House Bill 1121e2

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                                         HB 1121, Second Engrossed



  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; specifying that

30         the act be implemented as funded; providing an

31         effective date.


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                                         HB 1121, Second Engrossed



  1

  2         WHEREAS, the United States Department of Health and

  3  Human Services has identified 67 regions in Florida, including

  4  13 entire counties, most of them in rural North Florida, as

  5  Health Professional Shortage Areas; and 40 percent of the

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

  7  population, compared to the national average of 221 doctors

  8  per 100,000 population, and

  9         WHEREAS, in Florida, more than 3.2 million residents

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

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

12  60 percent and 70 percent of persons seeking medical care are

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

14  especially among its older residents, is contributing to an

15  increasing shortage of physicians in the state, and

16         WHEREAS, Florida has large areas of medically

17  underserved minority populations, and

18         WHEREAS, there are hundreds of highly qualified

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

20  admission to medical school, and

21         WHEREAS, Florida currently imports a substantial number

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

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

24  physician workforce who are international medical graduates,

25  and

26         WHEREAS, Florida's existing medical education system

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

28  growing population, which leaves the state vulnerable to

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

30  time limiting opportunities for Florida's best students to

31  enter the medical field and serve their communities, and


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                                         HB 1121, Second Engrossed



  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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                                         HB 1121, Second Engrossed



  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,

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

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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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                                         HB 1121, Second Engrossed



  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 and

  4  behavioral sciences training utilizing medical problem-based

  5  teaching; and clinical training at several dispersed sites

  6  throughout the state in existing community hospitals, clinics,

  7  and doctors' offices.  The Legislature further intends that

  8  study of the aging human be a continuing focus throughout the

  9  4-year curriculum and that use of information technology be a

10  key 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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                                         HB 1121, Second Engrossed



  1  program development is underway and a sufficient number of

  2  basic and behavioral sciences and clinical faculty are

  3  recruited, the Institute of Human Medical Sciences shall

  4  evolve into the Florida State University College of Medicine,

  5  with appropriate departments. The current admissions procedure

  6  utilized by the Program in Medical Sciences (PIMS) shall

  7  provide the basis for the design of an admissions process for

  8  the College of Medicine, with selection criteria that focus on

  9  identifying future primary care physicians who have

10  demonstrated interest in serving underserved areas. Enrollment

11  levels at the College of Medicine are planned to not exceed

12  120 students per class, and shall be phased in from 30

13  students in the Program in Medical Sciences (PIMS), to 40

14  students admitted to the College of Medicine as the charter

15  class in Fall 2001, and 20 additional students admitted to the

16  College of Medicine in each class thereafter until the maximum

17  class size is reached.

18         (5)  PARTNER ORGANIZATIONS FOR CLINICAL INSTRUCTION;

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

20  instruction in both rural and urban settings for students in

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

22  Medicine, through creation of nonprofit corporations, shall

23  seek affiliation agreements with health care systems and

24  organizations, local hospitals, medical schools, and military

25  health care facilities in the following targeted communities:

26  Pensacola, Tallahassee, Orlando, Sarasota, Jacksonville, and

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

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

29         (a)  Baptist Health Care in Pensacola.

30         (b)  Sacred Heart Health System in Pensacola.

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


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                                         HB 1121, Second Engrossed



  1         (d)  Tallahassee Memorial Healthcare in Tallahassee.

  2         (e)  Florida Hospital Health System in Orlando.

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

  4         (g)  Mayo Clinic in Jacksonville.

  5         (h)  Lee Memorial Health System, Inc. in Fort Myers.

  6         (i)  Rural hospitals in the state.

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  8  The College of Medicine shall also explore all alternatives

  9  for cooperation with established graduate medical education

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

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

12  Florida State University is directed to submit to the

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

14  increase opportunities for Florida medical school graduates to

15  enter graduate medical education programs, including

16  residencies, in the state.

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

18  develop a program which conforms to the accreditation

19  standards of the Liaison Committee on Medical Education

20  (LCME).

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

22         (a)  The pre-clinical curriculum shall draw on the

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

24  experience and national trends in basic and behavioral

25  sciences instruction, including use of technology for

26  distributed and distance learning. First-year instruction

27  shall include a lecture mode and problem-based learning. In

28  the second year, a small-group, problem-based learning

29  approach shall provide more advanced treatment of each

30  academic subject in a patient-centered context. Various

31  short-term clinical exposures shall be programmed throughout


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                                         HB 1121, Second Engrossed



  1  the pre-clinical years, including rural,  geriatric, and

  2  minority health, and contemporary practice patterns in these

  3  areas.

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

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

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

  7  assigned to clinical rotation training sites in local

  8  communities in roughly equal numbers, as follows:

  9         1.  Group 1 - Tallahassee.

10         2.  Group 2 - Pensacola.

11         3.  Group 3 - Orlando.

12         4.  Group 4 - Sarasota.

13         5.  Group 5 - Jacksonville.

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

15  emerging state needs.

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

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

18  Medicine shall develop a comprehensive program to ensure

19  training in the medical needs of the elderly and incorporate

20  principles embodied in the curriculum guidelines of the

21  American Geriatric Society.  The College of Medicine shall

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

23  education for physicians who will treat elder citizens.  To

24  accomplish this mission, the College of Medicine shall

25  establish an academic leadership position in geriatrics,

26  create an external elder care advisory committee, and

27  implement an extensive faculty development plan.  For student

28  recruitment purposes, the current Program in Medical Sciences

29  (PIMS) selection criteria shall be expanded to include

30  consideration of students who have expressed an interest in

31


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                                         HB 1121, Second Engrossed



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

  2  commitment to serve older persons.

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

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

  5  populations, the College of Medicine shall develop a

  6  Department of Family Medicine with a significant rural

  7  training track that provides students with early and frequent

  8  clinical experiences in community-based settings to train and

  9  produce highly skilled primary care physicians.  The College

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

11  practice clinical training programs and shall establish a

12  partnership with the West Florida Area Health Education Center

13  to assist in developing partnerships and programs to provide

14  incentives and support for physicians to practice in primary

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

16  the state.

17         (10)  INCREASING PARTICIPATION OF UNDERREPRESENTED

18  GROUPS.--To increase the participation of underrepresented

19  groups and socially and economically disadvantaged youth in

20  science and medical programs, the College of Medicine shall

21  continue the outreach efforts of the Program in Medical

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

23  including the Science Students Together Reaching Instructional

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

25  endowment income to support recruitment programs and

26  scholarship and financial aid packages for these students. To

27  develop a base of qualified potential medical school

28  candidates from underrepresented groups, the College of

29  Medicine shall coordinate with the undergraduate premedical

30  and science programs currently offered at the Florida State

31  University, develop relationships with potential feeder


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                                         HB 1121, Second Engrossed



  1  institutions, including 4-year institutions and community

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

  3  as support scholarship and financial aid packages. The College

  4  of Medicine shall develop plans for a postbaccalaureate,

  5  1-year academic program that provides a second chance to a

  6  limited number of students per year who have been declined

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

  8  meet established criteria as socially and economically

  9  disadvantaged. The College of Medicine shall make every

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

11  and support staff that reflect the heterogeneous nature of the

12  state's general population.

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

14  environments, the College of Medicine shall build on the

15  considerable infrastructure that already supports the many

16  technology resources of the Florida State University and shall

17  expand the infrastructure to conduct an effective medical

18  education program, including connectivity between the main

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

20  locations.  Additional technology programs shall include

21  extensive professional development opportunities for faculty,

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

23  students, faculty, and community preceptors, and

24  technology-sharing agreements with other medical schools to

25  allow for the exchange of technology applications among

26  medical school faculty for the purpose of enhancing medical

27  education.  The College of Medicine shall explore the

28  opportunities afforded by Mayo Clinic in Jacksonville through

29  clerkships, visiting professors or lectures through the

30  existing telecommunications systems, and collaboration in

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


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                                         HB 1121, Second Engrossed



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

  2  community-based clinical rotation training sites described in

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

  4  affairs/administrative officer.  Teaching faculty for the

  5  community-based clinical training component shall be community

  6  physicians serving part-time appointments.  Sixty faculty

  7  members shall be recruited to serve in the basic and

  8  behavioral sciences department.  The College of Medicine shall

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

10  administrators at the Florida State University, including a

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

12  associate dean for clinical education, a chief

13  financial/administrative officer, an admissions/student

14  affairs officer, an instructional resources coordinator, a

15  coordinator for graduate and continuing medical education, and

16  several mission focus coordinators.

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

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

19  to practice medicine in the evolving national system of health

20  care delivery, the College of Medicine shall fully integrate

21  modern health care delivery concepts into its curriculum.  For

22  this purpose, the College of Medicine shall develop a

23  partnership with one or more health care organizations in the

24  state and shall recruit faculty with strong health care

25  delivery competencies. Faculty from other disciplines at the

26  Florida State University shall be utilized to develop

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

28  health care.

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

30  shall be construed to authorize the Florida State University,

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


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                                         HB 1121, Second Engrossed



  1  purchase policies of insurance to indemnify from any liability

  2  those individuals or entities providing sponsorship or

  3  training to the students of the medical school, professionals

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

  5  school.

  6         Section 2.  This act shall be implemented as provided

  7  in the General Appropriations Act.

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

  9  law.

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