House Bill 1121

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    Florida House of Representatives - 2000                HB 1121

        By Representative Peaden






  1                      A bill to be entitled

  2         An act relating to the Florida State University

  3         College of Medicine; establishing a 4-year

  4         allopathic medical school within the Florida

  5         State University; providing legislative intent;

  6         providing purpose; providing for transition,

  7         organizational structure, and admissions

  8         process; providing for partner organizations

  9         for clinical instruction in a community-based

10         medical education program; specifying targeted

11         communities and hospitals; providing for

12         development of a plan for graduate medical

13         education in the state; providing for

14         accreditation; providing curricula; providing

15         for clinical rotation sites in local

16         communities; providing for training to meet the

17         medical needs of the elderly; providing for

18         training to address the medical needs of the

19         state's rural and underserved populations;

20         providing for increased participation of

21         underrepresented groups and socially and

22         economically disadvantaged youth; providing for

23         technology-rich learning environments;

24         providing for administration and faculty;

25         providing for collaboration with other

26         professionals for integration of modern health

27         care delivery concepts; authorizing the Florida

28         State University to negotiate and purchase

29         certain liability insurance; providing an

30         effective date.

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    Florida House of Representatives - 2000                HB 1121

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  1         WHEREAS, the United States Department of Health and

  2  Human Services has identified 67 regions in Florida, including

  3  13 entire counties, most of them in rural North Florida, as

  4  Health Professional Shortage Areas; and 40 percent of the

  5  state's 67 counties have fewer than 100 doctors per 100,000

  6  population, compared to the national average of 221 doctors

  7  per 100,000 population, and

  8         WHEREAS, in Florida, more than 3.2 million residents

  9  are over the age of 60, more than 80 percent of patients who

10  visit a primary care physician are elder persons, and between

11  60 percent and 70 percent of persons seeking medical care are

12  age 60 and over; and Florida's continuing population growth,

13  especially among its older residents, is contributing to an

14  increasing shortage of physicians in the state, and

15         WHEREAS, Florida has large areas of medically

16  underserved minority populations, and

17         WHEREAS, there are hundreds of highly qualified

18  university students in Florida who seek, but cannot gain,

19  admission to medical school, and

20         WHEREAS, Florida currently imports a substantial number

21  of its doctors from other states or countries, and ranks third

22  highest, nationally, in the percentage of its total allopathic

23  physician workforce who are international medical graduates,

24  and

25         WHEREAS, Florida's existing medical education system

26  has an extremely limited capacity to serve the state's rapidly

27  growing population, which leaves the state vulnerable to

28  physician shortages at the national level, while at the same

29  time limiting opportunities for Florida's best students to

30  enter the medical field and serve their communities, and

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    Florida House of Representatives - 2000                HB 1121

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  1         WHEREAS, a medical school is not required to have its

  2  own teaching hospital in order to have a high-quality,

  3  accredited medical education program, and

  4         WHEREAS, community-based medical education programs are

  5  significantly less expensive than teaching-hospital-based

  6  medical education programs, do not involve the financial risks

  7  associated with the operation of a hospital, and enable the

  8  state to work with local hospitals, and

  9         WHEREAS, a community-based medical education program

10  relies on clinical resources available in each community and

11  requires support by hospitals, private and public health

12  clinics, and other health care organizations willing to enter

13  into affiliation agreements to provide clinical education as

14  part of a medical education program, and

15         WHEREAS, a number of hospitals, private and public

16  health clinics, and other health care organizations in the

17  state have expressed an interest in affiliating with a Florida

18  State University community-based medical education program,

19  and

20         WHEREAS, the Florida State University's Tallahassee

21  location is near the center of the region of the state with

22  the greatest current shortage of physicians, and

23         WHEREAS, the Florida State University has, since 1971,

24  successfully operated a first-year medical school program in

25  concert with the University of Florida College of Medicine and

26  is noted for its success in attracting students who eventually

27  become primary care physicians, and

28         WHEREAS, the Florida State University has strong

29  research programs in the applied biomedical and behavioral

30  sciences, autism, cancer, chronic diseases, and geriatrics,

31  and

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    Florida House of Representatives - 2000                HB 1121

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  1         WHEREAS, there has been no new medical school

  2  established in the United States in two decades despite the

  3  large growth in the nation's population, particularly the

  4  elderly population, and

  5         WHEREAS, there is now an unusual opportunity to design

  6  and operate an innovative medical education program in our

  7  state, which takes advantage of the advances in medical and

  8  communication technology, NOW, THEREFORE,

  9

10  Be It Enacted by the Legislature of the State of Florida:

11

12         Section 1.  Florida State University College of

13  Medicine.--

14         (1)  CREATION.--There is hereby established a 4-year

15  allopathic medical school within the Florida State University,

16  to be known as the Florida State University College of

17  Medicine, with a principal focus on recruiting and training

18  medical professionals to meet the primary health care needs of

19  the state, especially the needs of the state's elderly, rural,

20  minority, and other underserved citizens.

21         (2)  LEGISLATIVE INTENT.--It is the intent of the

22  Legislature that the Florida State University College of

23  Medicine represent a new model for the training of allopathic

24  physician healers for the citizens of the state. In accordance

25  with this intent, the governing philosophy of the College of

26  Medicine should include the training of students, in a humane

27  environment, in the scientific, clinical, and behavioral

28  practices required to deliver patient-centered health care in

29  the 21st century.  Key components of the College of Medicine,

30  which would build on the foundation of the 30-year-old Florida

31  State University Program in Medical Sciences (PIMS), would

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  1  include:  admission of diverse types of students who possess

  2  good communication skills and are compassionate individuals,

  3  representative of the population of the state; basic science

  4  training utilizing medical problem-based teaching; and

  5  clinical training at several dispersed sites throughout the

  6  state in existing community hospitals, clinics, and doctors'

  7  offices.  The Legislature further intends that study of the

  8  aging human be a continuing focus throughout the 4-year

  9  curriculum and that use of information technology be a key

10  component of all parts of the educational program.

11         (3)  PURPOSE.--The College of Medicine shall be

12  dedicated to:  preparing physicians to practice primary care,

13  geriatric, and rural medicine, to make appropriate use of

14  emerging technologies, and to function successfully in a

15  rapidly changing health care environment; advancing knowledge

16  in the applied biomedical and behavioral sciences, geriatric

17  research, autism, cancer, and chronic diseases; training

18  future scientists to assume leadership in health care delivery

19  and academic medicine; and providing access to medical

20  education for groups which are underrepresented in the medical

21  profession.

22         (4)  TRANSITION; ORGANIZATIONAL STRUCTURE; ADMISSIONS

23  PROCESS.--The General Appropriations Act for fiscal year

24  1999-2000 included initial funding for facilities and

25  operations to provide a transition from the Program in Medical

26  Sciences (PIMS) to a College of Medicine at the Florida State

27  University. For transitional purposes, the Program in Medical

28  Sciences (PIMS) in the College of Arts and Sciences at the

29  Florida State University shall be reorganized and

30  restructured, as soon as practicable, as the Institute of

31  Human Medical Sciences. At such time as the 4-year educational

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  1  program development is underway and a sufficient number of

  2  basic science and clinical faculty are recruited, the

  3  Institute of Human Medical Sciences shall evolve into the

  4  Florida State University College of Medicine, with appropriate

  5  departments. The current admissions procedure utilized by the

  6  Program in Medical Sciences (PIMS) shall provide the basis for

  7  the design of an admissions process for the College of

  8  Medicine, with selection criteria that focus on identifying

  9  future primary care physicians who have demonstrated interest

10  in serving underserved areas. Enrollment levels at the College

11  of Medicine are planned to not exceed 120 students per class,

12  and shall be phased in from 30 students in the Program in

13  Medical Sciences (PIMS), to 40 students admitted to the

14  College of Medicine as the charter class in Fall 2001, and 20

15  additional students admitted to the College of Medicine in

16  each class thereafter until the maximum class size is reached.

17         (5)  PARTNER ORGANIZATIONS FOR CLINICAL INSTRUCTION;

18  GRADUATE PROGRAMS.--To provide broad-based clinical

19  instruction in both rural and urban settings for students in

20  the community-based medical education program, the College of

21  Medicine shall seek affiliation agreements with health care

22  systems and organizations, local hospitals, and military

23  health care facilities in the following targeted communities:

24  Pensacola, Tallahassee, Orlando, Sarasota, Jacksonville, and

25  the rural areas of the state. Selected hospitals in the target

26  communities include, but are not limited to, the following:

27         (a)  Baptist Health Care in Pensacola.

28         (b)  Sacred Heart Health System in Pensacola.

29         (c)  West Florida Regional Medical Center in Pensacola.

30         (d)  Tallahassee Memorial Healthcare in Tallahassee.

31         (e)  Florida Hospital Health System in Orlando.

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    Florida House of Representatives - 2000                HB 1121

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  1         (f)  Sarasota Memorial Health Care System in Sarasota.

  2         (g)  Mayo Clinic in Jacksonville.

  3         (h)  Rural hospitals in the state.

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  5  The College of Medicine shall also explore all alternatives

  6  for cooperation with established graduate medical education

  7  programs in the state to develop a plan to retain its

  8  graduates in residency programs in Florida.  To this end, the

  9  Florida State University is directed to submit to the

10  Legislature, no later than November 30, 2001, a plan to

11  increase opportunities for Florida medical school graduates to

12  enter graduate medical education programs, including

13  residencies, in the state.

14         (6)  ACCREDITATION.--The College of Medicine shall

15  develop a program which conforms to the accreditation

16  standards of the Liaison Committee on Medical Education

17  (LCME).

18         (7)  CURRICULA; CLINICAL ROTATION TRAINING SITES.--

19         (a)  The initial 2-year curriculum shall draw on the

20  Florida State University's Program in Medical Sciences (PIMS)

21  experience and national trends in basic science instruction,

22  including use of technology for distributed and distance

23  learning. First-year instruction shall include a lecture mode

24  and problem-based learning. In the second year, a small-group,

25  problem-based learning approach shall provide more advanced

26  treatment of each academic subject in a patient-centered

27  context. Various short-term clinical exposures shall be

28  programmed throughout the first 2 years, including rural,

29  geriatric, and minority health, and contemporary practice

30  patterns in these areas.

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  1         (b)  During the third and fourth years, the curriculum

  2  shall follow a distributed, community-based model with a

  3  special focus on rural health. Subgroups of students shall be

  4  assigned to clinical rotation training sites in local

  5  communities in roughly equal numbers, as follows:

  6         1.  Group 1 - Tallahassee.

  7         2.  Group 2 - Pensacola.

  8         3.  Group 3 - Orlando.

  9         4.  Group 4 - Sarasota.

10         5.  Group 5 - Jacksonville.

11         6.  Group 6 - To be determined prior to 2005, based on

12  emerging state needs.

13         7.  Group 7 - Rural Physician Associate Program (RPAP).

14         (8)  MEDICAL NEEDS OF THE ELDERLY.--The College of

15  Medicine shall develop a comprehensive program to ensure

16  training in the medical needs of the elderly and incorporate

17  principles embodied in the curriculum guidelines of the

18  American Geriatric Society.  The College of Medicine shall

19  have as one of its primary missions the improvement of medical

20  education for physicians who will treat elder citizens.  To

21  accomplish this mission, the College of Medicine shall

22  establish an academic leadership position in geriatrics,

23  create an external elder care advisory committee, and

24  implement an extensive faculty development plan.  For student

25  recruitment purposes, the current Program in Medical Sciences

26  (PIMS) selection criteria shall be expanded to include

27  consideration of students who have expressed an interest in

28  elder care and who have demonstrated, through life choices, a

29  commitment to serve older persons.

30         (9)  MEDICAL NEEDS OF UNDERSERVED AREAS.--To address

31  the medical needs of the state's rural and underserved

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  1  populations, the College of Medicine shall develop a

  2  Department of Family Medicine with a significant rural

  3  training track that provides students with early and frequent

  4  clinical experiences in community-based settings to train and

  5  produce highly skilled primary care physicians.  The College

  6  of Medicine shall consider developing new, rural-based family

  7  practice clinical training programs and shall establish a

  8  partnership with the West Florida Area Health Education Center

  9  to assist in developing partnerships and programs to provide

10  incentives and support for physicians to practice in primary

11  care, geriatric, and rural medicine in underserved areas of

12  the state.

13         (10)  INCREASING PARTICIPATION OF UNDERREPRESENTED

14  GROUPS.--To increase the participation of underrepresented

15  groups and socially and economically disadvantaged youth in

16  science and medical programs, the College of Medicine shall

17  continue the outreach efforts of the Program in Medical

18  Sciences (PIMS) to middle and high school minority students,

19  including the Science Students Together Reaching Instructional

20  Diversity and Excellence (SSTRIDE), and shall build an

21  endowment income to support recruitment programs and

22  scholarship and financial aid packages for these students. To

23  develop a base of qualified potential medical school

24  candidates from underrepresented groups, the College of

25  Medicine shall coordinate with the undergraduate premedical

26  and science programs currently offered at the Florida State

27  University, develop relationships with potential feeder

28  institutions, including 4-year institutions and community

29  colleges, and pursue grant funds to support programs, as well

30  as support scholarship and financial aid packages. The College

31  of Medicine shall develop plans for a postbaccalaureate,

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  1  1-year academic program that provides a second chance to a

  2  limited number of students per year who have been declined

  3  medical school admission, who are state residents, and who

  4  meet established criteria as socially and economically

  5  disadvantaged. The College of Medicine shall make every

  6  effort, through recruitment and retention, to employ a faculty

  7  and support staff that reflect the heterogeneous nature of the

  8  state's general population.

  9         (11)  TECHNOLOGY.--To create technology-rich learning

10  environments, the College of Medicine shall build on the

11  considerable infrastructure that already supports the many

12  technology resources of the Florida State University and shall

13  expand the infrastructure to conduct an effective medical

14  education program, including connectivity between the main

15  campus, community-based training locations, and rural clinic

16  locations.  Additional technology programs shall include

17  extensive professional development opportunities for faculty,

18  an on-line library of academic and medical resources for

19  students, faculty, and community preceptors, and

20  technology-sharing agreements with other medical schools to

21  allow for the exchange of technology applications among

22  medical school faculty for the purpose of enhancing medical

23  education.  The College of Medicine shall explore the

24  opportunities afforded by Mayo Clinic in Jacksonville through

25  clerkships, visiting professors or lectures through the

26  existing telecommunications systems, and collaboration in

27  research activities at the Mayo Clinic's Jacksonville campus.

28         (12)  ADMINISTRATION; FACULTY.--Each of the major

29  community-based clinical rotation training sites described in

30  subsection (7) shall have a community dean and a student

31  affairs/administrative officer.  Teaching faculty for the

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  1  community-based clinical training component shall be community

  2  physicians serving part-time appointments.  Sixty faculty

  3  members shall be recruited to serve in the basic and

  4  behavioral sciences department.  The College of Medicine shall

  5  have a small core staff of on-campus, full-time faculty and

  6  administrators at the Florida State University, including a

  7  dean, a senior associate dean for educational programs, an

  8  associate dean for clinical education, a chief

  9  financial/administrative officer, an admissions/student

10  affairs officer, an instructional resources coordinator, a

11  coordinator for graduate and continuing medical education, and

12  several mission focus coordinators.

13         (13)  COLLABORATION WITH OTHER PROFESSIONALS.--To

14  provide students with the skills, knowledge, and values needed

15  to practice medicine in the evolving national system of health

16  care delivery, the College of Medicine shall fully integrate

17  modern health care delivery concepts into its curriculum.  For

18  this purpose, the College of Medicine shall develop a

19  partnership with one or more health care organizations in the

20  state and shall recruit faculty with strong health care

21  delivery competencies. Faculty from other disciplines at the

22  Florida State University shall be utilized to develop

23  team-based approaches to core competencies in the delivery of

24  health care.

25         (14)  INDEMNIFICATION FROM LIABILITY.--This section

26  shall be construed to authorize the Florida State University,

27  for and on behalf of the Board of Regents, to negotiate and

28  purchase policies of insurance to indemnify from any liability

29  those individuals or entities providing sponsorship or

30  training to the students of the medical school, professionals

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  1  employed by the medical school, and students of the medical

  2  school.

  3         Section 2.  This act shall take effect upon becoming a

  4  law.

  5

  6            *****************************************

  7                          HOUSE SUMMARY

  8
      Establishes a 4-year allopathic medical school within the
  9    Florida State University. Provides legislative intent and
      purpose. Provides for transition from the university's
10    Program in Medical Sciences (PIMS). Provides for
      evolution of an organizational structure and for an
11    admissions process. Provides for partner organizations
      for clinical instruction in a community-based medical
12    education program through affiliation agreements with
      health care systems and organizations, local hospitals,
13    and military health care facilities in specified target
      communities. Provides for development of a plan for
14    graduate medical education in the state, to be submitted
      to the Legislature by November 30, 2001. Provides for
15    accreditation. Provides for certain curricula. Provides
      for clinical rotation sites in local communities.
16    Provides for training to meet the medical needs of the
      elderly. Provides for training to address the medical
17    needs of the state's rural and underserved populations.
      Provides for programs and efforts to increase
18    participation of underrepresented groups and socially and
      economically disadvantaged youth. Provides for
19    technology-rich learning environments and programs.
      Provides for administration and faculty at the Florida
20    State University and major community-based clinical
      rotation sites. Provides for collaboration with other
21    professionals for integration of modern health care
      delivery concepts. Authorizes the Florida State
22    University to purchase certain liability insurance.

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