healthcare – Missouri House of Representatives Newsroom

Ban of invasive medical exams without consent sent to governor

The legislature has voted to ensure that Missouri patients can no longer have invasive medical examinations performed while they’re unconscious and without prior knowledge or consent.

*Representative Hannah Kelly (Photo: Tim Bommel, Missouri House Communications)*

Legislators were told that medical students and residents have been allowed and even directed to perform anal, prostate, or pelvic examinations on unconscious patients as part of their instruction, sometimes without those patients’ consent.

House Bill 402 contains several provisions regarding healthcare. One of those would specify that such exams on unconscious patients may only be conducted when that patient or their authorized representative has given consent; the examination is necessary for medical purposes; or when such an exam is necessary to gather evidence of a sexual assault. The legislature voted last week to send HB 402 to Governor Mike Parson (R) for his action.

Representative Hannah Kelly (R-Mountain Grove) sponsored that provision. She told House Communications, “The patient has the right to know what’s going on.”

She said her first concern regarding that issue was for survivors of sexual assault, some of whom she knows personally.

“If you talk to sexual assault survivors, often times they’re very hesitant, especially if they’re younger, to go seek healthcare and to have confidence to get the proper healthcare that they need. This was brought to me out of the concern that we make it abundantly clear in statute that if you’re going to put somebody under anesthesia in regards to any kind of female exam that they have full disclosure of what’s happening before you go under,” said Kelly. “I think anybody likes that, right? But especially if you’re a sexual assault survivor that’s something that is of utmost importance to make sure that you’re getting what you need from your healthcare provider because you’re hesitant, because you’re not secure and you’re not feeling confident of the process.”

The patient examination issue was an important one for legislators in both parties, and as a standalone bill, was voted out of the House 157-0.

Representative Patty Lewis (D-Kansas City) was glad to see it achieve final passage this year.

*Representative Patty Lewis (Photo: Tim Bommel, Missouri House Representatives)*

“I’m a nurse by background. I worked in academic, teaching hospitals. I worked with residents and med students all the time and when I first learned about this issue I was shocked. I couldn’t believe that intimate examinations were happening to people without their consent.”

Lewis noted that this passage shouldn’t hamper students’ abilities to learn. She said they have other chances to receive instruction in such examinations.

“If you go to one of the academic facilities you can opt in to have the med students or residents be part of your care team, or opt out if you don’t want to.”

Any health care provider who violates the new section of law, or any supervisor of a student or trainee who violates it, would be subject to discipline by their licensing board.

Kelly, meanwhile, encourages Missourians to ask questions of their healthcare providers and to makes sure they are made fully aware of what will happen if and when they are put under anesthesia.

The House voted 120-31 to send HB 402 to Governor Parson, who can now sign it into law, veto it, or allow it to become law without his action.

Physical therapists to no longer require referrals after Governor signs new law

The first legislation signed into law out of this session will get Missourians in front of the caregivers they need more quickly and with less cost.

*Governor Mike Parson signs into law Senate Bill 51, as its sponsor, Senator Karla Eslinger, and its House handler, Representative Brenda Shields, look on. (Photo: the Office of Governor Mike Parson)*

Governor Mike Parson (R) on Thursday signed Senate Bill 51, sponsored by Senator Karla Eslinger (R-Wasola), which will allow people to go to physical therapists without having to first visit another doctor and get a referral.

“Currently, patients must visit a physician before they can make an appointment with a physical therapist. This costs the patient additional money and delays in returning to their life before the injury,” said Representative Brenda Shields (R-St. Joseph), who handled the bill in the House. “It is time for Missourians to choose their own healthcare path and get their lives back.”

Shields has spoken passionately about this proposal largely because of the role physical therapists have played in her own life.

“I’m excited to be able to carry, I’m honored to be able to carry this bill this year. If it wasn’t for physical therapists I would not be before this body this year. When I had my brain bleed stroke almost seven years ago, it took them to give me back my life and I cannot thank them enough.”

Shields said no matter what she does from here on, she expects the passage of this language will stand as a highlight of her political career.

“You almost bring me to tears when I think about that … with my experience that I’ve had a physical therapist when I had my stroke seven years ago and the work that they did and the continued support that they gave me through my recovery. Even when I became depressed or sad, or questioned if I was ever going to return to normal, their continued work and their support … I just really wanted to [get this passed] to thank them for the care that they provided me.”

Shields announced to her colleagues in the chamber on Thursday morning that the bill would be signed, and her physical therapist Dr. Ben Perkins was her guest in the chamber then and at the bill signing.

Representative Deb Lavender (D-Manchester) is a physical therapist. She said it’s frustrating to have to turn away people who come to her, knowing she could ease their pain.

“I have actually lost business in my small, private practice physical therapy because when somebody would call me and say, ‘I want to see you,’ I’d say, ‘You have to see the physician first.’”

The proposal has been around for years in the legislature, with Governor Parson saying he handled it early in his legislative career which began in 2005.

*Representative Brenda Shields carried the House version of Senate Bill 51 for multiple years. She said its passage into law will likely always be one of the highlights of her legislative career.* *(Photo: Tim Bommel, Missouri House Communications)*

“I couldn’t be more pleased signing this, being the first bill that we’re really going to sign,” said Parson. “I think one thing we learned is how important healthcare is no matter where you live in the State of Missouri, and how many opportunities people have to get it. By doing this bill we’re going to expand that to many more people and cut a lot of bureaucracy out of the way simply to care for people, and I think that’s what we all wanted to do.”

Under the bill, a physical therapist can refer a patient to another health care provider if they exhibit certain conditions which the physical therapist is unable to treat, or if the patient’s condition doesn’t improve within 30 days or ten visits.

The House voted on April 12 to pass SB 51, 146-2. With its signing, Missouri joins 47 other states who already allowed people to go to physical therapists without first getting a referral. The bill’s provisions take effect August 28.

House votes to bar invasive patient exams without consent

The Missouri House has voted unanimously to end the practice of performing certain invasive medical exams on patients who are unconscious and have not given consent.

Legislators learned that in Missouri and elsewhere, medical students and residents in teaching hospitals are allowed and even instructed to perform anal, prostate, or pelvic exams on unconscious patients as part of their instruction.

“That’s a really bad practice because it’s not a good way of teaching students, but it’s also incredibly traumatic and harmful for that patient, to know that they could have been violated while they were unconscious,” said Matthew Huffman with the Missouri Coalition against Domestic and Sexual Violence.

Representative Hannah Kelly (R-Mountain Grove) agrees and she sponsors House Bill 283, which would require informed consent from the patient or someone authorized to make decisions for them, unless the exam is deemed necessary for diagnostic purposes, or for the collection of evidence when a crime is suspected and the patient cannot give consent for medical reasons. If an exam is performed the patient would have to be notified.

“This bill is aimed at making sure that those who are survivors of trauma don’t have to experience further trauma as they go seek healthcare from their provider,” said Kelly. “I want to make sure that sexual assault survivors can confidently walk into their doctor’s office and know that they are empowered to be in control of the process and that there are no surprises. I have seen firsthand how important that is to strengthen the individual.”

Huffman explained that this issue is particularly important for the people his organization works to protect.

“The harm a survivor may feel is retriggering for the simple fact that we know survivors of sexual violence have felt a loss of their own bodily autonomy, and it can be retriggering to find out that someone performed an exam on you while you were unconscious without you being able to give specific consent.”

Kelly said she has seen what Huffman is talking about through her daughter, who has given Kelly permission to speak publicly about her experience and encouraged her to pursue related policy.

“She is someone who has dealt with the unfortunate situation of being a victim of sexual assault … we all need healthcare, right? Someone who is a victim of assault, that’s a paramount kind of subconscious concern is, ‘Okay, am I going to be safe? Am I going to be in control of this situation?’”

Both Kelly and Huffman say whether this bill becomes law this year, they hope it will help call attention to what has been happening to some patients and what people can do now. They encourage people to ask questions when visiting a medical practitioner.

“I would hope that an individual who might … feel like they’re not getting full disclosure or they feel like they have questions, I hope he or she will raise their hand and say, ‘I have some questions. What are we going to do here today? There’s not going to be any surprises, right? Walk me through what’s going to happen once I go under anesthesia,” said Kelly. “That’s what I would hope, is that people feel empowered to hold up their hand and say, ‘Hey, make sure that I understand what’s happening here, please.’”

Huffman said what is as important as anything about this proposal, which has come up for several years now but has yet to reach the governor, is that it’s made people aware that these incidents are happening.

*Representative Patty Lewis (Photo: Tim Bommel, Missouri House Communications)*

“As soon as we started talking to people about it, everyone’s jaw immediately drops open [as if to say] how is this a thing that could even still be occurring and why have I never heard about it? So that’s why we really wanted to bring a lot of attention to the issue because once people know that it’s a thing they absolutely want to make sure that it’s no longer a practice that can happen.”

Representative Patty Lewis (D-Kansas City) was one of the legislators who expressed the surprise Huffman references, when HB 283 reached the House Floor.

“Last year was when I was first made aware of this practice, and I worked in academic, teaching hospitals and wasn’t aware that was going on. Quite frankly I was shocked … is this really, really happening?”

Huffman said what is not known is how often such instances are occurring, largely because they aren’t always reported.

“For anyone who has experienced this, they become aware of it after the fact, and that can be a really traumatic thing to want to speak openly about.”

HB 283 was sent to the Senate on a 157-0 vote and awaits action in that chamber. A similar measure has been advancing through the Senate.

Production note: some of Rep. Kelly’s audio was overmodulated and not fit for air, so it is quoted here but not linked.

Bipartisan set of bills would extend post-pregnancy healthcare

A bipartisan group of House lawmakers is sponsoring legislation that they hope will save the lives of women and infants in Missouri, and in doing so, move the state farther from the bottom in the nation in infant and maternal mortality.

*Majority Floor Leader Jon Patterson (R) (Photo: Tim Bommel, Missouri House Communications)*

Their proposals would extend MO HealthNet or Show-Me Healthy Babies coverage for low-income pregnant women to a full year after the end of their pregnancy. Currently that coverage stops after 60 days.

Six representatives have filed that proposal, including Majority Floor Leader Jonathan Patterson (R-Lees Summit).

“The wellbeing of the child is based upon the wellbeing of the mother, so that’s why we’re really worried about, and we really want to focus on, healthcare for the mother, because it affects the child,” said Patterson.

He says there are about 5,000 women in Missouri who don’t have insurance coverage either through the state, personal coverage, or an employer.

“The data are very clear that it’s critically important. You’re talking about the physical development of the child, development of the brain, that they have support, and one of those things is having a mother that can be there. For example if your mother is in the hospital for a mental crisis or high blood pressure they can’t be there for the child so that’s what we’re trying to avoid.”

*Representative LaKeySha Bosley (Photo: Tim Bommel, Missouri House Communications)*

Governor Mike Parson (R) in his State of the State Address earlier this month said, “we are heartbroken to be failing,” in the area of infant mortality, with Missouri ranking 44^th in the nation for its “abnormally high” rate.

Kansas City Democrat Patty Lewis calls the situation, “abysmal.” She said in a Department of Health and Senior Services report covering 2017 to 2019, “Something that was pretty astounding to me based on their findings is 75-percent of the deaths are preventable. As [someone with a] background in nursing, if we can prevent something that’s what I want to do,” said Lewis.

She said in the years covered by the report an average of 61 women died while pregnant or within one year of pregnancy, with 68 in 2018.

“If we can just save one that would be great, but saving 60 women I think would be very important to me.”

Freshman representative Melanie Stinnett (R-Springfield) said maternal healthcare was an issue that voters talked to her about leading up to her election in November.

“I work in the realm of healthcare and I work with a lot of families with children with disabilities, specifically, but also work really closely with organizations like The Doula Foundation and midwife groups in Springfield so it’s certainly something that’s come up in Springfield and a topic that has been something that I’ve talked about in our community,” said Stinnett.

Representative Brad Pollitt (R-Sedalia) said the data about how many of those deaths could have been prevented weighs heavily on him.

He said the proposal, “is just giving a little extra healthcare to get them off on the right foot and to help the mother who may be having issues and I just think it’s the right thing to do.”

“It’s not the state’s job, it’s not the taxpayer’s job to financially take care of every individual from birth to death. That’s not what this is doing. This is giving someone an opportunity to start off on a better life and if we can do that then I just think it’s the right thing to do and I think it shows that we do care as a party about life after the baby’s born, and about the mother’s life.”

The Republican sponsors of the bill acknowledge that it also relates to their party’s identity regarding its pro-life stance. Bishop Davidson (R-Republic) said his party is often criticized as only supporting life before birth, but this bill is one thing that demonstrates otherwise.

*Representative Melanie Stinnett (Photo: Tim Bommel, Missouri House Communications)*

“We carried it before that Dobbs case. We’re going to carry it after that Dobbs case. We’re interested in lives, and lives being fulfilled from conception to death, and so I see this piece of legislation as a part of a holistic agenda that is pro-life.”

Representative LaKeySha Bosley (D-St. Louis), who is for the fourth time sponsoring this proposal, says that it is “imperative” after Dobbs, “as we did pass the abortion ban, and [even] before we passed House Bill 126, the heartbeat bill, women who were in rural or underserved communities were dying [in] childbirth.”

Patterson agrees with his fellow Republicans, “We’re a pro-life state. I’m very proud to be pro-life, but that also means taking care of these children that are born. This is a measure that would ensure that the mother has healthcare for a year after they’re born, which is critically important to the wellbeing of the newborn baby.”

*Representative Brad Pollitt (Photo: Tim Bommel, Missouri House Communications)*

Bosley notes that while maternal mortality rates are an issue statewide, they hit some in Missouri harder than others.

“As an African American woman, as a minority in the State of Missouri … women who look like me are dying at a higher number and at a higher rate than our white counterparts.”

Bosley is glad that this proposal has gained more sponsors and a lot of media attention and she hopes it will lead to more.

“I’m happy that it’s a hot topic. Let’s go further than just the 12^th months. Let’s talk about doulas. Let’s go into the holistic conversation about how we can provide some assistance to doulas and have them be reimbursed,” adding, “Extending the coverage from the three months to the twelve months is just one of the small things that we can do, and it may seem small but it’s going to mean so much to a lot more people across the state.”

*Representative Bishop Davidson (Photo: Tim Bommel, Missouri House Communications)*

Patterson observes that the broad appeal of this plan isn’t limited to the House but extends to the Senate, where two versions have been filed and have already received a hearing. He and the other sponsors share great optimism that this will pass this year.

“It’s just a common sense measure that we can do to ensure the health of the babies.”

None of the House versions of this bill have been referred to a committee.

The bills that have been filed are: House Bill 91 (Patterson), House Bill 254 (Pollitt), House Bill 286 (Lewis), House Bill 328 (Bosley), House Bill 354 (Davidson), and House Bill 965 (Stinnett).

House approves ‘No Patient Left Alone Act’

The House has approved the easing of restrictions on visitors in hospitals and nursing homes such as those experienced during the COVID-19 pandemic.

*Representative Rusty Black (Photo: Tim Bommel, Missouri House Communications)*

Representatives who backed the proposal cited instances of Missourians going for days or more and even dying without loved ones being allowed to see them. Opponents said it should be up to facilities how best to place restrictions for the good of patients and residents.

Called the “No Patient Left Alone Act,” House Bill 2116 was the combination of four pieces of legislation. The sponsor of HB 2116 is Chillicothe Republican Rusty Black.

“The overall bill would – I’m going to use the word ‘force’ – healthcare providers to allow a patient to list up to four people that could come visit them while they’re in the hospital,” Black explained.

The plan drew an impassioned speech from Majority Floor Leader Dean Plocher (R-St. Louis) who spoke about his late father-in-law’s stay in a hospital that lasted more than 20 days, during most of which he was not allowed visitors. Plocher said for much of this his family was not updated on his condition; his call light was not answered, and they were denied an explanation on the administering of unusual medications. He complained of improper care and was at one point found to have a fork embedded in his skin and to be suffering from mouth sores.

He said what happened to his father-in-law in the days before his death was not unique.

*House Majority Floor Leader Dean Plocher (Photo: Tim Bommel, Missouri House Communications)*

“Health care facilities were allowed to arbitrarily set rules for visitation all while staff could come and go on a daily basis, and I guess they could, in fact, bring in viruses too. Health care facilities essentially became prisons for our loved ones. People were admitted. One day you could have visitors, the next day you couldn’t. People were confined without access to an advocate from those that knew them. It was arbitrary and there was no recourse if you were locked away by a health care facility without access to visitors,” said Plocher. “This bill protects all Missourians and all of our loved ones. This bill is necessary and should be a right for of those receiving care, to have a visitor and an advocate by their side.”

Several Republicans called the legislation perhaps the most important bill they could handle this year.

“I truly believe that this bill will prevent a loss of life in many situations,” said Neosho representative Ben Baker (R), who chaired the committee that handled HB 2116. “When you are in that situation where you have no one to turn to, no one that you know, no one that you have that personal relationship with, it’s extremely important for the mental well-being, the physical well-being of those patients in those situations to have that. I can’t imagine what it would be like if I was in that situation where I had no one to advocate for me.”

Some Democrats spoke against the measure saying health care facilities should be able to determine what practices are the safest for their staff and those in their care, particularly during a pandemic.

“We all have rights and we all have freedoms and while your loved one is potentially needing support in one room, somebody else’s loved one is down the hall and they don’t need to be exposed to whatever it is that folks are bringing into that care facility,” said Representative Ashley Aune (D-Kansas City).

*Representatives Ashley Aune (left) and Bridge Walsh Moore (Photos: Tim Bommel, Missouri House Communications)*

“I can respect this is a horrible situation. It was a horrible situation we were put in. No one wants to keep family members from their loved ones in the hospital when they are sick. No one wants to do that, but a lot of times it’s what has to be done,” said Representative Bridget Walsh Moore.

“We all have high emotions about not being able to be with our loved ones at the end of their life , but I’m wondering if the policy, the legislation … takes the work and takes the authority, really, away from the people who are closest to the situation, working with their patients, to make a determination as to how safe, or not, it is for others to come in when people are sick,” said Representative Yolanda Young (D-Kansas City).

Republicans maintained that they worked with health care industry representatives in creating a bill that would answer their concerns while not jeopardizing safety in health care facilities.

“It’s done in a very prudent way. It does not open up visitation in a free-for-all manner. It’s thoughtful to where there’s only a handful of people that can get in off of a list and only a couple at a time, the facility can screen those folks, and so we can have the best of both worlds. We can have the safety that’s required but we can also have those visitation rights that is so important to the folks who need us to come in to hold their hand, to be with them, to help them with their mental health and physical health by being there for them in person,” said Representative J. Eggleston (R-Maysville).

The bill specifies that a patient’s list of visitors would include a spouse, or parents or guardians in the case of a child. Facilities could still deny access to patients under specified circumstances including at the request of the patient or law enforcement; when a person has signs and symptoms of a transmissible infection; or when the attending physician believes the presence of visitors would be detrimental to the patient. The bill’s provisions do not grant visitors access to restricted areas like operating rooms or behavioral health units.

The House voted 120-27 to send the bill to the Senate.