Legislation that would clear the way for phone-based health care services in Arkansas -- but restrict telemedicine in schools -- won a favorable recommendation from a legislative panel in a divided vote Wednesday.
Sponsored by Sen. Cecile Bledsoe, Senate Bill 146 would remove a legal requirement for a patient to be at a doctor's office or other health care facility at the time of an initial examination conducted via telemedicine.
That restriction, included in a 2015 law that was sponsored by Bledsoe, has prevented companies based outside the state from allowing Arkansas residents to use their smartphones or computers to receive diagnoses from doctors they have never met in person.
But for a health care provider to conduct an exam by telemedicine on a child at school, SB146 would require authorization from a child's primary-care physician.
Bledsoe, chairman of the Senate Public Health, Welfare and Labor Committee, told committee members that the restriction is intended to ensure that the child receives appropriate treatment.
The Rogers Republican said the proposed child-treatment restriction is a response to a pilot project by Arkansas Children's Hospital that allows pupils at Angie Grant Elementary School in Benton to receive video examinations, conducted in the school nurse's office, from one of the Little Rock hospital's doctors.
"They jumped ahead of what we allowed in that first bill," Bledsoe said, referring to the 2015 law.
Bledsoe's husband, James, is medical director of the Arkansas Department of Health's trauma system and emergency medical services programs, and their son, Greg, is the state's surgeon general.
Sen. Missy Irvin, R-Mountain View, said schools could reduce overall access to care by taking business from doctors in small towns and making it more difficult for the towns to recruit doctors.
"If the public school is bypassing the local doctor in town, that becomes extraordinarily difficult," said Irvin, who works at her husband's medical clinic.
Irvin and Bledsoe voted along with fellow Republicans David Sanders of Little Rock, Scott Flippo of Mountain Home, Lance Eads of Springdale and Democrat Eddie Cheatham of Crossett in support of the recommendation.
John Cooper, R-Jonesboro, and Stephanie Flowers, D-Pine Bluff, voted against it.
"I've yet to have any professional tell me they weren't concerned by this," Cooper said, referring to health care providers and educators in his district.
Rep. Deborah Ferguson, D-West Memphis, a co-sponsor of the bill, said the restriction on telemedicine in schools "is not about protecting doctors, although that is an important aspect, that you may lose physicians in rural areas."
"This is about protecting children and their quality of care," said Ferguson, whose husband is a radiologist.
Children's Hospital Chief Executive Officer Marcy Doderer said the pilot program in Benton complies with the 2015 law and helps reach children who might otherwise go without care.
From the time the program started, in September, until the winter break, 13 children were examined by a doctor with the help of the school nurse and a $30,000 cart of telemedicine equipment, she said.
Parents, who must authorize the examinations, participate in the exams over a teleconference, Doderer said. Afterward, the doctor sends a record of the exam to the child's doctor.
Doderer said some children's doctors may decline to authorize exams conducted at the school. For instance, when children show up at the hospital's emergency room with medical concerns that aren't emergencies, the children's primary-care doctors often decline to provide needed referrals to hospital clinics, she said.
"Many, many times the primary-care physician will say, do not send them to the clinic, don't send them to the ER, tell them to come to my office tomorrow," Doderer said.
At that point, parents often choose to have the child treated in the emergency room anyway, she said.
The requirement to obtain approval from the child's doctor would take the choice "out of the hands of the parent," she said.
"Our question is, why would we require that only in a school setting and not require that in a Wal-Mart clinic, in an urgent care clinic, in any other site that telemedicine will be delivered?" Doderer said.
The hospital has plans to expand the telemedicine program to about 40 schools in more than 10 school districts, a hospital spokesman has said.
The University of Arkansas for Medical Sciences is planning to use similar technology to provide telemedicine to school-based health centers in the Jasper, Lee County, Malvern and Magazine school districts.
UAMS Chancellor Dan Rahn said obtaining a doctor's permission for each telemedicine exam might be "a bit of a bureaucratic barrier." But he suggested it would be more manageable if telemedicine providers could obtain a "blanket authorization" from the children's doctors in advance through a written agreement.
Ferguson said the law would allow for such agreements.
Sanders said the requirement to obtain permission from the child's doctor would help prevent some health care providers from using telemedicine to bilk the state's Medicaid program. Such abuse has been a problem with some providers of in-person services in the past, he said.
"My fear is that we're going to see new service lines develop," he said.
Act 887 of 2015 allows doctors to treat patients they have examined at some point in person, when they have ongoing professional or personal relationships with the patients, when they have referrals from other doctors or when they are filling in for the patients' regular doctors.
The law also allows the Arkansas State Medical Board to specify other ways the physician-patient relationship can be established.
Last year, the board adopted regulations allowing the relationship to be established through an examination using "real time audio and visual telemedicine technology."
SB146 would remove a requirement in the 2015 law for the telemedicine exam to be conducted at the "offices of a health care professional or a licensed health care entity" or at the home of a patient with end-stage renal disease.
Claudia Tucker, vice president of government affairs for Dallas-based Teladoc, which provides phone-based health care services, said removing the requirement would allow her company to operate in Arkansas.
But, she said, requiring video technology to be a part of the initial exam might pose a problem for customers with limited Internet access. Many other states allow the exam to be conducted using a simple phone call, she said.
"It would be our hope that as business friendly as Arkansas is that they would also see the need" to drop the video requirement, she said.
A Section on 02/02/2017