By Jim Saunders and Carol Gentry
10/13/2010 © Health News Florida
Anyone who hasn't noticed the big difference between the world views of doctors and nurses could catch on just by looking at their endorsements in the Florida governor's race.
To the Florida Medical Association, the overriding factor in the election of the next governor is protection against medical-malpractice lawsuits. Tort reform trumps every other issue, and FMA believes Republican Rick Scott can deliver it.
The Florida Nurses Association, which endorsed Democrat Alex Sink, doesn't have just one big issue. Like other health associations, FNA has turf issues. It also has numerous members who are state employees that it wants to protect from Scott's vow to cut the state workforce.
But there's something else, something FNA only hints at: Respect.
When the nurses held telephone interviews with candidates, Scott was given a time to call in. He didn't.
Sink not only called in, she showed up in person at the annual meeting in September to thank the nurses for their endorsement.
"It does send a message about the importance of our endorsement," FNA lobbyist Anna Small said.
The nurses association also has concerns about Scott's role in the multibillion-dollar Medicare fraud case against the hospital chain he headed in the 1990s, Columbia/HCA.
"We have a tremendous amount of concern about his track record in health care," Small said.
Barbara Lumpkin of the FNA Political Action Committee echoed that: "We feel Rick Scott's record on health care is not stellar."
The FMA endorsement of Scott, released Tuesday, doesn't even mention his role in the case, which ended in the company pleading guilty and paying a $1.7 billion fine, the largest ever imposed on a hospital company. Scott has said he did not know about the fraud; none of the executives was criminally charged.
The FMA's political-action committee switched to Scott after supporting Attorney General Bill McCollum in the Republican primary. FMA leaders in an e-mail emphasized Scott's support for reining in lawsuits and the related issue of trying to attract doctors to Florida.
"Florida is not a physician-friendly state to practice medicine because of the high cost of medical liability insurance and excessive lawsuits," said Madelyn Butler, a Tampa OB/GYN and president of the association.
"The FMA PAC supports Rick Scott for Governor because he shares our goal of increasing access to quality health care for all of Florida's citizens. Rick Scott is not afraid of taking on personal injury lawyers and shaking up the status quo in order to get things done for the people of Florida.''
The FMA, which is the state's largest and most-powerful physicians' group, often backs Republican candidates and has long made medical-malpractice reform a top priority. Also, many of its leaders agree with Scott about issues such as opposing the federal health-care overhaul.
But Scott's positions clash with the FMA on at least one major issue: He supports expanding managed care in the Medicaid program, an idea that the doctors group has fiercely opposed.
Both the nurses and the doctors say they want to increase "access to care." But they don't mean the same thing.
FMA says patients can have more doctors to choose from if the threat of lawsuits is reduced.
"The repercussions of this crisis are apparent in terms of access to care, as the citizens of Florida will have fewer physicians to choose from, will experience longer wait times to receive emergency medical care, and will have dramatically reduced access to specialists," said Timothy J. Stapleton, the FMA's executive vice president. "We need a Governor like Rick Scott who understands these complex issues and will fight for much needed reforms to our out-of-control tort system."
FNA says patients can get easier access to care if nurse-practitioners -- who provide primary care in many settings in place of physicians -- get the right to prescribe controlled drugs. In rural areas and specialized settings such as hospice, FNA's Small says, it's important for patients to be able to get prescriptions from the same person who delivers their primary care.
Nurses say patients' access to care is not just about expanding their scope-of-practice, which they have fought the FMA over for many years. FNA says it's also about expanding insurance coverage to the uninsured; the organization supported the Affordable Care Act, signed into law on March 27.
While the American Medical Association also supported it, with some caveats, the FMA has been vocal in opposition, saying it will take away physicians' independence and lead to a government takeover of health care.