Politics
Checking the pulse of Florida health care news and policy
Welcome back to Diagnosis, a vertical that focuses on the crossroads of health care policy and politics.
— FAU study —
A research paper by Florida Atlantic University professors adds a wrinkle to the annual scope-of-practice battle between certified registered nurse anesthetists and physician anesthesiologists.
CRNAs are highly trained nurses who administer anesthesia care. Florida law requires CRNAs to practice under a supervising physician, making autonomous practice unattainable to some practitioners with advanced nursing degrees.
The trade group representing CRNAs, the Florida Association of Nurse Anesthetists (FANA), makes a scope-of-practice play nearly every Legislative Session. Thus far, they haven’t been successful.
Still, FANA’s top argument in favor centers on health care access. CRNAs claim that some Floridians can’t get quality anesthesia care under the current paradigm, but the FAU paper says that’s an inaccurate narrative.
The paper focuses on “opt-out” provisions, which allow patients — typically those in rural states — who may not be able to get speedy care from a physician anesthesiologist to be treated by a CRNA who a physician doesn’t supervise after they learn of the potential risks.
Lead author Scott Feyereisen, Ph.D., examined hospital data from 2010 through 2021 and found no meaningful increase in access to anesthesia care in states with “opt-out” provisions.
“We discovered that adopting opt-out provisions does not universally result in increased CRNA service provision in U.S. hospitals,” the paper reads, with a subsequent section noting, “Notably, opt-out provisions do not improve access in rural counties.” The study did find that “surgical access limitations still exist” in rural states but that “opt-out” provisions have done little to ameliorate the shortage.
The Florida Society of Anesthesiologists (FSA), a trade group representing physician anesthesiologists (and FANA’s foil), funded Feyereisen’s research. The latest report follows up on prior research that also found opt-out provisions had no impact. The FSA hailed the findings, asserting they proved what medical doctors have been saying.
“We have long suspected — based on our direct field experiences — that when states dangerously expand the scope-of-practice for CRNAs, allowing them to perform anesthesia services without the supervision of a physician, areas with nurse shortages do not benefit. This detailed analysis by three respected FAU professors clearly bears this out,” said FSA President Asha Padmanabhan.
“Not only is the practice of allowing nurses to independently practice anesthesia medicine without physician supervision costly and potentially dangerous, but this paper also demonstrates that it does not yield more nurses working in underserved areas.”
Padmanabhan concluded, “In the end, the data unequivocally showed that taking the costly and potentially dangerous steps of expanding scope in anesthesia medicine does not improve access to care — especially in rural communities.”
— Belt-tightening —
GuideWell, the parent company of Jacksonville-based Florida Blue, is implementing a 3% reduction in its workforce nationwide.
The layoffs, first reported by the Jacksonville Business Journal, are expected to affect employees in 29 states. Florida Blue did not disclose how many Jacksonville-based employees would be affected.
“The health care industry is facing complex challenges, including competitive market conditions, regulatory changes and rising medical costs. We are driving necessary innovation and transformation to keep health care costs under control, advance operational excellence, and improve care for our members,” a Florida Blue spokesperson said. The spokesperson added that the company is committed to supporting affected employees during this transition.
Florida Blue is the largest health insurer in Florida, with over 5 million members and 8,900 employees statewide.
— Win-win —
HCA Florida Ocala Hospital and HCA Florida West Marion Hospital recently announced a $10,000 donation to Interfaith Emergency Services to help combat hunger in Marion County.
As part of the 2024 Healthy Food for Healthier Tomorrows Food and Nutrition Drive, HCA Healthcare hospitals nationwide were encouraged to showcase their creativity by constructing sculptures from cans and boxes of food donated by staff. The winning hospital in each division received a $10,000 grant from the HCA Healthcare Foundation to support a local food bank.
HCA Florida Ocala Hospital emerged as the winner for HCA Healthcare’s North Florida Division and donated the grant to the food bank operated by Interfaith Emergency Services.
The nursing managers at HCA Florida Ocala Hospital created a food sculpture of a smiling turkey to emphasize the importance of supporting neighbors during the holiday season.
“HCA Florida Ocala Hospital is proud to assist Interfaith Emergency Services in the fight against food insecurity and to help our less fortunate neighbors achieve a healthier tomorrow,” said HCA Florida Ocala Hospital CEO Alan Keesee. “I am incredibly proud of our hospital team whose creativity and commitment made this donation possible.”
Interfaith Emergency Services CEO Karla Greenway added, “This $10,000 will sustain our truck and driver for five months, enabling us to collect approximately 365,000 pounds of food, including fresh produce, dairy, meats, and nonperishable items, which will be delivered to households within 48 hours.”
— Welcome aboard —
A new head and neck specialist joins HCA Florida Memorial Hospital in Jacksonville.
Russell B. Smith is the latest addition to the hospital’s dedicated care team. He specializes in advanced surgical care for conditions in the head and neck regions. His treatment area is relatively broad, including cancers of the head and neck and associated areas such as the mouth, throat, voice box, sinonasal cavities and skin.
“We understand that being diagnosed with cancer is life changing. We are committed to taking a personalized approach to provide multidisciplinary care for each of our patients, making sure they understand all options to therapy,” said Smith. “At all times, our patient’s care and comfort is our highest priority, and our entire team works diligently to ensure that each patient and their entire family are supported throughout the process.”
Smith’s practice will be in the Head & Neck Specialists wing of HCA Memorial Hospital, located at University and Beach Boulevards in Jacksonville.
— Roster —
Amit Parmar has been hired as the Chief Operating Officer at HCA Florida Woodmont Hospital. Parmar has been working at HCA Healthcare for eight years, most recently at Tristar Skyline Medical Center, a Level I Trauma Center in Nashville, where he was vice president of Operations. In that role, he oversaw several key capital investment projects, including launching the HCA Healthcare TriStar Division’s first Helicopter Fuel Depot, planning and phasing an additional $128 million tower expansion, and an East Nashville FSER expansion.
— ICYMI —
“Medicaid cuts could devastate rural Florida, affecting children” via Trimmel Gomes of Public News Service — A new report from the Georgetown University Center for Children and Families highlights the significant role Medicaid plays in ensuring health care access for rural communities in Florida. The report reveals that rural Floridians face unique challenges, including provider shortages, long commutes, and limited connectivity, all of which make accessing health care more difficult. Erica Li, a health policy analyst with the Florida Policy Institute, emphasizes the program’s importance for the state, noting that more than 52% of children in rural Florida rely on Medicaid or CHIP for their health insurance. “Medicaid is a critical lifeline for families who need it. And the longer that children go without coverage in health care, the more risk they are at for poor outcomes and other aspects of their life, such as educational obtainment and other quality of life measures,” she explained.
“Florida leads the nation (again) In Obamacare enrollment” via Craig Pittman and Christine Sexton of Florida Phoenix — Data released by the Centers for Medicare & Medicaid Services show that 4,633,650 residents signed up for insurance coverage through the Marketplace by the end of 2024. Nationally, CMS reports that 23.6 million people enrolled for 2025 coverage, including 3.2 million new consumers. Total enrollment is record-breaking, CMS said in a statement. Four insurance companies and 12 health maintenance organizations (HMOs) are participating in the Florida Marketplace, as shown on the Florida Office of Insurance Regulation website. HMO coverage is regional, and people must live where an HMO is authorized to operate to enroll in the managed care plan.
“State health care agency wants $6.7 million to hike staff pay, improve services” via Jeffrey Schweers of the Orlando Sentinel — The state agency that administers Florida’s Medicaid program for 5 million residents told lawmakers it needs a midyear budget boost of $6.7 million to address chronic staffing shortages that advocates say prevent needy families from getting medical care. The agency wants to raise the salaries of underpaid positions to hang on to those employees. Studies show that at current employee levels, some state residents wait hours on hold to talk to someone at Florida’s Medicaid call center. “Current salaries do not attract candidates with the desired skill sets, experience, and expertise,” Sonya Smith, Chief of Finance and accounting for the Division of Health Care Finance at the Agency for Health Care Administration, said in an email to legislators Dec. 27.
“Health services at historic Key West building will resume after lead concerns” via Julia Cooper of WLRN Public Media — A historic Key West building that houses critical public health services were closed down in November after trace amounts of lead were found in construction material. It will soon reopen to the public. The shutting down of the historic Gato building on Simonton Street displaced the administrative offices of several municipal agencies, including the Florida Department of Health in Monroe County. Testing determined that the lead came from a paint layer dating back to the 1970s or earlier. Now, the county says it’s safe for occupancy again. Officials expect the building to be fully operational in about six months.
— Rules —
The Florida Department of Health has issued a final rule for 65B1-4.001, which concerns acupuncture program requirements and will become effective Feb. 6, 2025. More here.
Rule 64B-4.022, related to standards of practice for Autonomous Certified Nurse Midwives, goes into effect Feb. 4, 2025. More here.
Rule 64B16-27.79, related to the standards of practice for compounding sterile products, goes into effect Feb. 2, 2025. More here.
— Pencil it in —
— Jan. 28 —
3:30 p.m. — The House Human Services Subcommittee meets. Room 314, House Office Building.
— Jan. 29 —
1 p.m. — The House Health Care Budget Subcommittee will meet. The agenda includes a mental health and substance abuse panel discussion with reports from the Department of Children and Families and the Agency for Health Care Administration. Room 314, House Office Building.
3:30 p.m. — The House Health Care Facilities & Systems Subcommittee meets. The agenda includes an implantation briefing on a 2023 bill (HB 121) related to Florida KidCare Eligibility. Room 404, House Office Building.
— Feb. 1 —
Happy birthday to Rep. Chuck Brannan!
— Feb. 4 —
1:45 p.m. — The Senate Health Policy Committee meets. Room 412, Knott Building.
— Feb. 5 —
1:15 p.m. — The Senate Appropriations Committee on Health and Human Services meets. Room 412, Knott Building.
— Feb. 6 —
Happy birthday to Sen. Clay Yarborough!
— Feb. 10 —
1:30 p.m. — Day One of the Florida Chamber of Commerce’s 2025 Legislative Fly-in. Donald L. Tucker Civic Center.
— Feb. 11 —
1:30 p.m. — Day Two of the Florida Chamber of Commerce’s 2025 Legislative Fly-in. Donald L. Tucker Civic Center.
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Chuck Millar is a longtime Palm Beach Gardens resident. Over the past four decades, he’s become well-known in the community for his activism and involvement in local government, including a current unelected Chair post on the city’s Planning and Zoning Board.
Now, he’s seeking a seat on the City Commission. It’s his first run at public office.
Elections attract scrutiny. A look into Millar’s legal history shows that seven years ago, he faced accusations of cyberstalking and harassment. An ex-girlfriend sought a temporary restraining order against him, and she included in the request screenshots of messages he sent her.
The woman, whom we’ll call Kathy, filed a petition seeking protection against him for stalking, Palm Beach County Clerk records show. It included a request that Millar stay at least 500 feet from her and four people, including her two daughters, and the Jupiter-based K-12 private school they attended.
She provided proof that between March 4, 2018, when she broke up with him, and March 15, 2018, when she took legal action, Millar sent dozens of texts and emails to which she did not respond.
Some of the messages were sexually demeaning. In others, Millar implied that he was tracking her online dating accounts and referenced a domestic battery case from her past.
Millar is 65. He was 58 at the time he sent the messages. In an email to Millar’s sister seeking help, Kathy said they’d only dated a month, during which she’d broken up with him twice “due to his extreme and violent temper and outbursts that made no sense to me.”
Millar told Florida Politics they dated for a little more than a month. He regretted his actions and the whole ordeal, which ended on March 29, 2018, when Judge Karen Miller of the 15th Judicial Circuit instructed him to stop contacting Kathy before dismissing the case.
“I followed the court’s direction verbatim,” Millar said Thursday, adding that he’d since undergone counseling and treatment. “It made me a better person.”
Millar sent Kathy a lengthy text on March 4, 2018, after she cut things off with him, referencing “issues” and his “character flaws.”
“(I) take full responsibility for my faults. My heart is broken, but you tore my heart to pieces as I prayed each night you’d finally say you loved me, too. Those words are so powerful to me. You’re my true love, and I know it could work. I would have taken a bullet for you,” he wrote.
Later that day, seemingly in response to Kathy telling him her decision was final, Millar’s amorous tenor turned vitriolic.
“I’m fucking done with you too. Go fuck yourself. Get out and stay the hell out of my life. You have serious mental health issues,” he wrote. “You can have your fucking underware (sic) back. Enjoy the pink vibrator. You’ll need it. Bitch!”
Millar sent another text at 3:25 a.m. on March 5.
“Guaranteed the next time you have sex, you’ll think of me. Enjoy that train wreck,” he wrote. “And by the way, I read your entire file on your domestic battery case. It’s public record.”
Kathy said in her petition that she blocked Millar’s number after that.
He then sent her emails. One on March 8 was a variation of the prior message. “Your comment about never dating again is just total crap,” he wrote. “You know it, and I know it. But trust me, the next time you have sex with whomever or whatever, you’ll think of me.”
On March 10, Millar sent another email intimating Kathy had “a new man” and that the three of them should meet up at a baseball game. Two days later, he sent her an email titled “Weekend Fun” and asked about dates he believed Kathy had arranged on Match.com.
He wrote again on March 13, telling her, “Enjoy that vacation with your ex, no drama, mama. LOL.”
Later that day, Kathy — who said she and the ex to whom Millar referred never vacationed together — emailed Millar’s sister with screenshots of his communications. Kathy described Millar’s actions as “creepy” and “very frightening” and noted that she’d instructed a security guard at her gated community to call the police if he showed up.
Millar’s sister called her brother’s messages “completely unhinged” and said she’d talk to her husband about developing a plan of action to deal with him. The sister told Kathy in a follow-up email that after conferring with her spouse, they’d decided to stay out of it but advised Kathy to “take whatever steps (are) necessary to ensure” her and her children’s safety, including filing a temporary injunction or calling the police.
In the days that followed, Millar continued with his emails. One included a message Kathy sent him about a continuous neighborhood issue she’d had with her homeowner’s association. In another, Millar said he’d spoken with one of the association’s board members with whom Kathy had an issue.
“I see this as a threat from Chuck that he will continue to contact (the board member) and get in my neighborhood that way. Empty threat because I have taken necessary action and alerted our Board and the Security company of his actions,” Kathy told Millar’s sister. “I’m terrified of your brother. He’s a loose canon (sic). Right now, I want to move as far away from him as I can, but I can’t.”
A log of texts sent to Kathy’s cellphone show he messaged her 25 separate times in nine days.
Florida Politics contacted Kathy by text and email for comment but received none by press time.
Millar told Florida Politics he was “very remorseful” about his behavior, which he attributed to issues he’s since addressed in therapy. He said it was the first time he’d been broken up with by text.
“My emotions overcame my intelligence. That doesn’t usually happen,” he said. “My past has made me what I am today, which is a better ex-husband, father, brother and employee, and the best and most qualified candidate.”
He said that if he thought he still had emotional issues that needed addressing, he wouldn’t be running for office.
“It was an unfortunate thing, but it was a learning tool that I use today to be a better person, to understand empathy and sympathy,” he said. “I have the utmost respect for women, and most of my campaign team is made up of amazing ladies.”
A land use, zoning, planning, and real estate research professional, Millar switched his voter registration from Democrat to Republican in 2016, according to state records. He faces 47-year-old Republican firefighter John Kemp for the City Council’s Group 4 seat.
The Palm Beach Gardens election is on March 11. In the race, incumbent Commissioner Marcie Tinsley and her lone challenger, John “Scott” Gilow, will also be on the ballot.
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Last Call – A prime-time read of what’s going down in Florida politics.
First Shot
Florida Republicans’ intraparty battle continued Thursday, with the Legislature telling the Governor that it was their way or the highway, not the other way around. Ron DeSantis returned the favor by threatening defiant lawmakers with primary challengers.
Reminiscent of a call by DeSantis earlier this month, House Speaker Daniel Perez held a town hall with state GOP leaders, pushing the Legislature’s narrative on the immigration bill scuffle packaged alongside criticism of the Governor’s plan.
According to those on the call, Perez said the Legislature’s bill was more conservative than the one pushed by DeSantis, which he claimed was a thinly veiled play to give the Governor a “mini version of ICE” that would duplicate the Trump administration’s immigration crackdown efforts rather than augment them.
“He (DeSantis) is not going to work with ICE. He wants a little mini version of ICE. He wants his own state guard, with his own bureaucrat, picking up the illegal aliens and shipping them off to another portion of the world, wherever it is that they originate from. That’s not working (in) conjunction with President Trump.”
The Governor, meanwhile, amped up his rhetoric — he has gone from casting the Legislature’s bill as “weak, weak, weak” to a “very grotesque piece of legislation.” He’s also directing more frustration at Agriculture Commissioner Wilton Simpson, whom he accused of instigating this saga by supposedly leveraging his influence as a former Senate President.
As it stands, the Legislature is still winning the numbers game, with just one GOP lawmaker — Rep. Mike Caruso — publicly breaking ranks to side with the Governor.
Evening Reads
—“Donald Trump blames predecessors, diversity programs for fatal air collision” via Isaac Arnsdorf of The Washington Post
—“The 25 most eye-popping lines from Trump’s off-the-rails remarks on the D.C. plane crash” via Chris Cillizza of So What
—“The plane crash that ripped through the world of elite figure skating” via Louise Radnofsky, Allison Pohle and Jennifer Levitz of The Wall Street Journal
—“Trump kicks Congress to the curb, with little protest from Republicans” via Carl Hulse of The New York Times
—“What it’s like to go to school in the shadow of ICE” via Anna North of Vox
—“Trump is just watching this crisis unfold” via David A. Graham of The Atlantic
—”As GOP rift widens, Ron DeSantis pledges money to elect ‘strong conservative’ successor” via Skyler Swisher of the Orlando Sentinel
—”Joel Rudman said he felt unwelcome in a House ‘itching for a fight’ with DeSantis” via Jacob Ogles of Florida Politics
—”‘Powerless and angry’: Venezuelans react to roll-back of deportation protections” via Verónica Egui Brito and Syra Ortiz Blanes of the Miami Herald
—”Mercenaries for Millionaires: Inside the private army that protects L.A.’s rich and famous” via Jason McGahan of The Hollywood Reporter
Quote of the Day
“This was an argument waiting for an excuse. If not for immigration, they would have fought over new hours for the cafeteria.”
— Former Rep. Joel Rudman, on the Legislature v. Ron DeSantis bout.
Put it on the Tab
Look to your left, then look to your right. If you see one of these people at your happy hour haunt, flag down the bartender and put one of these on your tab. Recipes included, just in case the Cocktail Codex fell into the well.
Rudman’s campaign for Florida’s 1st Congressional District may’ve gone bust, but Doc Rock deserves a “Peace Out” for heading for the exit before the gloves came off.
Separate from his war with the Legislature, DeSantis is catching flak from Tucker Carlson, who called him a “donors’ puppet.” Since the strings aren’t showing up on camera, however, we’re recommending he be served a Muppet.
With all the drama, we imagine rank-and-file staffers are itching for politics-free happy hour. A Paris Between the Wars should help them forget work for a few minutes.
Breakthrough Insights
Tune In
Gators face Vols in key rematch
For the second time this month, the Florida Gators and Tennessee Volunteers meet when the teams tip off on Saturday in Knoxville (noon ET, ESPN).
On Jan. 7, Florida shocked then-top-ranked Tennessee 73-43 in Gainesville. The win was among the Gators’ most notable regular-season victories in program history. Ince beating Tennessee, Florida (18-2, 5-2 SEC) has won four of five games, only losing to Missouri on Jan. 14.
The game is the first since the school cleared Florida head coach Todd Golden following a four-month investigation into sexual misconduct allegations.
Both teams enter the game ranked in the top 10 of the Associated Press poll. Florida is ranked #5, while Tennessee (17-4, 4-4) is ranked eighth. The game is also the first of four straight for the Gators against ranked teams. Between now and Feb. 11, Florida will face Tennessee, Vanderbilt, Auburn, and Mississippi State.
The Gators are coming off an 89-59 win over Georgia on Saturday. Five Gators scored in double figures in the game, including Walter Clayton Jr. and Alijah Martin, who each scored 17 points. Both rank in the top 10 in scoring average in the SEC. Clayton is tied for sixth (17.8 points per game), while Martin is tied for 10th (16.1).
___
Last Call is published by Peter Schorsch, assembled and edited by Phil Ammann and Drew Wilson, with contributions from the staff of Florida Politics.
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