduce school dropout rates, and decrease the state’s high rate of infant mortality, among other issues.
Allow physicians to provide expedited partner therapy for STDs. To help decrease the risk of persistent or
recurrent sexually transmitted diseases (STDs), the CDC recommends that physicians should be allowed to
prescribe medication for both their patients and the patients’ partners, without requiring medical evaluation
for the partners. In accordance with the CDC recommendations, the WVSMA supports state legislation that
would allow expedited partner therapy.
The WVSMA strongly supports SB 232 “Providing for expedited partner therapy.”
Preventing the Criminalization of Medicine
The WVSMA does not take a position on abortion, but we do oppose the criminalization of
medicine, so we will oppose any bills that include criminal sanctions for physicians, who
should be allowed to exercise clinical judgment without fear of being prosecuted.
The WVSMA opposes provisions in HB 2153, “The Pain-Capable Unborn Child Protection Act” which call for felony
penalties and civil actions against physicians who use their best clinical judgment to perform a lawful medical act.
Ensuring Telemedicine Is Used Appropriately
The WVSMA recognizes that telemedicine can help provide access to care in rural
communities, but, in order to ensure quality of care, telemedicine providers must be
appropriately credentialed and have active licenses issued by the WV Board of Medicine or
Board of Osteopathy.
Combating Poor Oral Health
The WVSMA supports efforts to make policy changes which foster improved oral health for
West Virginia’s children and families.
Regrettably, West Virginia leads the nation in the percentage of our citizens with tooth loss and decay. By
the time of high school graduation, over 80 percent of West Virginia youth have had dental decay; over 60
percent have had dental decay by age 8 and over 30 percent of West Virginia children suffer from untreated
decay. Strikingly, over 45 percent of West Virginia adults, aged 65 and older, have lost all their natural teeth.
Dental disease is the single most prevalent chronic childhood disease and correlates directly to other health
concerns. With today’s tools and technologies, oral disease is almost 100 percent preventable and is cost
effective, with the potential to save millions of dollars. Poor oral health can contribute to a lifetime of overall
poor health, including diabetes and heart disease.
The WVSMA supports the following recommendations to address poor oral health:
• Encourage school-aged children to have dental exams at appropriate intervals;
• Prohibit the sale of sugary snacks and beverages in schools; and
• Address the use of smokeless tobacco among our youth by increasing the tobacco tax and increasing
counter marketing and cessation programs.
Promoting Tobacco Control and Clean Indoor Air Initiatives
The WVSMA supports policies that protect public health by discouraging tobacco use and
promoting clean indoor air. Such policies include increasing the tobacco excise tax, allocating
sufficient funding for education programs designed to reduce or eliminate tobacco use and
exposure to secondhand smoke, and supporting counties’ indoor air regulations.
The WVSMA seeks to reduce or eliminate tobacco use and exposure to secondhand smoke by West
Virginia citizens, especially children and pregnant women. Among the states, West Virginia ranks worst in
the nation for smoking rates of adults and youth. We rank first in smoking during pregnancy and second
overall in women smokers. Further, West Virginia has the highest rate of smokeless tobacco use in the nation
with one in three high school students currently use tobacco and one in five males use smokeless tobacco.
The deleterious effects of tobacco use affect not only smokers but also the public at large. Scientific studies
clearly show that secondhand cigarette smoke is a hazardous, cancer-causing air pollutant. Exposure to
secondhand smoke causes increased risk for disease and death in healthy nonsmokers and is the third leading
cause of preventable death among nonsmokers. The prevalence of tobacco use in West Virginia translates to
an enormous economic toll as the state annually spends $1 billion on direct healthcare costs of smoking, and
another $1 billion on occupational costs due to smoking.
The WVSMA joins the Coalition of a Tobacco Free WV in recommending a three-tiered approach toward
addressing tobacco use:
• Increase the Tobacco Excise Tax;
• Provide adequate state funding for cessation education programs; and
• Protect county clean indoor air policies.
Strengthening and Preserving Safety Laws
The WVSMA strongly supports strengthening West Virginia’s All-Terrain Vehicle safety law
and maintaining the motorcycle helmet law for operators and riders of all ages.
Although the Legislature passed the All-Terrain Vehicle (ATV) Child Safety law in 2004, more can be done
to protect the health and safety of our citizens. The WV State Legislature has made positive strides toward
ATV safety, but still needs to improve such safety laws, including the following:
• Removing non-road-worthy vehicles from public roadways;
• Expanding the mandatory helmet law;
• Strengthening the requirement for ATV safety instruction to require hands-on safety courses; and
• Prohibiting multiple passengers, with the exception of machines that manufacturers have designed for
more than one passenger.
Another important safety issue is that of preserving the motorcycle helmet law. In recent years, efforts have
been made by various groups to repeal our critically important motorcycle helmet law. Such an action by
the Legislature would be highly irresponsible. Helmets are the best known way to reduce motorcycle
accident deaths and injuries. The WVSMA strongly supports the retention of our State’s current mandated
helmet use law for all motorcycle operators and riders of all ages.
Protecting Against a Healthcare Provider Tax
The WVSMA applauds the completion of the phase-out of the healthcare provider tax. We
strongly encourage the Legislature to reject any proposal to reinstate a healthcare provider tax
in the future.
The healthcare provider tax, imposed in 1993, was onerous and widely considered a burden on the health
care provider community. In 2001 the Legislature passed a bill initiating the repeal of this tax on all
individual practitioners through a ten-year phase out. As a result, on July 1, 2010 the tax on all individual
health care practitioners, including physicians, was eliminated.
The WVSMA thanks the Legislature for their foresight in the passage of this phase-out and for their
fortitude in continuing down the path of repeal. The WVSMA strongly recommends that no similar taxes be
considered in the future.