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State funding for podiatry medical residencies in the Valley – supported by DHR Health to increase care for Texans with foot, ankle, and leg problems – approved by House of Representatives and Senate Committee on Higher Education. - Titans of the Texas Legislature

FEATURED, FROM LEFT: Joe E. Vega, Parks Director, Cameron County; Pete Sepulveda, Jr., Executive Director, Cameron County Regional Mobility Authority; Speaker of the House Dade Phelan, R-Beaumont; Rep. Eddie Lucio, III, D-Brownsville; and Cameron County Commissioner Joey López. This image was taken at the Texas Capitol on Wednesday, April 14, 2021.

Photograph Courtesy REP. EDDIE LUCIO, III FACEBOOK

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State funding for podiatry medical residencies in the Valley – supported by DHR Health to increase care for Texans with foot, ankle and leg problems – approved by House of Representatives and Senate Committee on Higher Education

By DAVID A. DÍAZ
[email protected]

The University of Texas Rio Grande Valley’s planned podiatry program, which will produce physicians skilled in the healing treatment of complications in the foot, ankle, and leg, would qualify for state funding for medical residencies under House Bill 2509, authored by Rep. Eddie Lucio, III, D-Brownsville, that has been approved by the House of Representatives and the Senate Committee on Higher Education.

The House of Representatives approved House Bill 2509 on Wednesday, April 28, 2021.

The Senate Committee on Higher Education approved the measure on Wednesday, May 19, 2021, with the recommendation that it also be supported by the Senate.

House Bill 2509 “would expand the definition of a graduate medical education program in Education Code ch. 58A to include a nationally accredited post-doctor of podiatric medicine program that prepared podiatrists for independent practice in the specialty area of podiatry,” according to a bill analysis of the proposal by the House Research Organization.

Currently, only accredited Doctor of Osteopathic Medicine, or DO, and Doctors of Medicine degree programs are eligible for money from a state fund, established in 2015 by the Texas Legislature, to expand graduate medical education and increase the number of physicians in Texas, Lucio, III noted.

“Unfortunately, the (Texas) education code, as it currently stands, the (UTRGV podiatry) school cannot compete for (state money) to support new residency positions. Our podiatry graduates will likely need to leave this state to complete their residencies,” Lucio, III testified on Thursday, April 1, 2021 before the House Committee on Higher Education. 

A committee is a group of legislators appointed by the presiding officer of the House or the Senate to which bills are referred or a specific task is assigned.

“The purpose of this bill is to make funds available for the education and training of podiatrists as valued members of the health care workforce of Texas, as it is done federally by the Centers of Medicare and Medicaid Services,” he added.

After completing medical school, almost all doctors enter a residency program. While practicing independently is possible, the vast majority of physicians choose to pursue a residency for further training.

Residency can range from an additional two years of education to an additional seven years of training, depending on the specialty. For example, a family practice residency would be two years of residency while a surgery residency may last five, seven, or more years.

https://www.verywellhealth.com/types-of-doctors-residents-interns-and-fellows-3157293

Rep. Armando “Mando” Martínez, D-Weslaco, and Rep. Sergio Muñoz, Jr., D-Mission, are featured as joint authors of House Bill 2509, while Sen. Juan “Chuy” Hinojosa, D-McAllen, is carrying the identical version – Senate Bill 956 – in the Senate. 

As joint authors, Martínez and Muñoz have been authorized by Lucio, III to have their names shown following the primary author’s name on official printings of the measure, on calendars, and in the journal. The primary author may authorize up to four joint authors.

House Bill 2509 and Senate Bill 956 are both being supported by DHR Health.

Anchored in southwest Edinburg, with a growing presence in neighboring McAllen, DHR Health offers some of the most comprehensive medical care on the U.S. southern border, with more than 1,400 nurses and 600+ physicians providing care in 70+ specialties and sub-specialties.

DHR Health is the flagship teaching hospital for the University of Texas Rio Grande Valley School of Medicine and encompasses a general acute hospital with the only dedicated women’s hospital south of San Antonio, a rehabilitation hospital, a behavioral hospital, more than 70 clinics Valley-wide, advanced cancer services, the only transplant program in the Rio Grande Valley – and the only functioning 24/7 Level 1 Trauma Center south of San Antonio.

A bill is type of legislative measure that requires passage by both chambers of the legislature (House of Representatives and Senate) and action by the governor in order to become effective. A bill is the primary means used to create and change the laws of the state. The term “bill”  includes Senate and House bills, Senate and House joint resolutions, Senate and House concurrent resolutions, and Senate and House resolutions.

House Bill 2509’s passage in the House of Representatives comes six months after the Texas Higher Education Coordinating Board approved a request from the University of Texas Rio Grande Valley to create aDoctor of Podiatric Medicine (DPM) with a major in Podiatric Medicine, for the UTRGV School of Podiatry. 

This will be the first school of podiatry in Texas and will allow students to pursue careers in the medical and surgical care of the foot and ankle – an important specialization for the Valley, with its high incidence of diabetes and related diseases of the lower extremities, according to a news release issued on Friday, October 23, 2020 by UTRGV officials.

Podiatric medical schools offer the Doctor of Podiatric Medicine (DPM) degree following four years of medical training. As a general rule, the first two years of the podiatric medical school curriculum involve primarily course work, while the third and fourth years involve clinical rotations and training.

The complications from diabetes can lead to blindness, amputation, and even death. However, including these physicians (podiatrists) and the health care team can reduce a patient’s risk of limb amputation by 85 percent,” Lucio, IIIsaid. “I was surprised to learn that we do not have a podiatry school in Texas. This bill will insure the increase in the number of podiatrists available to the growing population. I am proud to say that UT Rio Grande Valley will be the first to offer a Doctor of Podiatric Medicine (DPM) program.”

Lucio, III said that the U.S. Centers for Disease Control (CDC) estimates that there are 2.8 million people in Texas, or 14.2 recent of the adult population of the state, with diabetes.

The numbers are worse in the four-county Rio Grande Valley, he reported.

“In the Valley, the numbers are staggering. The rates are the highest (in Texas) in the Rio Grande Valley. I remember just recently I went to a doctor’s appointment – I had to get my eyes checked – and it was standing-room only. I didn’t make the correlation, and I thought, ‘Man, that’s a lot of people with eye problems,’” Lucio, III recalled. “I went in and talked to the doctor, and I said, ‘Man, you have a thriving business, a lot of people’s eyesights are failing.’ He said, ‘No, that has to do with diabetes, Representative. All those people in there are suffering from diabetes.’”  

Guy Bailey, President, the University of Texas Rio Grande Valley, also testified on Thursday, April 1, 2021 before the House Committee on Higher Education.

“As we all know, there is a high level of diabetes – 38 percent of the population of the Rio Grande Valley. That’s pretty significant. The alarming incidents of obesity, diabetes, and heart disease have an enormous effect on the economy of the Valley, the health and the well-being,” Bailey said.

The university leader spoke about the vital importance of podiatrists, especially relating to individuals with diabetes.

“Tragically, many patients who suffer from diabetes, it’s not managed well, may end up losing limbs, especially feet, ankles and legs. A podiatrist can play a critical role in achieving health care, especially for rural, socioeconomically disadvantaged, historically medically-underserved communities,” Bailey said.  “Their expertise can be used to contribute in novel ways to managing foot, ankle and leg conditions. The best way to deal with these is not to amputate them, but to manage them in the beginning.”

DHR Health on Thursday, April 1, 2021 registered in support of House Bill 2509 at the public hearing by the House Committee on Higher Education, which includes Muñoz as a member of that legislative panel.

Doctors Hospital at Renaissance, Ltd (“DHR”) and its general partner, RGV Med, Inc. (“RGV  Med”) own and operate a 519 licensed bed general acute care hospital located at 5501 South McColl in Edinburg. The facility is one of the largest physician-owned facilities in the United States that began as an ambulatory surgery center in 1997.

DHR Health is headquartered on a 130-acre site, with most of the facilities in southwest Edinburg but with a growing presence in McAllen, including its South Campus located immediately across Owassa Road in northeast McAllen.

In addition to DHR Health’s presence in support of House Bill 2509, other regional leaders in the Rio Grande Valley publicly registered their respective organization’s favor for House Bill 2509 and Senate Bill 956 through written testimony provided to the House Committee on Higher Education.

Those leaders, in alphabetical order, and the organizations they represent, are:

• Dr. Linda Burke, DDS
Burke Children’s Dentistry
Harlingen

• Ann Cass
Executive Director
Proyecto Azteca
McAllen

• Sergio Contreras
President/CEO
Rio Grande Valley Partnership
Weslaco

• Raudel Garza
Manager and Chief Executive Officer
Harlingen Economic Development Corporation
Harlingen

• Shirley Hu
UT Health Houston School of Public Health
and School of Biomedical Informatics
UTRGV School of Medicine
McAllen

• Ronnie Larralde
Executive Director
Edinburg Chamber of Commerce
Edinburg

• Beverly Loftus
Commercial Development Manager
Harlingen Economic
Development Corporation
Harlingen

• Josh Mejia
Executive Director
Brownsville Community
Improvement Corporation
Brownsville

• Diana Ramírez
Executive Director
Rio Grande Valley Diabetes Association
McAllen

• Rebecca Ramírez-Stocker
Collective Impact Director
Unidos Contra la Diabetes
McAllen

• Patricia Rosenlund
Executive Director
Easter Seals Rio Grande Valley
McAllen

• Cynthia Sakulenzki
President/CEO
RGV Hispanic Chamber of Commerce
McAllen

• Lucy Torres
CEO
Nuestra Clinica del Valle
McAllen

• Mary Ann Villarreal
Office Manager
Harlingen Economic Development Corporation
Harlingen

A bill analysis prepared by the House Research Organization provided additional information about House Bill 2509.

A bill analysis is a document prepared for all bills and joint resolutions reported out of committee. A bill analysis may include background information on the measure, a statement of purpose or intent, and an analysis of the content of the measure.

The House Research Organization is a nonpartisan independent department of the Texas House of Representatives. It provides impartial information on legislation and issues before the Texas Legislature. 

The House Research Organization is governed by a broadly representative steering committee of 15 House members elected by the House membership to set policy for the organization, approve its budget, and ensure that its reports are objective.

The bill analysis follows:

04/27/21

Subject: 

Expanding Texas Higher Education Coordinating Board grants to apply to podiatry graduate medical programs

Committee: 

Higher Education — favorable, without amendment

Vote: 

9 ayes — Murphy, Pacheco, Frullo, Muñoz, Ortega, Parker, Raney, C. Turner, J. Turner
0 nays
2 absent — Cortez, P. King

Witnesses:

For — Steve Brancheau, Texas Podiatric Medical Association; (Registered, but did not testify: William Yarnell, City of Harlingen; Jonathan Connors, DHRHealth; Logan Spence, Texas Podiatric Medical Association)

Against — None

On — Guy Bailey, University of Texas Rio Grande Valley; (Registered, but did not testify: Hemant Makan, Texas Department of Licensing and Regulation)

Background:

Education Code ch. 58A.024 requires the Texas Higher Education Coordinating Board to award grants to new or existing graduate medical education programs to increase the number of first-year residency positions. Sec. 58A.001(5) defines a “graduate medical education program” as a nationally accredited post-doctor of medicine or post-doctor of osteopathic medicine program that prepares physicians for the independent practice of medicine in a specific specialty area.

Interested parties note that grants under the graduate medical education expansion program are restricted to programs for training medical doctors and osteopathic doctors and that programs for training individuals in the critical field of podiatry could benefit from these grants as well.

Digest:

House Bill 2509 would expand the definition of a graduate medical education program in Education Code ch. 58A to include a nationally accredited post-doctor of podiatric medicine program that prepared podiatrists for independent practice in the specialty area of podiatry.

The bill would take immediate effect if finally passed by a two-thirds record vote of the membership of each house. Otherwise, it would take effect September 1, 2021.

The written testimony in support of House Bill 2509 by the Valley leaders follow:

Dr. Linda Burke, DDS
Burke Children’s Dentistry
Harlingen

I would support House Bill 2509. We here in the Rio Grande Valley have a high number of diabetic patients that are in desperate need of care from a podiatrist. For this reason, I would welcome a medical residency for podiatrists in our area.

Ann Cass 
Executive Director
Proyecto Azteca
McAllen

Because I work with the residents in the Hidalgo County colonias, I know how endemic diabetes is among our families. While we work hard at prevention, the fact remains many family members already have the disease which leads to sores, particularly on their feet, untreated which results in amputation. 

I coordinate the RGV Health Working Group which includes all the safety net clinics. We had a health summit last year on access to secondary care which is lacking for the 300,000 people without insurance in Hidalgo County.

Clinic physicians and EDs shared that there is no place for patients to be sent for wound care and podiatric treatment. We really, really, need this residency program at UTRGV School of Medicine. 

Everyone seems to know someone who is missing one or both feet, or one or both legs. It would be great if everyone knew someone who was able to receive treatment from a podiatrist or podiatric resident and had a positive outcome.

Sergio Contreras
Rio Grande 
Valley Partnership
Weslaco

I and my organization support House Bill 2509 because it will help increase medical care for diabetic patients in the RGV. Podiatrists are needed across the State of Texas. The RGV Partnership organization supports House Bill 2509 and would welcome medical residency training of podiatrists in the RGV.

Raudel Garza
Harlingen Economic 
Development Corporation
Harlingen

The Rio Grande Valley is one of the least-served regions in terms of medical doctors per capita. If one is talking about specialty areas, that number skyrockets! Due to a high concentration of diabetes in our population, podiatrists are needed here.

Shirley Hu
UT Health Houston 
School of Public Health 
and 
School of Biomedical Informatics 
UTRGV School of Medicine
McAllen

As a resident of the Rio Grande Valley where many residents are uninsured or underinsured, and 2/3 have either diabetes or pre- diabetes we need accessible affordable health care and good preventative health programs. 

Our people have a high rate of poverty, which affects housing transportation and wellness. Currently staff in UTRGV School of Medicine, Department of Psychiatry I can say that we can not separate body from mind, nor health/ill health from economic prosperity. I urge you to support the DPM residency program and funding for it. Thank you

Ronnie Larralde
Executive Director 
Edinburg Chamber 
of Commerce
Edinburg

As the Executive Director of the Edinburg Chamber of Commerce, I would like to express my full support for HB 2509. According to the CDC, Diabetes Affects Hispanics/Latinos at a greater rate. Over their lifetime, U.S. adults overall have a 40% chance of developing type 2 diabetes. But if you’re a Hispanic/Latino American adult, your chance is more than 50%, and you’re likely to develop it at a younger age.

The Edinburg Chamber of Commerce supports House Bill 2509 because it will help increase medical care for diabetic patients in the RGV. The Edinburg Chamber supports HB 2509 and would welcome medical residency training of podiatrists in the RGV. I want to thank the House for its leadership and commitment to education in the RGV. If there is anything that we can do to assist in these efforts, please contact me at (956) 383-4974.

Beverly Loftus
Commercial Development Manager 
Harlingen Economic 
Development Corporation
Harlingen

The Rio Grande Valley and Texas require more podiatrists to serve the growing number of patients in need of podiatry care. I/my organization supports HB2509 and would welcome medical residency training of podiatrists in the Rio Grande Valley.

Josh Mejia
Executive Director
Brownsville Community 
Improvement Corporation
Brownsville

The Brownsville Community Improvement Corporation fully supports House Bill 2509 because it will help increase medical care for diabetic patients and expand opportunities for continued economic development in the healthcare industry for the Rio Grande Valley. 

The healthcare industry has brought in 43% of new jobs in the Rio Grande Valley over the past decade. This statistic alone not only points towards a viable pursuit for the region to grow economically but also highlights an increase in demand for healthcare services for the region.

Diabetes and “pre-diabetes” continue to be categorized as an epidemic in our region affecting our population which is predominantly hispanic. The ongoing side effects of such conditions include enhanced medical attention and treatment to our growing workforce. A workforce that continues to service our growing industries in the region. Based on these conditions, there should be no doubt that the needs of the region are evident and clear.

The solution is simple. Expand our healthcare services to include a pediatric school which will ultimately benefit our historically underserved region.

The University of Texas-Rio Grande Valley has worked diligently in expanding their educational curriculum to include medical education with the understanding that students graduating from such programs will help diversify the region’s healthcare industry and its outreach. 

I have personally witnessed UTRGV’s continued work in expanding partnerships with recognizable medical institutions to ensure its medical education is relevant to the region’s need which will only further enhance this future program’s effectiveness in addressing both quality-of-life and economic needs in the region. 

As an economic developer for a “type b” or “4b” economic development organization, I could not be more aligned with this legislative effort to address two major challenges that currently impede our residents to achieve the socioeconomic mobility they seek to desire.

Podiatrists are needed across the State of Texas. The BCIC fully supports House Bill 2509 and would welcome medical residency training of podiatrists in the Rio Grande Valley.

Rebecca Ramírez-Stocker
Collective Impact Director
Unidos Contra la Diabetes
McAllen

As the Collective Impact Director of Unidos Contra la Diabetes (UCD), a four county collaborative effort in the Rio Grande Valley aimed to reduce new instances of diabetes, I strongly support HB 2509. As you know, diabetes is impacts our community at an extremely high rate. If uncontrolled, those who have been diagnosed with this preventable chronic disease may be faced with additional ailments, including losses of limbs. 

Unidos Contra la Diabetes supports House Bill 2509 because it increases medical care for diabetic patients in the Rio Grande Valley. I greatly thank you for the acknowledgement and effort placed on the need for podiatrists in our community and the medical residency training they could receive.

Diana Ramírez
Executive Director
Rio Grande Valley 
Diabetes Association
McAllen

I support this bill. The Rio Grande Valley is one of the poorest areas in the state and is in need of more medical education. Diabetes is an epidemic in this area and there is a high number of patients with amputations and foot issues. It is very important that we receive help to enhance the graduate medical education program for the practice of podiatric medicine in Texas and the Rio Grande Valley.

Patricia Rosenlund
Executive Director
Easter Seals 
Rio Grande Valley
McAllen

On behalf of Easter Seals RGV organization, I support House Bill 2509 because it will help increase medical care for diabetic patients in the RGV.

Cynthia Sakulenzki
President/CEO
RGV Hispanic 
Chamber of Commerce
McAllen

The RGV Hispanic Chamber of Commerce not only focuses on small business, but education, government issues, international affairs, etc. Health is one of our major concerns. Here in the Rio Grande Valley, 3 out of 4 people are afflicted with diabetes. The feet are very much affected by diabetes. Podiatrists play a very important part in a diabetic’s life. We and the whole state of Texas are in need of many more Podiatrists. 

A medical residency training of podiatrists here at the UTRGV is an exceptional way to help fill the need for more podiatrists. Please know that the RGV Hispanic Chamber is in total support of this bill.

Lucy Torres
CEO
Nuestra Clinica del Valle
McAllen

This bill will help increase the specialty care for diabetic patients in the RGV.  In 2020, Nuestra Clinica del Valle served 24,834 patients and 30% were diabetics.

Mary Ann Villarreal
Office Manager
Harlingen Economic 
Development Corporation
Harlingen

There is a great need for more medical support in the podiatric area, as I have my mother and sister that are in great need of that specialty field. The foot, ankle and the knee as planters foot, fishers, etc.

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