LEGISLATORS IN THE NEWS
HB 2622: An Interview with Amish M. Shah, MD MPH FAAEM Lisa A. Moreno, MD MS MSCR FAAEM FIFEM – President, AAEM
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r. Amish Shah is an emergency physician (EP) and an elected member of the Arizona House of Representatives. Dr. Shah graduated from Northwestern University with both his Bachelor’s and his Medical Doctorate degrees and went on to complete an MPH at University of California, Berkeley. He did his emergency medicine residency at Lincoln Medical and Mental Health Center in the Bronx and a fellowship in Sports Medicine at the University of Arizona, Tucson. His run for the Arizona State House grew out of concerns that arose from his experiences as a practicing EP, and his work in the legislature has focused on health and education. Most recently, Rep. Dr. Shah introduced HB 2622, which has been ratified by both Houses of the Arizona legislature and signed into law by Arizona Governor Doug Ducey. A copy of the bill and Rep. Dr. Shah’s bio sketch appear at the end of this article. I recently had the privilege of interviewing Dr. Shah on his groundbreaking, and AAEM hopes, precedent-setting, legislation.
LM: Dr. Shah, would you share the context and a summary of the substance of your recently passed bill, HB 2622? AS: Prior to my bill, Arizona had a law on the books to prevent retaliation by health care institutions against health care professionals, but that law was outdated. It was written in 2003, and since then, the marketplace has substantially changed. Now, the health care marketplace is, in many regions of the country, dominated by corporate medical groups (CMGs). Even in areas where the CMGs do not dominate the health care marketplace, they are nonetheless significantly impactful. As you know, Dr. Moreno, CMGs have contractual relationships with health care institutions and as part of these contracts, the CMG provides physician services, in some cases for more than just the ED. Those services might include radiology, anesthesiology, critical care, hospitalist services, and inpatient psychiatry, to name a few. If the health care institution has an issue with a physician, the institution does not have to fire the physician because they do not employ the physician. Instead, they voice their complaint to the CMG, which in turn, will terminate the physician or keep the physician off the schedule. Similarly, if a physician voices a concern about staffing, patient safety, or a particular policy of the CMG or the hospital that the physician believes is not in the best interest of patient care, the CMG can retaliate by terminating the physician or failing to put him or her on the schedule. HB 2622 says that neither the health care institution nor the CMG can retaliate. A retaliatory action is not limited to termination but includes any adverse action, including taking a physician off the schedule. This bill is inclusive of all health care professionals and is not limited to physicians. My goal was to empower all health care professionals to be able to act with integrity around issues of patient safety and excellence in patient care without fear of retaliation.
LM: What prompted you to write this bill? AS: Two things: First, a friend who is an EP was in the ED and noticed a patient safety concern: a non-medical person was watching the nursing station telemetry monitors. The EP went to the administration and expressed the above concerns. The hospital administrator then talked to the third-party staffing company and informed them that the hospital did not want that physician on the schedule anymore because that physician was “causing trouble.” The staffing company took the doctor off the schedule, and the physician contacted me to share the story. Then, you invited me to speak at AAEM Advocacy Day 2019 in Washington DC. You asked me to speak about the physician’s role in public policy making. While I was there, I learned a lot about the work that AAEM does to protect physicians who are unjustly terminated for speaking up about patient safety and workplace fairness. I met Dr. Wanda Cruz from Florida, who shared her story about being terminated after reporting to her hospital administration that inadequate physician staffing had contributed to long waiting times and a poor outcome for one of her patients. I realized that retaliation against health care personnel, specifically emergency physicians, was far more common than I had previously been aware of, and I decided to act. I put forth a bill that allows physicians to address patient safety concerns. It also brings awareness to the public that these practices are in place. In the case of my friend’s situation, how would a patient know that they were being monitored by a non-medical person who was not trained to read a cardiac monitor? There are certain things that only the physician working in the ED would be aware of. The bill empowers these physicians to speak up about situations that only they could possibly be aware of by virtue of their work and education. And as I said, this bill is for all physicians, not just EPs, and for all health care professionals. As we know well, situations may arise that only nurses, or only respiratory therapists may be aware, and that have the potential to endanger patients or negatively impact their care.
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My goal was to empower all health
care professionals to be able to act with integrity around issues of patient safety and excellence in patient care without fear of retaliation.” COMMON SENSE MAY/JUNE 2021
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