Is there a doctor on the line?

AUSTIN -- Emergency medical technicians and entry-level nurses could be cut out of the telemedicine equation under a proposal the Texas Medical Board is considering.

The change would prohibit anyone but doctors, physicians' assistants and advanced practice nurses from presenting patients for care via long-distance videoconferencing – a move rural hospitals and prison doctors adamantly oppose.

It's an effort that appears to be designed to ensure telemedicine patients are receiving high quality care on both ends of the video camera — though officials with the Medical Board declined to comment Tuesday on their motivation.

Telemedicine advocates say it would hinder use of the technology in rural health centers, where licensed vocational nurses and emergency medical technicians are often the only health care providers available.

"In towns like Turkey, Texas, if you limit an EMT's ability to provide telemedicine, people there will have to drive 80 miles for any kind of health care," said Don McBeath, the former head of Texas Tech's telemedicine program who now advocates for the Texas Organization of Rural and Community Hospitals. "It's creating a huge barrier to the growth of telemedicine in rural areas."

And they say it would force prisons, which have limited nursing staffs, to transport more inmates long distances for care — a security risk and drain on manpower.

"We do 4,000 telemedicine visits a month in the criminal justice system alone," said Dr. Ben Raimer, senior vice president at the University of Texas Medical Branch, which provides medical care for much of the state's prison system. "This would be a very unfortunate setback for telemedicine in Texas, and result in a huge increase in cost for health care."

It's not Texas doctors instigating the change. Brent Annear, spokesman with the Texas Medical Association, said many of the organization's doctors do participate in telemedicine, and don't advocate doing anything that would curb its use.

Telemedicine experts say they think the proposal is a result of good intentions run amok. They say lawmakers made broad policy changes to improve Medicaid telemedicine care in 2007 — and that, as a result, the Health and Human Services Commission released its own set of recommendations on the technology. They think the Medical Board took those recommendations one step further and excluded EMTs and certain types of nurses, without realizing the potential consequences.

Medical Board officials didn't immediately clarify that. A public hearing on the rule change is scheduled for November 5.

"We are receiving a large number of comments so it's uncertain exactly what will be adopted," said Medical Board spokeswoman Jill Wiggins. "...We'd prefer to wait until after the November meeting and see what comes out of that."

Advocates of the technology say another tweak the Medical Board is suggesting — one that would limit telemedicine to medically underserved areas — wouldn't affect rural health care, but could affect its spread into impoverished urban communities.