By STEVE BOUSQUET, Times Staff Writer
Published June 15, 2006
TALLAHASSEE - For patients, the growing popularity of freestanding medical spas offers a range of skin care treatments without the long waits to see a dermatologist.
But with medical safety concerns on the rise, doctors see the trend as potentially dangerous to patients, not to mention a threat to their livelihood.
A bill unanimously approved by the Legislature and awaiting action by Gov. Jeb Bush would narrow the scope of care that nurse practitioners and physician assistants can give without the direct supervision of a dermatologist or plastic surgeon.
If Bush signs the bill into law, a primary care doctor could supervise no more than four satellite offices, and specialists could supervise no more than two. In 2011, the number of satellite offices supervised by dermatologists would be reduced from two to one.
The carefully negotiated legislation won support from medical groups, but has drawn criticism from a nationwide network of medical spas.
It also has placed a key lawmaker in an odd spot, because he sponsored the measure, then backed away about the time his law firm began working to defeat the bill on behalf of a medical spa client.
The lawmaker is Rep. Joe Negron of Stuart, who is seeking the Republican nomination for attorney general.
Every year in the Capitol brings new, high-stakes turf wars between medical groups over so-called scope-of-practice issues. The latest bill is partly a response to the steady growth of satellite medical offices that offer a wide range of health care services, and plans by large retail chains such as Publix and Wal-Mart to offer "retail medicine."
Negron filed the bill HB 699 at the request of the Florida Medical Association. Working with the influential doctors' lobby, the Florida Nurses Association and others, he spent months negotiating the details, and the bill cruised through the House on a unanimous vote April 19.
But two days later, Akerman Senterfitt, the law firm that employs Negron as an of-counsel attorney, was hired by Palomar Medical Technologies of Massachusetts to defeat the bill. Palomar markets myriad devices used by medical spas.
Negron confirmed he no longer supports the bill, but stopped short of calling for a Bush veto. "That's up to the governor," Negron said.
Negron said changes were made to the bill that he did not support, and he also wanted the bill to give the state Board of Medicine more power over operation of the satellite offices. The Senate refused to agree with that, and some medical groups staunchly opposed the idea.
Negron said his change of heart had nothing to do with his law firm's client. "I am not aware of any client that may or may not have engaged my law firm," Negron said. "My policy has consistently been to pursue my legislative agenda without regard to any client my law firm may or may not have."
Ed Jaffry, one of three Akerman lobbyists hired by Palomar to defeat the bill, said he never discussed the bill with Negron.
The lobbyist said he was a logical choice to fight the bill because he has opposed similar legislation in recent years on behalf of another client, the Florida Nurse Practitioners' Network.
"What it's intended to do," Jaffry said of the bill, "is force patients to use dermatologists for procedures that for God knows how long have been done by advanced registered nurse practitioners, who are supervised by physicians."
Barbara Lumpkin, the longtime lobbyist for Florida nurses, said she hopes Bush signs the bill because it stops any new restrictions on nurse practitioners. Lumpkin also said she is mystified by Negron's stance.
"I know he says it has nothing to do with the money, but it seems funny that he totally had a change of heart," Lumpkin said. "It's just amazing."
Dozens of people have sent letters or e-mails to Bush on both sides of the issue.