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.

Dispatchers ask for help dealing with PTSD, seek ‘first responder’ designation

      The state’s 911 dispatchers are urging lawmakers to add them to the state’s legal definition of “first responders,” before the legislative session ends.  Some of them visited the Capitol to share personal stories illustrating why they need the help in dealing with post-traumatic stress that comes with that designation.

Representative Chad Perkins (R-Bowling Green) is among the legislators who has carried legislation aimed at extending mental health services to dispatchers. (Photo: Tim Bommel, Missouri House Communications)

      First responders – which state statute currently defines as firefighters, law enforcement personnel, and emergency medical personnel – are afforded mental health resources, and several legislators say those should also be available to dispatchers.   

      Representative Lane Roberts (R-Joplin) has been Joplin’s Police Chief and the state’s Director of Public Safety, among other things in his career of more than 40 years.  Throughout all of that time he worked with dispatchers and even worked as one at times.

      “We have always underappreciated these folks.  They’re kind of out of sight, out of mind.  They work in a windowless environment, but they are the first of the first responders.  They’re the gateway to public safety,” said Roberts.  “Every time they get an emergency call they get an adrenaline dump just like people who work in the field do.  The difference is, the people in the field get to go somewhere, take action, use those chemicals, while the dispatcher will simply move on to the next call, take those chemicals home at night and go to sleep with them and suffer the health consequences.”

      Independence representative Robert Sauls (D) was a prosecutor in Jackson County and a public defender.

“As a former prosecutor I would regularly listen to 911 calls and what happens in those circumstances and … often times people are contacting 911 operators on their worst day.  Something’s happening, they’re scared, it’s a very stressful situation, and all of these 911 operators are under these stressful environments and the thing of it is, you’ve got to go on to the next one.  You’ve gotten your one situation settled, you hang up the phone, and you’ve got another one.  I think it’s very important to recognize these people as first responders.”

      Polk County 911 Director Sarah Newell said what she and her colleagues do is often dismissed as just answering phones or clerical work.

“It’s not.  We are the first point, so how that call goes is dependent on that dispatcher.  How fast that call gets put out, what information gets put out, resource allocation and knowing and forward thinking to say, ‘they’re probably going to need an ambulance on standby so let’s go ahead and roll one of those,’ so all things that they have to think about out of the box at any given time.”

      J.R. Webb, the Assistant Director of Springfield/Green County 911, said dispatchers, “have to be able to do a lot of things at once.  They have to be able to take that phone call, at the same time they’re typing that information into a computer, at the same time that they may be dealing with first responders on the radio.  The multitasking is incredible in a busy situation, and it takes a special kind of person to be able to do that.  It takes a kind of type ‘A,’ take charge personality to succeed at our job and it’s not meant for everybody.”

      The Chair of the State 911 Board of Governance, Alan Wells, said “Post-traumatic stress is a big, big thing for our 911 telecommunicators, and as of right now they do not have a lot of resources there to help with that.”

“Turnover is a big problem, burnout is a big problem that affects this industry, so we hope to be able to give them all the benefits necessary to sustain a good, long-lasting career,” said Wells.

Representative Robert Sauls also carries legislation intended to include dispatchers in the state’s legal definition of “first responders.” (Photo: Tim Bommel, Missouri House Communications)

      He said it’s not uncommon for dispatchers, especially in the smaller communities throughout Missouri, to know personally the people involved in the incidents they are handling.

      “Sometimes it can be very horrifying for those operators,” said Wells.  “It may be a loved one, a family member, an immediate family member, or in our case it was one of our own 911 call takers who had just left his shift, headed home on his motorcycle and hit a deer and it was a fatality.  The same operators that were just working with him had to take that call and work that incident.”

      Hailey Brunner is in her fourth year as a dispatcher at the Cass Co Sheriff’s Office.  She remembered one week in which her rotation, “worked seven fatalities, whether it be between an accident, people harming themselves, anything of that nature, natural deaths, anything, and it’s just a wide variety, whether it’s young kids to old kids.  My most recent one was a two year-old who died in a fatality car accident.”

      Blake Johnson has been dispatching for five years in Green County.  He said there is one call he’ll always remember. 

“I had taken a call from a family who had lost a child and I can still hear the mom screaming for her kid.  It’s absolutely horrible and it makes it worse when you actually know who those people are.”

      Newell said, “I have a dispatcher who actually worked a motor vehicle accident.  It was a rollover with ejection.  There were four juveniles in the vehicle.  She took the call and … right before she was ready to dispatch, she realized it was her son in the vehicle.”

      Brunner said dispatchers can’t help but imagine the scenes that they are hearing play out over the phone, and that can result in very vivid and very upsetting imagery. 

“You’re hearing all of this stuff that’s going on, on the phone.  You’re hearing the screams and … they’re painting a picture for you, so you have this picture in your mind of what it looks like and it could be completely the opposite of what they actually see on the scene.  It could be better, it could be worse.  We never quite know.”

      Webb said worse still, dispatchers often get no closure at the end of a call.

“You’re sending folks to help these people that are yelling and screaming at you and in their worst day, then you don’t really know for sure when the other first responders go there, and how this call turned out,” said Webb.

Representative Lane Roberts (Photo: Tim Bommel, Missouri House Communications)

      He said an increasing number of suicides in Missouri also directly impacts dispatchers. 

“It could be someone, honestly, wanting an audience while they commit suicide.  That happens way too much.”

      Some call centers, like that at Springfield, have mental health resources that are made available to dispatchers there and in surrounding communities.  Such resources aren’t available to all dispatchers in Missouri, though, especially in many smaller communities. 

      Several bills would address PTSD and mental health resources for dispatchers and other first responders.  These dispatchers and lawmakers are among those who hope at least one of those bills is passed before the session’s end on May 12.

As swatting incidents spike House weighs tougher penalties

      False reports of school shootings and other crimes have been rampant for months throughout the United States, and the state House is considering a bill to deal with such crimes.

Representative Lane Roberts (Photo: Tim Bommel, Missouri House Communications)

      The practice is commonly called “swatting:”  making a false report of a crime so that law enforcement – particularly a SWAT team – will respond to an address.  It is often used as a revenge tactic, as a way to cause unrest, or in the minds of some it is even seen as a joke.

      It isn’t funny to Representative Lane Roberts (R-Joplin), who has a lengthy career that includes time as Joplin’s Police Chief and Director of the Missouri Department of Public Safety.  He said such reports create needless danger for the public and for law enforcement.

      “Frequently people will make a false call for the purpose of harassing someone, discriminating against someone.  It affects their reputation, their business, there’s a lot of consequences to some of these false reports and some of it’s pretty darn malicious,” said Roberts.  “The difficulty is that the penalties for doing that now are pretty mild compared to the potential for injury that goes with a call like that.  It’s just not something that we can put up with.”

        For several years he has proposed legislation to address swatting.  This week his latest such effort was heard by the House Committee on Public Safety, which he chairs. 

He stressed to the committee that the key to House Bill 302 is how it would define the crime.  That is, to give a false report to law enforcement, a security officer, a fire department, or other such organization, “with reckless disregard of causing bodily harm to any person as a direct result of an emergency response.”

      Roberts explained, “This specifically says the person who makes the false report for the purpose of doing any of the enumerated things … we’re talking about, what’s the intent of the call?”

      Under HB 302 those who make false reports that result in a person being killed or seriously hurt could be charged with a class-B felony, punishable by 5 to 15 years in prison.  Falsely reporting a felony crime would be a class-E felony (up to four years in prison).  Any other false reports would be a class-B misdemeanor (up to six months in jail and a fine of up to $1,000).  

      Juveniles making false reports for the first time would be guilty of a status offense.  Any further offenses would be class-C misdemeanors and would require a juvenile court appearance or community service and a fine. 

      The bill would hold any person convicted under its provisions liable for the costs of any emergency response caused by their false report.  They could also be sued by any victims.  Roberts said that is because swatting can cause, “damage to someone’s business, their reputation, their ability to make a living, their livelihood, so if someone engages in that kind of conduct for the purpose of causing harm to someone’s livelihood, then by all means they should be accountable.”

      Jordan Kadosh with the Anti-Defamation League spoke in favor of HB 302.  He reiterated that instances of swatting have been spiking, especially after many of the recent shootings at schools throughout the nation.  He said after the recent shooting that killed six people at The Covenant School in Nashville, Tennessee, Missouri law enforcement was “inundated with false reports.”

      “These were later confirmed in the press to be attempts at swatting against schools.  The act of swatting turns law enforcement officers against the population that they serve,” said Kadosh.

      He said the bill is narrowly crafted to help prosecutors make cases against swatters and at last create real penalties for maliciously making false reports.

      The committee has not voted on HB 302.  Last year the House passed similar legislation 142-0, but it did advance out of the Senate.

Pronunciations:

Kadosh = kah-DOEsh

House votes to extend opportunities for more jobs, greater salaries to persons with disabilities

The House has voted to expand access to job opportunities and greater salaries to Missourians with disabilities by passing legislation that, backers say, will let those people simply live their lives.

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

House Bills 970 and 971 make changes to the state’s Ticket to Work health insurance program within MO HealthNet.  The key provisions increase the limit to how much a person can earn before they would lose benefits under Ticket to Work and disregard up to $50,000 of a spouse’s income, relative to that limit.  It will also direct state agencies to have policies to recruit and keep employees with disabilities and create competitive ways to integrate them into workforces.

      The bills are carried by Representative Melanie Stinnett (R-Springfield), whose career in healthcare and as a speech-language pathologist has included a great deal of focus on serving the disabled community.  She said she is honored to sponsor this legislation.

      “It provides language that tells individuals with disabilities that we value them as important members of our community.  It allows these individuals to enjoy the opportunity to enjoy competitive, integrated employment by decreasing barriers imposed by government,” said Stinnett.

      She said these changes address outdated statutes that might have made sense in their time, but set limits that today are far too low. 

“The restrictions we have in place limited them from being able to utilize the degrees that they had and the skills and the trades that they had in our communities in an effective way, and with today’s work force crunch, too, we certainly don’t want to be limiting our workforce,” said Stinnett.

      The legislation has been offered in the House for about eight years.  One person who has carried it throughout that time, Representative Sarah Unsicker (D-Shrewsbury), said individuals with disabilities have Missouri’s lowest unemployment rate, largely due to discrimination and lack of accommodation and understanding.

Representative Bridget Walsh Moore (Photo: Tim Bommel, Missouri House Communications)

      “Disability is a natural part of the human condition that affects everybody at some point in their lives, some sooner than others.  The existence of a disability should not stop somebody from working and living to their fullest capacity,” said Unsicker.  “There are people right now with master’s degrees who cannot work because of services they need just to get out of bed and survive and be physically able to meet the day even if they are mentally able to do incredible work.  This will help them be taxpayers to the fullest extent of their ability.  This will help people get jobs.”

      Representative Bridget Walsh Moore (D-St. Louis) is a Missourian living and working with a disability and has also for several years sponsored this legislation.  She said some people in the disabled community choose not to get married because if they do while the current limits are in place, they will lose their health benefits under Ticket to Work.

In her own life, said Walsh Moore, “If anything were to happen to me, my husband makes over $60,000.  We would receive nothing from the state, zero support, and $60,000 for the two of us plus our child is not enough, especially with any medical needs I might have,” said Walsh Moore.

      She said individuals need the benefits provided by that coverage to function daily, to hold jobs, and to live with dignity.  She said she often thinks of a friend of hers who is in her 20s and has a master’s degree.

“She had to go to her job and say ‘Cap my salary at 40 grand.’  They wanted to pay her almost double that and she had to say no because even 80-thousand won’t make up enough to cover the assistance [she needs].  She is in a powered wheelchair so she has someone who helps her in morning and night, in getting in and getting out of bed and all that, and it’s not enough.”

“Missouri is losing out twice.  They’re losing out on her income tax, and that’s another 40-grand that would have gone into our economy,” said Walsh Moore.

      She said the provisions aimed at state agencies are intended to create a system that can be a model outside of government.

Representative Sarah Unsicker (Photo: Tim Bommel, Missouri House Communications)

      “As the system stands, we have sheltered workshops and we have full competitive employment and no bridge in between.  What this would do is basically set up the state as a model employer.  Basically, we will figure out a program ourselves.  All state departments will hire people with disabilities.  We’ll kind of work out the kinks, figure out the program ourselves, and then we can sell it to corporate America,” Walsh Moore explained.  “A lot of corporations I’ve talked to are very interested.  They like the idea, they just don’t know what that looks like, and so we’re taking that burden off of them and saying we’ll do it first and we’ll figure it out.”

      Stinnett, who is in her first year in the House, said this was one of the first issues she asked about taking up. 

      “It’s something that’s come up in my work life outside of this building and was a really important thing to me that I found disability legislation that I could get across the finish line that would make a difference for our everyday Missourians living with disabilities.”

      The House voted 151-0 to send the legislation to the Senate, and has amended it to other bills.

Proposed Parkinson’s registry could foster work toward treatments and a cure

      Missouri could be a leader in creating a knowledge base to help understand and fight Parkinson’s disease, under a bill approved by a House committee.

Representative Travis Smith (Photo: Tim Bommel, Missouri House Communications)

      House Bill 822 would create the Parkinson’s disease registry to collect general information about people diagnosed with that disease and to be kept by the University of Missouri.  It would be used to identify commonalities between patients that could lead to a greater understanding of who is likely to develop Parkinson’s, and help to develop preventative measures, treatments, and perhaps even a cure.

      Bill sponsor Travis Smith (R-Dora) told the House Committee on Children and Families, “Little is known about Parkinson’s.  It is distributed among different population groups and the patterns of the disease are changing over time.  Knowing who has Parkinson’s will also assist researchers in acquiring more information about the causes of Parkinson’s, [which are] believed to be a combination of environmental and genetic factors.”

      “The whole idea with [HB 822] is:  we collect this data and we start learning from it and we prevent this happening to future generations.”

      Smith’s inspiration for carrying the proposal was a family friend, Ann Dugan, who often joined his family for dinner each year on Thanksgiving.

“[Ann] got Parkinson’s, and every year I saw her progress and get worse and worse and worse.  The hardest part for her was her mind was still 100% intact.  She was a brilliant lady, had a master’s degree, but her body functions – she could no longer control even her movement.  It just broke my heart and I could see how much frustration she was in year after year.”

      The registry would be part of a larger national effort in coordination with the Centers for Disease Control (CDC), which has created a National Neurological Conditions Surveillance Program.  That program would gather data on Parkinson’s that could be used by researchers internationally, as they look for a cure.

      Before it begins collecting data, however, it needs several states to be online.   Julie Pitcher with the Michael J. Fox Foundation for Parkinson’s Research said Missouri could be the fifth state in the nation with such a registry. 

      “We are on a quest to get better data,” Pitcher told the committee.  “Patients really do want to be part of this to look for long-term effects, genetic predispositions, biomarkers, and other reasons that they may be living with Parkinson’s, and for future generations.”

      Roughly 20-thousand to 30-thousand Missourians are believed to have Parkinson’s.  Nationally that number is about 1.2-million, and Pitcher said the rate of diagnosis is expected to increase.

“There is a rise and we don’t know why.  We do know that many veterans are exposed to toxic burn pits and other chemicals.  There are folks that work in fields and are exposed to very, very toxic chemicals – herbicides like paraquat – and then we are expecting a larger number of folks … those who were in their 20s fighting in Afghanistan who we believe are now in their 40s and we expect more diagnoses coming as they age into their 50s.  It usually presents itself in their 50s but we are seeing more, younger members, particularly women, are now being diagnosed younger.”

Researchers hope the registry would help answer the question as to why an increase in instances of Parkinson’s diagnoses is occurring. 

The registry would not include personally identifying information and patients could choose not to be included at all.  Smith said he made sure that was the case before moving forward with the proposal.

“That’s one thing I’ve always been super concerned about, is people’s privacy.  This will not have people’s names on it.  This will basically be like HIPAA where all their information is hidden away … the University of Missouri will collect this data and then start working with other universities and hopefully come up with solutions.”

      He said what it would include are things like, “What your age group is; geographical – where have you been, where have you been, what have you done; occupation – were you in the military, were you a farmer, were you a teacher, were you a lawyer.  It’s going to be very broad.”

      The committee voted 10-0 to advance that bill to another committee, and from there it could go on to the full House.