CODING: Words stricken are deletions; words underlined are additions.
SENATE AMENDMENT
Bill No. SB 1692
Amendment No.
CHAMBER ACTION
Senate House
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11 Senator King moved the following amendment:
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13 Senate Amendment (with title amendment)
14 Delete everything after the enacting clause
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16 and insert:
17 Section 1. Florida State University College of
18 Medicine.--
19 (1) CREATION.--There is established a 4-year
20 allopathic medical school within the Florida State University,
21 to be known as the Florida State University College of
22 Medicine, with a principal focus on recruiting and training
23 medical professionals to meet the primary health care needs of
24 the state, especially the needs of the state's elderly, rural,
25 minority, and other underserved citizens.
26 (2) LEGISLATIVE INTENT.--It is the intent of the
27 Legislature that the Florida State University College of
28 Medicine represent a new model for the training of allopathic
29 physician healers for the citizens of the state. In accordance
30 with this intent, the governing philosophy of the College of
31 Medicine should include the training of students, in a humane
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1 environment, in the scientific, clinical, and behavioral
2 practices required to deliver patient-centered health care in
3 the 21st century. Key components of the College of Medicine,
4 which would build on the foundation of the 30-year-old Florida
5 State University Program in Medical Sciences (PIMS), would
6 include: admission of diverse types of students who possess
7 good communication skills and are compassionate individuals,
8 representative of the population of the state; basic and
9 behavioral sciences training utilizing medical problem-based
10 teaching; and clinical training at several dispersed sites
11 throughout the state in existing community hospitals, clinics,
12 and doctors' offices. The Legislature further intends that
13 study of the aging human be a continuing focus throughout the
14 4-year curriculum and that use of information technology be a
15 key component of all parts of the educational program.
16 (3) PURPOSE.--The College of Medicine shall be
17 dedicated to: preparing physicians to practice primary care,
18 geriatric, and rural medicine, to make appropriate use of
19 emerging technologies, and to function successfully in a
20 rapidly changing health care environment; advancing knowledge
21 in the applied biomedical and behavioral sciences, geriatric
22 research, autism, cancer, and chronic diseases; training
23 future scientists to assume leadership in health care delivery
24 and academic medicine; and providing access to medical
25 education for groups which are underrepresented in the medical
26 profession.
27 (4) TRANSITION; ORGANIZATIONAL STRUCTURE; ADMISSIONS
28 PROCESS.--The General Appropriations Act for fiscal year
29 1999-2000 included initial funding for facilities and
30 operations to provide a transition from the Program in Medical
31 Sciences (PIMS) to a College of Medicine at the Florida State
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1 University. For transitional purposes, the Program in Medical
2 Sciences (PIMS) in the College of Arts and Sciences at the
3 Florida State University shall be reorganized and
4 restructured, as soon as practicable, as the Institute of
5 Human Medical Sciences. At such time as the 4-year educational
6 program development is underway and a sufficient number of
7 basic and behavioral sciences and clinical faculty are
8 recruited, the Institute of Human Medical Sciences shall
9 evolve into the Florida State University College of Medicine,
10 with appropriate departments. The current admissions procedure
11 utilized by the Program in Medical Sciences (PIMS) shall
12 provide the basis for the design of an admissions process for
13 the College of Medicine, with selection criteria that focus on
14 identifying future primary care physicians who have
15 demonstrated interest in serving underserved areas. Enrollment
16 levels at the College of Medicine are planned to not exceed
17 120 students per class, and shall be phased in from 30
18 students in the Program in Medical Sciences (PIMS), to 40
19 students admitted to the College of Medicine as the charter
20 class in Fall 2001, and 20 additional students admitted to the
21 College of Medicine in each class thereafter until the maximum
22 class size is reached.
23 (5) PARTNER ORGANIZATIONS FOR CLINICAL INSTRUCTION;
24 GRADUATE PROGRAMS.--To provide broad-based clinical
25 instruction in both rural and urban settings for students in
26 the community-based medical education program, the College of
27 Medicine, through creation of nonprofit corporations, shall
28 seek affiliation agreements with health care systems and
29 organizations, local hospitals, medical schools, and military
30 health care facilities in the following targeted communities:
31 Pensacola, Tallahassee, Orlando, Sarasota, Jacksonville, and
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1 the rural areas of the state. Selected hospitals in the target
2 communities include, but are not limited to, the following:
3 (a) Baptist Health Care in Pensacola.
4 (b) Sacred Heart Health System in Pensacola.
5 (c) West Florida Regional Medical Center in Pensacola.
6 (d) Tallahassee Memorial Healthcare in Tallahassee.
7 (e) Florida Hospital Health System in Orlando.
8 (f) Sarasota Memorial Health Care System in Sarasota.
9 (g) Mayo Clinic in Jacksonville.
10 (h) Lee Memorial Health System, Inc. in Fort Myers.
11 (i) Rural hospitals in the state.
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13 The College of Medicine shall also explore all alternatives
14 for cooperation with established graduate medical education
15 programs in the state to develop a plan to retain its
16 graduates in residency programs in Florida. To this end, the
17 Florida State University is directed to submit to the
18 Legislature, no later than November 30, 2001, a plan to
19 increase opportunities for Florida medical school graduates to
20 enter graduate medical education programs, including
21 residencies, in the state.
22 (6) ACCREDITATION.--The College of Medicine shall
23 develop a program which conforms to the accreditation
24 standards of the Liaison Committee on Medical Education
25 (LCME).
26 (7) CURRICULA; CLINICAL ROTATION TRAINING SITES.--
27 (a) The pre-clinical curriculum shall draw on the
28 Florida State University's Program in Medical Sciences (PIMS)
29 experience and national trends in basic and behavioral
30 sciences instruction, including use of technology for
31 distributed and distance learning. First-year instruction
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1 shall include a lecture mode and problem-based learning. In
2 the second year, a small-group, problem-based learning
3 approach shall provide more advanced treatment of each
4 academic subject in a patient-centered context. Various
5 short-term clinical exposures shall be programmed throughout
6 the pre-clinical years, including rural, geriatric, and
7 minority health, and contemporary practice patterns in these
8 areas.
9 (b) During the third and fourth years, the curriculum
10 shall follow a distributed, community-based model with a
11 special focus on rural health. Subgroups of students shall be
12 assigned to clinical rotation training sites in local
13 communities in roughly equal numbers, as follows:
14 1. Group 1 - Tallahassee.
15 2. Group 2 - Pensacola.
16 3. Group 3 - Orlando.
17 4. Group 4 - Sarasota.
18 5. Group 5 - Jacksonville.
19 6. Group 6 - To be determined prior to 2005, based on
20 emerging state needs.
21 7. Group 7 - Rural Physician Associate Program (RPAP).
22 (8) MEDICAL NEEDS OF THE ELDERLY.--The College of
23 Medicine shall develop a comprehensive program to ensure
24 training in the medical needs of the elderly and incorporate
25 principles embodied in the curriculum guidelines of the
26 American Geriatric Society. The College of Medicine shall have
27 as one of its primary missions the improvement of medical
28 education for physicians who will treat elder citizens. To
29 accomplish this mission, the College of Medicine shall
30 establish an academic leadership position in geriatrics,
31 create an external elder care advisory committee, and
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1 implement an extensive faculty development plan. For student
2 recruitment purposes, the current Program in Medical Sciences
3 (PIMS) selection criteria shall be expanded to include
4 consideration of students who have expressed an interest in
5 elder care and who have demonstrated, through life choices, a
6 commitment to serve older persons.
7 (9) MEDICAL NEEDS OF UNDERSERVED AREAS.--To address
8 the medical needs of the state's rural and underserved
9 populations, the College of Medicine shall develop a
10 Department of Family Medicine with a significant rural
11 training track that provides students with early and frequent
12 clinical experiences in community-based settings to train and
13 produce highly skilled primary care physicians. The College of
14 Medicine shall consider developing new, rural-based family
15 practice clinical training programs and shall establish a
16 partnership with the West Florida Area Health Education Center
17 to assist in developing partnerships and programs to provide
18 incentives and support for physicians to practice in primary
19 care, geriatric, and rural medicine in underserved areas of
20 the state.
21 (10) INCREASING PARTICIPATION OF UNDERREPRESENTED
22 GROUPS.--To increase the participation of underrepresented
23 groups and socially and economically disadvantaged youth in
24 science and medical programs, the College of Medicine shall
25 continue the outreach efforts of the Program in Medical
26 Sciences (PIMS) to middle and high school minority students,
27 including the Science Students Together Reaching Instructional
28 Diversity and Excellence (SSTRIDE), and shall build an
29 endowment income to support recruitment programs and
30 scholarship and financial aid packages for these students. To
31 develop a base of qualified potential medical school
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1 candidates from underrepresented groups, the College of
2 Medicine shall coordinate with the undergraduate premedical
3 and science programs currently offered at the Florida State
4 University, develop relationships with potential feeder
5 institutions, including 4-year institutions and community
6 colleges, and pursue grant funds to support programs, as well
7 as support scholarship and financial aid packages. The College
8 of Medicine shall develop plans for a postbaccalaureate,
9 1-year academic program that provides a second chance to a
10 limited number of students per year who have been declined
11 medical school admission, who are state residents, and who
12 meet established criteria as socially and economically
13 disadvantaged. The College of Medicine shall make every
14 effort, through recruitment and retention, to employ a faculty
15 and support staff that reflect the heterogeneous nature of the
16 state's general population.
17 (11) TECHNOLOGY.--To create technology-rich learning
18 environments, the College of Medicine shall build on the
19 considerable infrastructure that already supports the many
20 technology resources of the Florida State University and shall
21 expand the infrastructure to conduct an effective medical
22 education program, including connectivity between the main
23 campus, community-based training locations, and rural clinic
24 locations. Additional technology programs shall include
25 extensive professional development opportunities for faculty,
26 an on-line library of academic and medical resources for
27 students, faculty, and community preceptors, and
28 technology-sharing agreements with other medical schools to
29 allow for the exchange of technology applications among
30 medical school faculty for the purpose of enhancing medical
31 education. The College of Medicine shall explore the
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1 opportunities afforded by Mayo Clinic in Jacksonville through
2 clerkships, visiting professors or lectures through the
3 existing telecommunications systems, and collaboration in
4 research activities at the Mayo Clinic's Jacksonville campus.
5 (12) ADMINISTRATION; FACULTY.--Each of the major
6 community-based clinical rotation training sites described in
7 subsection (7) shall have a community dean and a student
8 affairs/administrative officer. Teaching faculty for the
9 community-based clinical training component shall be community
10 physicians serving part-time appointments. Sixty faculty
11 members shall be recruited to serve in the basic and
12 behavioral sciences department. The College of Medicine shall
13 have a small core staff of on-campus, full-time faculty and
14 administrators at the Florida State University, including a
15 dean, a senior associate dean for educational programs, an
16 associate dean for clinical education, a chief
17 financial/administrative officer, an admissions/student
18 affairs officer, an instructional resources coordinator, a
19 coordinator for graduate and continuing medical education, and
20 several mission focus coordinators.
21 (13) COLLABORATION WITH OTHER PROFESSIONALS.--To
22 provide students with the skills, knowledge, and values needed
23 to practice medicine in the evolving national system of health
24 care delivery, the College of Medicine shall fully integrate
25 modern health care delivery concepts into its curriculum. For
26 this purpose, the College of Medicine shall develop a
27 partnership with one or more health care organizations in the
28 state and shall recruit faculty with strong health care
29 delivery competencies. Faculty from other disciplines at the
30 Florida State University shall be utilized to develop
31 team-based approaches to core competencies in the delivery of
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1 health care.
2 (14) INDEMNIFICATION FROM LIABILITY.--This section
3 shall be construed to authorize the Florida State University,
4 for and on behalf of the Board of Regents, to negotiate and
5 purchase policies of insurance to indemnify from any liability
6 those individuals or entities providing sponsorship or
7 training to the students of the medical school, professionals
8 employed by the medical school, and students of the medical
9 school.
10 Section 2. This act shall be implemented as provided
11 in the General Appropriations Act.
12 Section 3. This act shall take effect upon becoming a
13 law.
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16 ================ T I T L E A M E N D M E N T ===============
17 And the title is amended as follows:
18 Delete everything before the enacting clause
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20 and insert:
21 A bill to be entitled
22 An act relating to the Florida State University
23 College of Medicine; establishing a 4-year
24 allopathic medical school within the Florida
25 State University; providing legislative intent;
26 providing purpose; providing for transition,
27 organizational structure, and admissions
28 process; providing for partner organizations
29 for clinical instruction in a community-based
30 medical education program; specifying targeted
31 communities and hospitals; providing for
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1 development of a plan for graduate medical
2 education in the state; providing for
3 accreditation; providing curricula; providing
4 for clinical rotation sites in local
5 communities; providing for training to meet the
6 medical needs of the elderly; providing for
7 training to address the medical needs of the
8 state's rural and underserved populations;
9 providing for increased participation of
10 underrepresented groups and socially and
11 economically disadvantaged youth; providing for
12 technology-rich learning environments;
13 providing for administration and faculty;
14 providing for collaboration with other
15 professionals for integration of modern health
16 care delivery concepts; authorizing the Florida
17 State University to negotiate and purchase
18 certain liability insurance; specifying that
19 the act be implemented as funded; providing an
20 effective date.
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22 WHEREAS, the United States Department of Health and
23 Human Services has identified 67 regions in Florida, including
24 13 entire counties, most of them in rural North Florida, as
25 Health Professional Shortage Areas; and 40 percent of the
26 state's 67 counties have fewer than 100 doctors per 100,000
27 population, compared to the national average of 221 doctors
28 per 100,000 population, and
29 WHEREAS, in Florida, more than 3.2 million residents
30 are over the age of 60, more than 80 percent of patients who
31 visit a primary care physician are elder persons, and between
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1 60 percent and 70 percent of persons seeking medical care are
2 age 60 and over; and Florida's continuing population growth,
3 especially among its older residents, is contributing to an
4 increasing shortage of physicians in the state, and
5 WHEREAS, Florida has large areas of medically
6 underserved minority populations, and
7 WHEREAS, there are hundreds of highly qualified
8 university students in Florida who seek, but cannot gain,
9 admission to medical school, and
10 WHEREAS, Florida currently imports a substantial number
11 of its doctors from other states or countries, and ranks third
12 highest, nationally, in the percentage of its total allopathic
13 physician workforce who are international medical graduates,
14 and
15 WHEREAS, Florida's existing medical education system
16 has an extremely limited capacity to serve the state's rapidly
17 growing population, which leaves the state vulnerable to
18 physician shortages at the national level, while at the same
19 time limiting opportunities for Florida's best students to
20 enter the medical field and serve their communities, and
21 WHEREAS, a medical school is not required to have its
22 own teaching hospital in order to have a high-quality,
23 accredited medical education program, and
24 WHEREAS, community-based medical education programs are
25 significantly less expensive than teaching-hospital-based
26 medical education programs, do not involve the financial risks
27 associated with the operation of a hospital, and enable the
28 state to work with local hospitals, and
29 WHEREAS, a community-based medical education program
30 relies on clinical resources available in each community and
31 requires support by hospitals, private and public health
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1 clinics, and other health care organizations willing to enter
2 into affiliation agreements to provide clinical education as
3 part of a medical education program, and
4 WHEREAS, a number of hospitals, private and public
5 health clinics, and other health care organizations in the
6 state have expressed an interest in affiliating with a Florida
7 State University community-based medical education program,
8 and
9 WHEREAS, the Florida State University's Tallahassee
10 location is near the center of the region of the state with
11 the greatest current shortage of physicians, and
12 WHEREAS, the Florida State University has, since 1971,
13 successfully operated a first-year medical school program in
14 concert with the University of Florida College of Medicine and
15 is noted for its success in attracting students who eventually
16 become primary care physicians, and
17 WHEREAS, the Florida State University has strong
18 research programs in the applied biomedical and behavioral
19 sciences, autism, cancer, chronic diseases, and geriatrics,
20 and
21 WHEREAS, there has been no new medical school
22 established in the United States in two decades despite the
23 large growth in the nation's population, particularly the
24 elderly population, and
25 WHEREAS, there is now an unusual opportunity to design
26 and operate an innovative medical education program in our
27 state, which takes advantage of the advances in medical and
28 communication technology, NOW, THEREFORE,
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