Senate Bill 5387: A bill that protects the doctor/patient relationship

One year ago, I walked into my first state congressional hearing, curious about health care legislation in general and particularly as it related to the topics I have been writing about for this column. Two weeks ago, I testified in a Senate hearing for the first time.

Democracy and the legislative process

A relative novice in governance before a year ago, I’ve learned that creating laws to govern our society is as complex as medicine. And just as messy.

The stepwise process is not easily understood nor typically proceeds straightforwardly.  Uncertainty and unpredictability are not the bedrock of human security though they are life’s reality. As a physician, this reality is one of the most challenging to communicate with patients.

Like practicing medicine and healing, the legislative process can be slow, uncertain, and unpredictable. Working in the arena requires professional skill and knowledge, enormous patience, and the ability to pay close attention to detail. That is what it takes to move forward and heal the patient, and in the case of laws, society.

Without health, we have no life. Without societal organization, we have no society.

Senate Bill 5387

I testified in favor of SB 5387, which in essence, protects the physician-patient relationship from corporate interference.

SB 5387’s primary sponsor is Senator June Robinson (D-Everett) with the support of the Medical Commission, the state agency that licenses physicians and oversees their professional ethics.

SB 5387 sets parameters for the ownership and control of incorporated medical practices and prohibits non-licensed individuals from interfering with the clinical decisions of licensed health care providers. It defines the details of implementation.  

This bill is important to ensure that only licensed medical professionals, not business executives, determine how care is provided. Patients can trust their health care decisions are based on medical expertise regarding what is best for them and not what is best for the system’s bottom line.

The doctor-patient relationship

The doctor-patient relationship is sacred. All graduating medical students take an oath to uphold their commitment to the profession and their patients.

This relationship is central to the practice of medicine and health care. Built on mutual trust, respect, communication, knowledge, and loyalty, it has been shown to have a significant effect on healthcare outcomes. This relationship keeps the quality of care for the patient high and the doctor functioning at their optimum.

It takes time to build rapport, trust, mutual understanding, and good communication. Doctors know this. Patients know this.

That relationship is not only dependent on patient and doctor factors, but in these times it has been impacted by health system factors.

Medical practices are being bought and sold like commodities

Private equity (PE) firms and large corporations are buying up medical practices. In the last 10 years, 100 private equity acquisitions have occurred in Washington, affecting primary, specialty, and hospice care.

Time is money

Corporate and PE ownership has inserted time pressure into clinical care. In the office, this means shorter visits, more visits in a day for the physician, more patients on a physician’s panel making them less accessible, more documentation requirements, and less time for doctors to consider and study their cases.  

These pressures lead to long waits for appointments, can result in missed and delayed diagnoses, lost follow-ups that prevent unnecessary hospitalizations, risk errors, and underlie health care professional burnout. Burnout is a significant contributor to the doctor shortage.

My testimony

At the hearing of the Senate Health and Long-term Committee, I spoke on behalf of the profession to which I dedicated my life.  Not on behalf of any organization or business interest. Here is the essence of my testimony:

 “I am a retired primary care internal medicine physician, which was for me, both a career and a calling.

 My 30 years in private practice were a time when doctors were unencumbered in providing the best care for our patients based on what we dedicated a decade of our young lives to learn — what was ailing our patients and how to help them.

Doctors need to maintain control of clinical decision-making and the authority to direct care as only they understand what it takes to do so. 

Later, at the VA and Providence Hospice, I experienced the handcuffs of bureaucracy controlling clinical care.

 Corporate and private equity control of physician practices redirects the focus of medical care toward efficiency and profitability for the business rather than the patient. 

Please support SB 5387, which keeps the management of medical practices in physician’s hands, where it should be. Thank you. “

The hearing process

The Senate and House of Representatives hold public hearings to air the pros and cons of bills being proposed each year. 

I stayed to hear all the testimonies in that meeting. I found the committee members attentive and pointed in their questions. The sponsor was responsive and willing to consider both sides.  

After such hearings, the committee staff prepare a summary. The highlights follow:

Staff summary of public testimony on original bill: 

The committee recommended a different version of the bill than what was heard

5387 SBR HLTC OC 25

PRO: This bill would help prevent further encroachment by private equity into health care in the state. Patients should receive the care they need not based on corporate interests. Private equity acquisitions in health care are on the rise and are associated with increased cost and decreased quality. Doctors need to retain control of clinical decision-making. This bill centers health care back to patient care. Patients do not benefit from the corporatization of medicine. 

 CON and other concerns: would limit financial investment from management service organizations (MSOs) and limit telehealth.

Large medical practice representatives testified to their reliance on MSOs for managing their practices, currently without clinical practice interference. MSOs are owned by private equity. If they are not interfering with clinical care and decision-making yet, they will.

 The legislative process proceeds

On Wednesday, Feb. 26, 2025, at 1:30 p.m., the amended SB 5387 will be heard in the Senate Committee on Ways and Means. SHR 4 and Virtual, J.A. Cherberg Building  Committee Schedules, Agendas, and Documents

Democratic government is functioning here and now

Observing, learning about, and participating in the process as a voter, journalist, and professional testifier has been enlightening and humbling. 

I highly recommend going to a hearing. Watch, listen to bills presented, testify, and bring your students, children, and grandchildren. It is an incredible educational experience.

Doing so is the antidote to anarchy, oligarchy, a monarchy, or a society led by a dictator. We have not been as close to this risk in my lifetime as we are now. Having read history, I am all too aware of how easily this can happen. Anywhere.

The democratic process assures that all sides have a voice, are included and considered.

 Our democracy was created by our founding fathers to shed the yoke of the British monarchy. Their vision was a government for the people and by the people. To protect our rights; the right of each citizen to speak up and be heard about what we believe in without risk of retribution.

In the case of SB 5387, this is about the right to have your health care decisions made by your doctors without interference by corporate business interests.  

Debra L. Glasser, M.D. is a retired internal medicine physician in Olympia. Got a question for her? Write drdebra@theJOLTnews.com