To Whom This May Concern:

I am sending this comment in response to the regulations regarding the licensure of genetic counselors, Chapter 266, section 54.1-2957.18 (D) which includes a grandfathering clause for counselors, such as myself, that have been practicing for over 20 years but do not have their master's degree. Although the bill for licensure was signed in 2014, the date listed to apply for licensure based on the grandfathering clause was July 1, 2016, which has now expired. The expiration date of the grandfathering clause was inserted into the bill with the full intent that all genetic counselors would obtain licensure by that date. Unfortunately this process has taken longer  than anyone imagined. I have complied with the date listed in the grandfathering clause by submitting the required documents to the Virginia Board of Medicine by certified mail which they received June 21, 2016. However, the feedback I received from them was that this action may not be adequate for me to obtain licensure after the regulations are passed. I am posting this comment to request that as the regulations are finalized, that either the date for the grandfathering clause be updated to allow adequate time for counselors to whom this pertains to comply with the requirements, or that the language be changed to permit acceptance of the documents sent in prior to July 1, 2016 so that those counselors like myself can obtain licensure. I have been a prenatal genetic counselor for 29 years. If the date or language for the grandfathering clause is not amended and I am unable to obtain licensure due to this circumstance, then I will no longer be able to call myself a genetic counselor or maintain a job in the field that I have worked in for more than half of my life. During this time I have assisted thousands of patients by providing genetic counseling services, trained 18 years of master's level genetic counseling students at VCU who are now my colleagues, and elevated the standard of care in the practices where I have worked by imparting my expertise in this field.

Thank you for your time and consideration of my proposal to modify the regulations regarding the grandfathering clause. 

Respectfully,

Laurie Tams, Genetic Counselor

To Whom It May Concern:

The National Society of Genetic Counselors (NSGC) is submitting comments regarding the drafting of regulations for the licensure of genetic counselors, specifically 18VAC85-170-60 Licensure requirements pursuant to Chapter 266, section 54.1-2957.18 (D) which is a grandfathering clause for counselors;

B. Pursuant to § 54.1-2957.19 D of the Code of Virginia, applicants for licensure who do not meet the requirements of subsection A of this section may be issued a license provided they (i) apply for licensure before July 1, 2016; (ii) comply with the board's regulations relating to the NSGC Code of Ethics; (iii) have at least 20 years of documented work experience practicing genetic counseling; (iv) submit two letters of recommendation, one from a genetic counselor and another from a physician; and (v) have completed, within the last five years, 25 hours of continuing education approved by the NSGC or the ABGC. For the purpose of this subsection, the board deems the provisions of Part IV (18VAC85-170-110 et seq.) of this chapter to be consistent with the NSGC Code of Ethics.

Although the bill for licensure was signed in 2014, NSGC is concerned that rules have not been finalized and the application deadline for this section of law has expired. The application requirements in the law are very clear. NSGC respectfully requests that the draft rule be modified to include clarifying language that individuals who supplied the required application information to the Virginia Board of Medicine by the July 1, 2016 deadline, as required by law, are deemed to have met the requirements under section 54.1-2957.18(D).  This will ensure the final rule implements the law as the legislature intended.  

NSGC appreciates the consideration of these comments as you work to finalized the rule and regulations.

If you have any questions, please do not hesitate to contact me directly.

Sincerely,

John Richardson

Director of Policy and Government Relations

National Society of Genetic Counselors

2025 M Street Suite 800 NW

Washington, DC 20036

202-367-1239

To Whom It May Concern:

The Virginia Association of Genetic Counselors (VaAGC) is submitting comments regarding the drafting of regulations for the licensure of genetic counselors, specifically Chapter 266, section 54.1-2957.18 (D), the grandfathering clause for currently practicing genetic counselors.

Although the bill for licensure was signed in 2014, we are concerned that rules have not been finalized and the application deadline for this section of law has expired. The expiration date for the grandfathering clause was inserted into the bill with the full intent that all genetic counselors would obtain licensure by that date. Unfortunately this process has taken longer than anyone anticipated. VaAGC respectfully requests that the draft rule be modified to include clarifying language that individuals who supplied the required application information to the Virginia Board of Medicine by the July 1, 2016 deadline, as required by law, are deemed to have met the requirements under section 54.1-2957.18(D).  This will ensure the final rule implements the law as the legislature intended.  

VaAGC appreciates the consideration of these comments as you work to finalize the rule and regulations.

If you have any questions, please do not hesitate to contact me directly.

Sincerely,

Elizabeth Chisholm Spears, MS, CGC

President

Virginia Association of Genetic Counselors

To whom it may concern:

In 2014, a “refusal clause” was written into otherwise harmless legislation to license genetic counselors, allowing genetic counselors to refuse service to patients based on the counselors’ “deeply held moral or religious beliefs” and to shield those same counselors from damages. As a result of this legislation, a state-licensed genetic counselor will be able, based on the genetic information provided to the counselor, to deny counseling to any patient simply because the counselor knows or believes that: the patient is lesbian, gay, or transgender; subscribes to a certain religious faith; is unmarried and pregnant; or the person may want to take an action with which the counselor doesn’t personally agree, as some examples.

No genetic counseling client should be subjected to substandard, harmful, misleading, inaccurate, or incomplete care based on a genetic counselor’s deeply held moral or religious beliefs. All genetic counseling clients, regardless of their sexual orientation, gender identity, marital status, religion, or viewpoint on abortion, should expect to receive, and should receive, the highest level of care from his or her genetic counselor.

Accordingly, the Board of Medicine should adopt the regulations as drafted by the Advisory Board on Genetic Counseling, and as unanimously approved by the full Board of Medicine on February 18, 2016. 

Sincerely,
James Parrish 
Executive Director
Equality Virginia

We write in support of the proposed regulations drafted by the Advisory Board of Genetic Counseling, which were unanimously approved by the full Board of Medicine on February 18, 2016.

The National Abortion Federation (NAF) is the professional association of abortion providers. Our mission is to ensure safe, legal, and accessible abortion care, which promotes health and justice for women. Our member facilities care for half of the women who choose abortion in the United States and Canada each year, including Virginia women. NAF is the leading organization offering accredited continuing medical education to health care professionals in all aspects of abortion care. NAF member facilities, including our Virginia members, adhere to our evidence-based Clinical Policy Guidelines (CPGs), which set the standards for quality abortion care in North America. Our experience and expertise includes developing evidence-based standards, drafting medically-appropriate regulations for abortion facilities with state health departments, and assisting health care providers in the delivery of high-quality abortion care.

NAF is committed to patient health and safety, and evidence-based regulations. As such, we support rulemaking for the licensure of medical professionals – including genetic counselors – that is based on the highest standards of professional competence and on the values of care and respect for patients. Likewise, we recognize the importance of empowering patients with knowledge when they make the decision to have an abortion, which is why we have a chapter on “patient education, counseling, and informed consent” in our Clinical Policy Guidelines.

It is also vital that patients be able to rely on their medical professionals to provide unbiased information to help them cope with the difficult decisions that relate to genetic testing. The “refusal clause” in the 2014 legislation to license genetic counselors allows genetic counselors to refuse service to patients based on the counselors’ “deeply held moral or religious beliefs” and shield those same counselors from damages. As a result of this legislation, genetic counselors could deny counseling to any patient for many reasons, including the patient’s willingness to take an action – such as accessing abortion care – with which the counselor does not personally agree.

The denial of such counseling, without protections in place, could risk patient health and diminish their ability to make educated decisions about their healthcare. Delay in accessing abortion care unnecessarily increases the risks to the patient as gestational age increases, and potentially prohibits patients from accessing abortion care entirely.

NAF operates a hotline that is a source of unbiased information about abortion and referrals to providers of quality care. Recently we heard from a woman named Sara B.* who was trying to find sources of funding to access abortion care. She felt anxious about her decision but felt it was right for her situation at the time. She had recently given birth to a son who was born without one of his legs, with his foot attached directly to his pelvis. Her doctor had known that her son would be born without a limb, but did not tell her until the week before her due date. Sara decided to terminate her second pregnancy because of the difficulty of caring for her son and financial issues that resulted from quitting her job, thereby losing her health insurance, to care for him full-time. She also expressed extreme mistrust of the medical community, which made her fear going through another pregnancy, since she felt her doctor had been dishonest with her during her first pregnancy.

Sara’s situation is just one example of why genetic counseling clients should be able to receive the highest level of care from his or her genetic counselor – and should not be subject to substandard, harmful, misleading, inaccurate, or incomplete care based on a genetic counselor’s moral or religious beliefs.

We urge the Board of Medicine to adopt the draft regulations, which have already been unanimously approved by the Advisory Board on Genetic Counseling and the Board of Medicine, certified by the Attorney General, and approved by the Governor. The regulations, particularly 18VAC85-170-150(B), are necessary to ensure the health, safety, and well-being of all Virginia genetic counseling clients.

NARAL Pro-Choice Virginia (“NPCVA”) urges the Board of Medicine (“the Board”) to adopt the draft regulations for the licensure of genetic counselors in the Commonwealth.

At NPCVA, we believe that medical evidence should guide the Board in drafting regulations that promote the health and safety of all Virginians. After numerous meetings, in-depth discussion, and careful consideration of public comment from physicians, individuals, and advocacy organizations, the Advisory Board on Genetic Counseling unanimously approved the draft regulations for the licensure of genetic counselors on December 16, 2015. The Board subsequently unanimously approved the draft regulations at its February 18, 2016 meeting. The draft regulations have since been certified by the Office of the Attorney General and approved by the Governor’s office. We encourage the Board to approve the draft regulations for final adoption to promote the health, safety, and wellbeing of all Virginians.

In particular, NPCVA encourages the Board to approve Section 150(B) (“Exercise of the conscience clause”) of the draft regulations for final adoption. The so-called conscience clause that appears in the enabling statute for the licensure of genetic counselors operates not at all as a matter of conscience, but as a blanket license to discriminate. The “conscience clause” enables genetic counselors to discriminate against, and even harm, clients with total impunity. The “conscience clause” enables state-licensed genetic counselors, based on the genetic information provided to the counselor, to deny counseling to any patient simply because the counselor knows or believes that: the patient is lesbian, gay, or transgender; subscribes to a certain religious faith; is unmarried and pregnant; or the person may want to take an action with which the counselor does not personally agree, as some examples. The statute is so extreme that it will shield a genetic counselor from damages even if the counselor takes purposeful action based on his or her personal beliefs that results in actual physical harm or death to the patient.

While the regulations for the licensure of genetic counselors cannot supplant, contradict, or supersede the enabling statute, they can at the very least provide much-needed protection for the health and safety of all Virginians who seek genetic counseling services. No genetic counseling client should be subjected to substandard, harmful, misleading, inaccurate, or incomplete care based on a genetic counselor’s deeply held moral or religious beliefs. Rather, all genetic counseling clients, regardless of their sexual orientation, gender identity, marital status, religion, or viewpoint on abortion, should expect to receive, and should receive, the highest level of care from his or her genetic counselor. Clients should not be punished for their genetic counselors’ refusal to provide medically accurate, complete, high-quality care. Where a genetic counselor cannot provide medically accurate or complete care to his or her patients because of his or her religious or moral beliefs, a client, at the very least, should be informed of the counselor’s limitations, and should be afforded the opportunity to seek a counselor who can provide complete, accurate, high-quality health care.

The draft regulations seek to promote, as much as is possible given the incredibly harmful enabling statute, the health and well-being of all Virginians. Accordingly, the Board of Medicine should adopt the regulations as drafted by the Advisory Board on Genetic Counseling, and as unanimously approved by the full Board of Medicine on February 18, 2016.

To Whom It May Concern:

The Virginia Latina Advocacy Network (“VA-LAN”) of the National Latina Institute for Reproductive Health urges the Board of Medicine to adopt the draft regulations for the licensure of genetic counselors in the Commonwealth.  The VA-LAN centralizes its work in Northern Virginia, promoting access to reproductive health services, immigrant and economic justice and advocating for healthy lives for Latinas, their families and their communities.

In 2014, a religious exemption was written into otherwise harmless legislation to license genetic counselors, allowing genetic counselors to refuse service to patients based on the counselors’ “deeply held moral or religious beliefs” and to shield those same counselors from damages.  As a result of this legislation, a state-licensed genetic counselor will be able, based on the genetic information provided to the counselor, to deny counseling to any patient simply because the counselor knows or believes that: the patient is lesbian, gay, bisexual, transgender, or queer (“LGBTQ”); subscribes to a certain religious faith; is unmarried and pregnant; or the person may want to take an action with which the counselor doesn’t personally agree.  This legislation is so extreme that it will shield a genetic counselor from damages even if the counselor took purposeful action based on his or her personal beliefs that results in physical harm or death to the patient.

Religious exemptions have hurt many communities, including Latinas/os and LGBTQ Latinas/os, by denying needed reproductive and gender-affirming healthcare when they needed it.  These exemptions have been used to deny services such as abortion care, contraception, including emergency contraception, and post exposure prophylaxis (PEP).  Because of these exemptions in healthcare, individuals may be delayed in accessing life-saving treatment or may not receive comprehensive, medically accurate information regarding their treatment options.  Religious exemptions worsen health inequities that our communities face and the discrimination they experience in healthcare settings. 

Regulations for the licensure of genetic counselors should ensure the health, safety, and wellbeing of all genetic counseling clients in the Commonwealth.  No genetic counseling client should experience harmful, biased, and medically incomplete care based on a genetic counselor’s deeply held moral or religious beliefs.  All genetic counseling clients, regardless of their sexual orientation, gender identity, marital status, religion, or viewpoint on abortion care, should expect to receive, and should receive, the highest level of care from their genetic counselor.  

Accordingly, the Board of Medicine should adopt the regulations as drafted by the Advisory Board on Genetic Counseling, and as unanimously approved by the full Board of Medicine on February 18, 2016.

Sincerely,

Margie Del Castillo

Virginia Latina Advocacy Network, National Latina Institute for Reproductive Health

The American Civil Liberties Union of Virginia (ACLU-VA) urges the Board of Medicine (“the Board”) to adopt the proposed regulations for the licensure of genetic counselors in the Commonwealth.

ACLU-VA supports rulemaking for the licensure of genetic counselors that is based on the highest standards of professional competence, and on the values of care and respect for the patient’s autonomy, individuality, welfare, and freedom.

Contrary to those principles, in 2014, a “refusal clause” was written into Virginia Code § 54.1.2957.18-21, allowing licensed genetic counselors to refuse service to patients based on their “deeply held moral or religious beliefs” and to shield them from damages. As a result of this legislation, a state-licensed genetic counselor is permitted, based on the genetic information provided to the counselor, to deny counseling to any patient simply because: the patient is lesbian, gay, bisexual, transgender, or gender non-conforming; is of a different religious faith; is unmarried and pregnant; or the person may want to take an action with which the counselor doesn’t personally agree, as some examples. This legislation is so extreme that it will shield a genetic counselor from damages even if the counselor took purposeful action based on his or her personal beliefs that results in actual physical harm or death to the patient. By allowing licensed genetic counselors to discriminate against their patients with impunity, potentially causing them physical harm as a result, this legislation threatens, rather than protects, patient health and safety.

The draft regulations seek to promote, as much as is possible given the constraints of Virginia Code § 54.1.2957.18-21, the health and well-being of all Virginians.  ACLU-VA particularly encourages the Board to approve Section 150(B) (“Exercise of the conscience clause”) of the draft regulations for final adoption. Genetic counseling clients should not be subjected to harmful, misleading, inaccurate, substandard, or incomplete care simply because their religion, sexual orientation, gender identity, marital status, or personal reproductive healthcare decisions conflict with a genetic counselor’s deeply held moral or religious beliefs. Rather than punishing clients for their genetic counselors’ refusal to provide medically accurate, complete, high-quality care because of their religious or moral beliefs, clients should be informed of any limitations on the counselor’s practice in advance and be provided the opportunity to seek a counselor who can provide complete, accurate, high-quality health care.

We encourage the Board of Medicine to adopt the regulations as drafted by the Advisory Board on Genetic Counseling, and as unanimously approved by the full Board of Medicine on February 18, 2016.