Jeb Bush John O. Agwunobi, M.D., M.B.A., M.P.H.
Governor Secretary
DEPARTMENT OF HEALTH
MAMMOGRAPHY ACCESSIBILITY WORKGROUP
MINUTES
NOVEMBER 16, 2004
DRAFT DRAFT DRAFT DRAFT
Conference Call
(800) 351-6801
MISSION: SB 2306 requires two studies related to the availability utilization, quality, and cost of
mammography services in all facilities performing mammography.
I. CALL TO ORDER
Ms. Nancy Humbert, Deputy Secretary for Health, called the MAMMOGRAPHY ACCESSIBILITY
WORKGROUP CONFERENCE CALL MEETING to order at 4:09 p.m. She welcomed the
participants and then turned the meeting over to Ms. Karen Eaton, who performed the roll call.
A. Roll Call
Members Present:
Nancy Humbert, Chair
Dr. Richard Bagby
Karen Eaton
Dr. Robert Entel
Dr. Eugenio Erquiaga
Cynthia Fletcher (delayed arrival)
David McKenney
Dr. Pat Romilly
Dr. Barbara Sharp (delayed arrival)
Dr. Mary Swain
Members Absent:
The Honorable Carole Green
Betsey Herd
Michael Meyer
The Honorable Burt Saunders
DOH Staff Present:
Margo Blake, Program Administrator
Lorraine Wells, Associate Director
Ms. Eaton noted that the quorum had been met for the meeting, and then gave a quick review of
the procedural guidelines for the conference call.
II. REVIEW OF RECOMMENDATIONS
Ms. Eaton said that she would go through the recommendations announcing how each one ranked,
and then the group would go through them one by one doing the following:
Noting the ones that are acceptable as is,
Noting the ones that might need to be eliminated,
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Fine-tuning the language for those that need it, and
Considering new recommendations.
Ms. Eaton gave the ranking results as follows:
Ranked First: Recommendation 1, which refers to immunity similar to the emergency room
physicians.
Ranked Second: Recommendation 10, which deals with changing the burden of proof.
Ranked Third: Recommendation 2, which is in reference to Amendment 8.
Ranked Fourth: Recommendation 5, which refers to the feasibility of a probable cause
panel.
Ranked Fifth (Tie): Recommendation 3, which refers to the Public Records Act.
Ranked Fifth (Tie): Recommendation 6, which would establish a multi-agency breast
cancer steering committee.
Ranked Sixth: Recommendation 9, which is further gathering of information by the Bureau
of Radiation Control.
Ranked Seventh: Recommendation 8, which deals with co-pays for the under/uninsured.
Ranked Eighth: Recommendation 7, which refers to the Legislature creating a scholarship.
Ranked Ninth: Recommendation 4, which is the charge of the Legislature collaborating
with the insurance industry to enhance reimbursement, including reimbursement for double
readings.
Ranked Tenth: Recommendation 11, which is the loan forgiveness program.
Ms. Eaton noted that the rankings were a little closer than the last time. She said that she would
now go through each one to see if they are acceptable as is.
Ms. Eaton mentioned that she realizes Recommendation 1 on immunity still needs wordsmithing.
The current wording is as follows:
Recognizing that mammography is not a perfect diagnostic screening test, but with the
desire to encourage health care practitioners performing mammography to provide the
necessary readings and interpretations to all persons without fear of litigation, it is
recommended that the practitioners who interpret mammograms shall not be held liable for
any civil damages as a result of such interpretation, where the practitioner acts as a
reasonably prudent practitioner would have acted under the same or similar circumstances.
The health care provider interpreting the mammogram shall not be held liable for any civil
damages as a result of such interpretation unless the interpretation is performed under
circumstances demonstrating a reckless disregard for the consequences, so as to affect the
life or health of the individual undergoing said study.
For the purposes of this recommendation, “reckless disregard” shall be conduct that a
practitioner knew or should have known, at the time such services were rendered, created
an unreasonable risk of inaccurate interpretation so as to affect the life or health of another;
such risk is substantially greater than that which is necessary to make the conduct
negligent.
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Ms. Eaton read Recommendation 2 as follows:
Should Amendment 8 be enacted, in drafting the enabling legislation, consideration should
be given to providing exemptions for practitioners interpreting mammograms.
Ms. Eaton asked if anyone has a problem with the wording or the concept of the recommendation.
Mr. McKenney noted that Amendment 8 will be going through litigation and then through the
Legislature. He said he is not sure if Amendment 8 will be enacted as it was passed when voted
on. Mr. McKenney suggested using phrasing such as “the essence of” or “the message of” when
referring to the amendment in the recommendation. Ms. Eaton asked if Mr. McKenney would like it
to read, “Should Amendment 8 be enacted in its current form…” or something similar to that. Mr.
McKenney said that would be fine, or “in its voted-on form,” or something to that effect.
Ms. Eaton read Recommendation 3 as follows:
The Legislature should amend the Florida Public Records Act creating an exemption for
information obtained from the FDA, and possibly other federal entities, for the purpose of
assessing the status of or improving public health, safety, and welfare of the citizenry of the
state of Florida.
Ms. Eaton asked if anyone disagreed with the language in the recommendation. No disagreement
was expressed.
Ms. Eaton read Recommendation 4 as follows:
The Legislature should collaborate with the state and federal insurance industry to increase
reimbursement for mammography services. This should include reimbursement to
radiologists for double reading of mammograms.
Ms. Eaton asked if anyone disagreed with the language in the recommendation. No disagreement
was expressed.
Dr. Sharp joined the call and asked for an update on what the group was doing at that point. Ms.
Eaton took a moment to bring Dr. Sharp up to speed on the group’s progress and the procedure for
reviewing the recommendations.
Ms. Eaton mentioned that she realizes Recommendation 5 still needs wordsmithing. The current
wording is as follows
The Legislature should examine the feasibility of using a probable cause panel, made up of
radiologists who routinely read mammograms, to review pre-suit films for “probable cause”
before advancing the case to further legal action. Both the Florida Board of Medicine and
the American College of Radiology should participate in the design of this pilot project.
Ms. Eaton read Recommendation 6 as follows:
The Legislature should establish a multi-agency breast cancer steering committee to
promote and enhance the use of annual mammograms. The committee would provide
comprehensive strategic planning, ensure statewide coordination of community-based care,
and enhance utilization, access, and quality of mammography service in the State of Florida.
Dr. Sharp stated that she thinks this recommendation should be omitted because it is fluffy and
distracts from the above recommendations. Ms. Eaton asked if anyone disagreed with the
language in the recommendation. No disagreement was expressed.
Ms. Eaton read Recommendation 7 as follows:
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The Legislature should create a scholarship in honor of Representative Carole Green for
radiology technology students committed for 5 years of mammography service in Florida.
Funds could come from the breast cancer license plate or other trust funds.
Ms. Eaton asked if anyone disagreed with the language in the recommendation. No disagreement
was expressed.
Ms. Eaton read Recommendation 8 as follows:
Health insurance co-payments serve as a barrier to annual screening; therefore the
Legislature should reduce or eliminate any co-pay or deductible requirement for those
under/uninsured with health insurance, HMO contracts, Medicaid or Medicare. This should
be accomplished in a way that will not reduce the reimbursement for services.
Ms. Eaton asked if anyone disagreed with the language in the recommendation. No disagreement
was expressed. Ms. Eaton suggested eliminating the word “uninsured” because there is no co-pay
for those who are uninsured. She asked if there were any other changes besides that one. None
was expressed.
Ms. Eaton read Recommendation 9 as follows:
The Legislature should require the Bureau of Radiation Control within the Department of
Health to maintain a database that tracks:
Utilization rates gathered from the FDA/BORC scorecard.
Number of women in Florida who receive an annual mammogram.
Licensed professionals at each facility (accreditation, licenses, etc.) per MQSA
requirements.
Ms. Eaton asked if anyone disagreed with the language in the recommendation. No disagreement
was expressed.
Ms. Eaton read Recommendation 10 as follows:
The Legislature should change the burden of proof in breast cancer medical malpractice
cases from the greater weight or preponderance of the evidence to the clear and convincing
standard.
Ms. Eaton asked if anyone disagreed with the language in the recommendation. No disagreement
was expressed.
Ms. Eaton read Recommendation 11 as follows:
The Legislature should establish a loan-forgiveness program for radiologists and radiology
technologists who perform mammography similar to those in place for nurses and public
defenders.
Ms. Eaton asked if anyone disagreed with the language in the recommendation. No disagreement
was expressed.
Ms. Eaton explained that now the group would go through the recommendations to see if there
were any that might need to be eliminated.
Ms. Eaton asked if anyone believes that Recommendation 1 should be eliminated. No one
expressed the desire to eliminate the recommendation.
Ms. Eaton asked if anyone believes that Recommendation 2 should be eliminated. No one
expressed the desire to eliminate the recommendation.
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Ms. Eaton asked if anyone believes that Recommendation 3 should be eliminated. No one
expressed the desire to eliminate the recommendation.
Ms. Eaton asked if anyone believes that Recommendation 4 should be eliminated. Dr. Sharp
answered in the affirmative. She said that this is typically a federal issue and that it points to people
thinking that reimbursement is the factor that is reducing access. She thinks this recommendation
will detract from the others. Dr. Entel concurred. He said that the recommendation detracts from
the consensus of the medical community, which is that the main problems are not related to
reimbursement. Dr. Bagby stated that he agrees with Drs. Sharp and Entel, and he thinks that in
the event that Recommendation 6 is kept, reimbursement would be an issue that the steering
committee could address. Drs. Swain and Erquiaga concurred.
MOTION was made by Dr. Bagby to eliminate Recommendation 4. Dr. Entel seconded the motion
and it was carried unanimously.
Ms. Eaton asked if anyone believes that Recommendation 5 should be eliminated. Dr. Sharp said
that she has misgivings but thinks the group can discuss it at next meeting. Ms. Eaton said they
would come back to this one after going through the rest and asked if anyone else had comments.
None was expressed.
Ms. Eaton asked if anyone believes that Recommendation 6 should be eliminated. Dr. Sharp said
that she thinks it should be deleted. She said that it is fluffy and that these types of programs
already exist, such as breast cancer awareness month. She thinks that women know they should
have annual mammograms. She thinks it detracts from what is truly needed. Ms. Humbert said
that she agrees, but that she was planning on introducing the idea of a measure that educates high
school women so they would better take advantage of this screening tool. She said that perhaps it
is going too far to recommend more nurses in the schools or more outreach activities to reach those
populations, but that the data speaks about Medicaid users having utilization significantly lower than
others, and that some sort of outreach to targeted populations might be in order. She said she
agrees that Dr. Sharp is right that the recommendation might be too fluffy and duplicative as it
reads, but that perhaps there could be discussion about adding a recommendation for more
outreach as a public health issue. Dr. Bagby said that he agrees with Ms. Humbert and that this
could be a very expensive item. He also acknowledged that there are groups not being reached in
spite of everything being done. He said that he is not prepared to vote against it yet, and that
perhaps they could discuss it further at the next face-to-face meeting. Dr. Sharp said that she is
amenable to that.
Dr. Fletcher joined the call.
Ms. Eaton said that what she likes about this recommendation is that in public health there are a lot
of private sector or federal programs but they are not coordinated to improve utilization, access, and
quality. She thinks that they are not being very effective as things stand, and that an overarching
steering committee might not require much additional funding. Even if in the beginning the funding
has to be funneled up and it seems top-heavy, in the long run, what is needed is a comprehensive,
combined effort so there are no gaps and disparities. Dr. Bagby asked Ms. Eaton if she sees that
multi-agency committee as including the private sector as well. Ms. Eaton said that she definitely
does see it that way, and that having the public and private sectors working together is one of the
beauties of this measure. She said that she would be more than happy to work with someone off
line to trim the wording down, but that ultimately, she is not sure how it could better be expressed.
Dr. Erquiaga said that some of the other measures deal with access, but that this one deals with
utilization. He agrees that there is a need to reach out to more of the women in Florida to get
mammograms. He said that whether they could provide mammograms to the women once they
responded is a different subject, but that there is a need for a coordinated effort to improve the rates
of women getting mammograms. He said there may be a way to improve coordination among
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agencies that are already trying to accomplish that, and he disagrees with eliminating the
recommendation.
Ms. Eaton asked Dr. Sharp if, after hearing the discussion and knowing that the Legislature might
not choose to enact the measure, she would be comfortable leaving the recommendation in place.
Dr. Sharp answered in the affirmative noting that the discussion was helpful. Dr. Erquiaga
suggested that language might be added to the recommendation about reimbursement because
Recommendation 4 was eliminated.
Ms. Eaton asked if anyone believes that Recommendation 7 should be eliminated. No one
expressed the desire to eliminate the recommendation.
Ms. Eaton asked if anyone believes that Recommendation 8 should be eliminated. Dr. Swain
expressed concern about the cost to the State for this recommendation. Ms. Eaton responded that
the Legislature can always turn it down if they choose. Dr. Swain mentioned that she does not want
it to detract from the other issues, but that she does not feel too strongly about it. Ms. Eaton asked
Ms. Humbert if she agrees that this recommendation is targeted at utilization and disparities. Dr.
Swain said that the way it is written, it would target all the co-pays and would subsidize even the
people who can pay. Ms. Eaton re-read the recommendation aloud pointing out that it targets just
the underinsured. She also noted that they had eliminated the notation of the uninsured because
that population does not have a co-pay. Dr. Swain said that she did not have the document in front
of her, but she acknowledged Ms. Eaton’s points.
Ms. Eaton asked if there was any further discussion on the recommendation. None was expressed.
Ms. Eaton asked if anyone believes that Recommendation 9 should be eliminated. No one
expressed the desire to eliminate the recommendation.
Ms. Eaton asked if anyone believes that Recommendation 10 should be eliminated. Dr. Erquiaga
pondered whether this recommendation should be worked into Recommendation 1 or kept by itself.
Dr. Entel said that he thinks it should stand by itself. He said that it is an important
recommendation, and he noted that if the group bundles too many things together, the
recommendation loses importance. Ms. Eaton stated that Recommendation 1 is fairly hefty as it is.
Dr. Sharp mentioned that she would like to hear Senator Saunders’ and Representative Green’s
thoughts about these two separate or together. Ms. Eaton noted that neither of those members are
on the call. She remarked that she does have Representative Green’s rankings, and that the
representative ranked it second. Dr. Sharp said that she also ranked it second, but that she would
be interested in hearing Senator Saunders’ opinion as well to ask if they are less likely to get either
one of them if there are two, or if they should just pick one. Ms. Eaton said that it is good to give
the Legislature a menu from which to pick without making it so large and difficult that they just throw
out all of the workgroup’s efforts. Dr. Sharp said that it is good to keep them separate.
Dr. Bagby noted that often if you lump things together, the whole concept will fail because of one
part of it. He suggests keeping them separate. Dr. Erquiaga withdrew his question.
Ms. Eaton asked if anyone believes that Recommendation 11 should be eliminated. Dr. Sharp said
that she keeps thinking about Dr. Bagby’s thoughts on this expressed during the last discussion in
terms of how it is difficult to track people, and how people may move from the State. She said that
she hopes it does not detract from the other recommendations, but that it is a nice idea and she is
not opposed to letting it remain. Dr. Entel said that taking into consideration previous experience on
this type of program, and how the programs sound good but tend not to work well as effectively
described by Dr. Bagby in the last meeting, he believes it will not alleviate the mammography
access situation. Dr. Swain concurred.
MOTION was made by Dr. Erquiaga to eliminate Recommendation 11. Dr. Sharp seconded the
motion.
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Dr. Bagby asked if Dr. Erquiaga wants to eliminate the program just for the radiologists and leave in
the radiology technologists, or eliminate it for both. Dr. Sharp suggested eliminating it for both. Dr.
Romilly concurred. Dr. Erquiaga said that he definitely wants to eliminate it for radiologists, but that
he is not sure how much of a school loan burden the technologists end up with and if that would
encourage more to go into mammography. He thinks it is distracting and takes the focus off of the
real problems. Dr. Erquiaga clarified that his motion is to eliminate it for everyone. Dr. Sharp
confirmed that she second the motion. Dr. Bagby asked how Representative Green ranked the
recommendation. Ms. Eaton replied that she ranked it ninth. Ms. Eaton commented on the nurse
loan forgiveness program that is run out of her office, and although people want to take advantage
of it, the criteria is very strict and requires a lot of paperwork. She said that she cannot really say
how well it works for retention of nurses. She said that she does not feel that it is very effective
other than recruitment for public health because public health is so far below the average salaries.
The motion was carried unanimously.
Ms. Eaton referred the group to the verbiage for Recommendation 1. She noted that she had sent
out the language for the recommendation on the ranking form and she also sent out secondary
language that Ms. Fletcher had helped to devise. Ms. Eaton said that she would like to hear
discussion and that afterward she might make one further wording suggestion. Dr. Bagby stated
that he does not have the new language. Dr. Entel read the updated recommendation as follows:
Recognizing that mammography is not a perfect diagnostic screening test and frequently
interpreted without a then-existing healthcare patient/practitioner relationship, but with the
desire to encourage health care practitioners performing mammography to provide the
necessary readings and interpretations to all persons without fear of litigation, it is
recommended that the practitioners who interpret mammograms should have a limitation on
non-economic damages for allegations of negligence in providing this service. This
limitation of non-economic damages should be in conjunction with the previously revised
section of Florida Statutes Chapter 766, and should provide that not withstanding those
revisions with respect to a cause of action for personal injury or wrongful death arising from
medical negligence of practitioners providing the mammography services: (a) Regardless of
the number of such practitioner defendants, non-economic damages shall not exceed
$150,000 per claimant. (b) Notwithstanding paragraph (a), the total non-economic damages
recoverable by all claimants from all such practitioners shall not exceed $300,000.
Dr. Sharp said she that she likes this iteration a lot more than the first one.
MOTION was made by Dr. Sharp to delete the language from the recommendation as listed on the
ranking form. Dr. Entel seconded the motion.
Dr. Entel said that he likes the replacement verbiage and that it more specifically focuses in on what
is needed to help the situation. He said that it serves as a better template for getting this
recognized in the Legislature.
Dr. Bagby stated that the first sentence is extremely long and he is concerned that people could get
bogged down trying to read it. He said that he wonders if the first portion of that sentence prior to
the text “it is recommended that” could be made into “Whereas” statements. Ms. Eaton sought to
confirm that Dr. Bagby wants to keep everything intact, but that he wants to format the first part of
the sentence as “Whereas” statements. Dr. Bagby answered in the affirmative.
Ms. Eaton referred the group to the motion on the table to delete the prior recommendation
language. The motion was carried unanimously.
Ms. Eaton asked Ms. Fletcher if the recommendation verbiage could end after the reference to
Chapter 766, presuming that 766 covers the rest of the information that follows. Ms. Fletcher
responded that Chapter 766 contains a lot more revisions than identified in the recommendation.
She said that her understanding was that the group wanted language in correlation with what was
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done for the emergency room physicians, which is set forth in parts (a) and (b) of the
recommendation. She noted that they could take out a few words by putting a period after “766”
and eliminating the phrase “and should provide that,” but that if the desire is to mirror what the
emergency room physicians were given, this is the language to use. Ms. Eaton deferred to Ms.
Fletcher on the verbiage.
Dr. Sharp said that she likes the introductory language about mammography not being a perfect
test. She said that she wonders if there are two more concepts to add: the access problem in four
major cities, and too few radiologists going into mammography. She said that perhaps a single
sentence could be made out of those three issues, but noted that she was open to other
suggestions. Ms. Eaton noted that those points are covered in the report findings, and that they will
precede all of the recommendations. She indicated that she it trying to keep the report trimmed
down so the Legislature does not get lost in the verbiage.
Dr. Swain noted that the recommendation has the phrase “readings and interpretations.” She
suggested that it just say “interpretation.” Dr. Sharp concurred. Ms. Fletcher said that the reason
for adding it was that overreads and double reads were discussed, so if the group wants protection
for all of the participants, not just the one who has interpreted the mammogram with the signature at
the bottom, that is the reason the term “necessary readings” is there. Dr. Romilly noted that that
was a good point. Dr. Sharp asked if it should say “necessary overreadings.” Ms. Fletcher said
that it is limiting yourself when you specify to the nth degree.
Dr. Entel said that he likes the re-wording but that, as was discussed earlier, he thinks the first few
lines are a little burdensome. He said he would like to make it more readable, perhaps using the
following verbiage, “It is recognized that mammography is not a perfect diagnostic screening test
and frequently interpreted without a healthcare patient/practitioner relationship. There is a need to
encourage health care practitioners performing mammography to provide necessary readings and
interpretations for all persons without fear of litigation. For those reasons, it is recommended that
the practitioners who interpret mammograms should have a limitation…” Dr. Bagby said that he
thinks that wording is better.
Karen asked Dr. Entel to repeat his suggested verbiage so she could ensure that they captured it in
its entirety. Dr. Entel repeated the verbiage. Ms. Fletcher stated that she does not have a problem
with the revision.
MOTION was made by Ms. Fletcher to accept the new verbiage for the recommendation. Dr.
Bagby seconded the motion.
Dr. Bagby asked if there would be an executive summary for the report. Ms. Eaton replied in the
affirmative. Dr. Bagby noted that the data that was mentioned by Dr. Sharp could be included in the
executive summary and therefore reviewed by the Legislature. Ms. Eaton asked if Dr. Bagby was
suggesting that they remove the first portion of the recommendation. Dr. Bagby said that he was
not. Dr. Erquiaga mentioned that there is one phrase he would like to change, which is “healthcare
provider/patient relationship.” He asked if they could change that wording to the more traditional
phrase “physician/patient relationship.” Ms. Eaton asked if the motion could be amended to include
“physician/patient.” Agreement was expressed.
The amended motion was carried unanimously.
Ms. Eaton referred the group to the one remaining recommendation, Recommendation 5, that
addresses the feasibility of a probable cause panel. She noted that she had sent out information
from Amy Jones to the group. She said that she has a longer executive summary that she can
send out if needed. The executive summary points to the fact that it is very time consuming and
costly, and that it has not been shown to be effective in reducing litigation.
Dr. Entel said that he received an interesting brief from the American Medical Association that
states that in this past general election in November, lawmakers in Wyoming looked at medical
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review panels, and on election day, Wyoming voters passed Amendment C, which allows the
Wyoming legislature to consider establishing medical review panels to help weed out meritless
medical liability suits. Dr. Entel noted that this is an example of a state that actually had a
constitutional amendment that was approved to look into these types of measures.
Dr. Sharp said that there are several states that have panels with state medical malpractice tort
laws. She said that one state does not allow the information from the panel to be admissible in
court, and that she thinks that is important because she would hate to penalize someone if two out
of three experts say it is a valid case. She noted that there was a case like that in her group
recently where the first two experts refused the case and then the next two accepted it. When she
saw the original films from the case, she could not believe the first two refused it. She said she
would hate to think that would penalize someone, and that it would force them to settle something,
so having it not admissible is good. Dr. Sharp that using the word “pilot” is important if the group is
keeping the recommendation, but that she thinks it will be rejected quickly when this other
information is introduced.
Ms. Eaton noted that she got a recommendation for replacement verbiage from Ms. Jones. She
asked if the members would like her to read it. They agreed.
Ms. Eaton read the suggested replacement language as follows:
The Legislature should amend the medical malpractice statute to require that affidavits filed in
medical malpractice suits must be from the same specialty as the respondent and that the number
of affidavits should be increased from one to two affidavits.
Mr. McKenney said that they pretty much have the specialty-specific issue handled, but the idea of
increasing from one affidavit to two is something new. Ms. Fletcher agreed that it is something
new, but said that she does not know if it will change the outcome much because she has not seen
the attorneys having trouble obtaining the one, and that she is not sure that obtaining another one
would cure the problem. Mr. McKenney said that plaintiff’s attorneys would be able to find a way
around it.
Dr. Erquiaga said that he likes the idea of a panel but he does not think it is the top
recommendation for access, and he would hate for a pilot program to be set up and the other
recommendations not enacted. He said that he is not sure if results from other states have been
that positive, and that he is concerned that some of the other recommendations might not be
enacted if the group gives the Legislature too many. He said that he is willing to decrease the
importance of this one or eliminate it.
Dr. Bagby said that he likes the idea of the recommendation but wonders if it can be wrapped into
Recommendation 6 and then ask that the steering committee take it on as one of its projects. Ms.
Eaton said that it certainly fits into utilization, access, and quality, which are the goals of that
committee. Ms. Fletcher said that she likes that idea, and that this would not put so much emphasis
on the concept by having it stand alone. Dr. Erquiaga stated that he agrees with Dr. Bagby. Ms.
Eaton asked if there should be a sentence summing up that idea in Recommendation 6 or if that
recommendation already covers it. Dr. Entel stated that he thinks it needs to be mentioned or it will
not get done. He said that the fact that the idea has rendered this much discussion and that
another state is doing this indicates that the concept should be included in Recommendation 6 to
cue that committee to take this as a priority. Eaton said that she could add this right after “quality of
mammography including…”
Dr. Swain said that she does not have the wording in front of her, but that she thought the steering
committee was about coordinating the public and private sectors in terms of promoting utilization in
underserved groups. She said she does not think this should be part of Recommendation 6 but
should stand alone.
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Ms. Eaton re-read Recommendation 6 aloud. Dr. Swain suggested that a sentence could be added
at the end of the recommendation stating that in addition, the committee should examine the
feasibility of using a probable cause panel. Dr. Bagby stated that he thinks the group also said they
would put verbiage about reimbursement in the recommendation, and that the group put more in
there than originally intended. Dr. Swain said that it seems to her that the group is just suggesting
that another committee be formed to look at the issue rather than making a recommendation
themselves. Ms. Eaton said that she thinks the way that Recommendation 5 is worded, in that it
states that they should examine the feasibility, the group is not asking them to do the pilot, but only
to get further information. Ms. Eaton added that now that other states are looking into this, some
information might become available that shows that a panel is beneficial.
Dr. Swain said that this workgroup should directly ask the Legislature to examine the feasibility
rather than referring it to another committee to then make that recommendation. Dr. Erquiaga said
that, in playing the devil’s advocate, if the Legislature puts in place the study of the feasibility
sometime within the next two years, in the meantime they will not change the system or take any
other recommendations because they will say they are studying the feasibility of this
recommendation first. Dr. Swain noted that the workgroup is not ranking that as its first
recommendation. Dr. Erquiaga said that he understands, but since they are all in the same
category, the Legislature will say, “Maybe this will take care of the problem. Why don’t we study
this first?” He said that rather than make a decision that will require them to be courageous, they
may choose to put courage off for a little while as they study something further. He is concerned
that if one of the recommendations given to the Legislature is to study something, they will take that
choice, and they may put off enacting other things that the group thinks are important while they do
the study. Ms. Eaton reminded the group that Senator Saunders had said that if you give the
Legislature the opportunity to delay doing anything, they will take it. Dr. Swain said that by putting
this in the steering committee, it is giving them even more opportunity to delay it.
Dr. Entel said that after thinking about this, he believes that while what Dr. Erquiaga is saying is true
about there potentially being a delay in getting screening panels or enacting something effective, he
does not think that it will be predicated upon this recommendation. He said that if the steering
committee gets the go-ahead and does decide to take the probable cause panel up as a study, then
that committee will refer it back to the Legislature and it cannot be known what might happen after
that. Dr. Entel said that he thinks Dr. Swain is correct in suggesting that it be referred directly to the
Legislature by this workgroup, and that it will be done more quickly that way because the alternative
is talking about adding an extra layer of committees before it would go to the Legislature. He
acknowledged that this is a controversial issue, but said that he believes that if the workgroup wants
this to be examined and ever have the chance that it might be implemented, it needs to be a stand-
alone recommendation and not given to another committee.
Ms. Humbert mentioned that the group has been having good discussion and has made excellent
points thus far.
Dr. Sharp said that the decision boils down to whether the group wants to risk not getting anything,
because they will roll it into that one recommendation and create a study group. Dr. Entel said that
is not necessarily the case, and he gave the example of the Governor’s taskforce
recommendations. He said that all of the recommendations from that taskforce were numbered and
presented, and that a bill was formed; however, not all of the recommendations were adapted in the
2003 tort reform legislation. He said that the Legislature did not agree with, and therefore did not
pass through, some of the recommendations. He pointed out that it did not mean that every
recommendation was thrown out because one or two were not approved.
Ms. Eaton suggested that the group let Senator Saunders decide whether the recommendation
should stay or go regardless of where it would reside. Ms. Eaton asked if the group wants the
recommendation to stay. The group responded in the affirmative. Dr. Sharp suggested leaving it
and then seeing what Senator Saunders and Representative Green suggest. Dr. Swain sought to
confirm that Representative Green ranked the recommendation third. Ms. Eaton replied in the
affirmative. Dr. Entel said that Representative Green’s ranking helps the group to know what she
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thinks about the recommendation. Dr. Sharp responded saying that Representative Green may not
know that this has already been studied as shown in the executive summary. Ms. Eaton
commented that the original wording for the recommendation stated, “The Legislature should further
examine…” but noted that she had taken out the word “further” to keep the verbiage short and to
the point. Ms. Eaton asked if anyone thinks that the recommendation should be eliminated. No
one expressed the desire to eliminate the recommendation.
Ms. Eaton acknowledged that the group believes it needs to stay. She asked if anyone feels that it
should not be a stand-alone item. Dr. Sharp said she is undecided. Ms. Fletcher said that she
thinks it is a good idea to roll it into Recommendation 6, but that she is not totally averse to having it
stand alone.
MOTION was made by Dr. Entel that the motion stand alone. Dr. Swain seconded the motion and it
was carried unanimously.
Ms. Eaton re-read the recommendation, noting that she wants to ensure the group is satisfied with
the verbiage since she authored it. Dr. Swain said that she likes the verbiage and that it is very
good. Ms. Humbert concurred. Ms. Eaton asked if she should change any of the verbiage. The
group agreed that the verbiage is good as it stands.
MOTION was made by Dr. Entel that Recommendation 5 remain as is. Dr. Swain seconded the
motion and it was carried unanimously.
Ms. Eaton asked if there were any new recommendations. Ms. Humbert requested that the group
discuss her suggestion about outreach to targeted groups. Dr. Swain responded that, to her, that is
what the steering committee would do. She also thinks that high school is way too young to
address the issue, and that the students have too many other things to be learning in high school.
Ms. Humbert said that she was particularly thinking in terms of self-breast exams. Dr. Bagby said
that he is torn somewhat because it is a brand new idea. He said he likes the idea of teaching
women when they are young for a lifetime of a good healthcare practice, plus they have mothers
and aunts and grandmothers who they could encourage to get mammograms. He thinks the idea
deserves some consideration. Dr. Swain said that she thinks it can be part of Recommendation 6.
Dr. Bagby concurred. Ms. Humbert agreed saying that she never likes to miss an opportunity to try
to ask for more nurses in the schools because that is where a lot of young women and men get
those awareness skills. She mentioned that Dr. Swain has a good point about the students having
too many other things on which to focus. She indicated that she is fine with folding it into
Recommendation 6.
Ms. Humbert asked if anyone had any other new thoughts to add. No one expressed any. Ms.
Humbert said that the group has made good recommendations. Ms. Eaton concurred.
III. NEXT STEPS
Ms. Eaton said that she will make the changes to the recommendations list and send it out once
more for comment. She said that they would establish a deadline date for responses and need the
members to reply by that deadline so they can bring the information into the report. She noted that
when the group members read the report they will have the findings and recommendations in front
of them. She said she will still need to run the report by legal counsel, and that there is still the
internal process to go through before it goes to the Legislature. Dr. Swain asked when the group
can see the report. Ms. Eaton said that she thinks they can see it by tomorrow or the next day.
She said there will still need to be some tweaking done at that point. Ms. Humbert commented that
the report has gone through a good internal process and that it looks really good. She said she
thinks that everyone will be pleased with it.
Dr. Romilly asked if the group could get the findings as soon as possible to look at those before
trying to rework the recommendations worked on today. Ms. Eaton reminded the group that the
recommendations mirror the findings. She said she had thought about sending out the first couple
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of parts of the report, but she believes the group will want to see the findings and recommendations
together to be sure that they match what is in the report. Dr. Swain asked if Ms. Eaton would be
sending the report by e-mail. Ms. Eaton replied that she could send it by e-mail or send it in the
mail. Dr. Swain noted that she prefers a hard copy. Dr. Bagby asked about the length of the
document. Ms. Eaton said that it will be 25 to 30 pages long and that she will probably send it out
via Federal Express. Several group members said that would be an even better option. Ms. Eaton
asked that the members let her know if they have any brainstorm ideas in the interim.
Dr. Sharp asked whether the group would be meeting December 3. Ms. Eaton said that she does
not think the group will need that second meeting day. She thinks the group has honed it down
pretty well, and that, if needed, they can continue to do work after that time via e-mail as they have
been.
Ms. Humbert said that it will be a new milestone when the members get the report, and that the
group can celebrate. Ms. Eaton pointed out that it will not be in the prettiest format when she sends
it out in the next couple of days, but that the finishing touches will come later. Ms. Eaton brought up
the idea of scheduling a conference call prior to the December meeting, but on reflection realized
that there probably would not be enough time to give notice for the meeting. Ms. Eaton mentioned
that if the group keeps doing what it has been doing, she believes everything will come together just
fine. Dr. Bagby concurred and said that he does not think a conference call is needed.
IV. ADJOURNMENT
MOTION was made by Dr. Bagby to adjourn.
The meeting adjourned at 5:14 p.m.
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