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Nurse practitioner bill passes second House committee without amendment

CHARLESTON, W.Va. — After around two hours of debate, a bill without amendments will head to the House floor that would give nurse practitioners in the state “full practice authority.”

The major changes proposed in H.B. 4334, which passed the Committee on Government Organization during its meeting Saturday, would allow advanced practice registered nurses to prescribe drugs after meeting certain requirements and also allow to practice within the scope of their training without the direct supervision of a physician.

A series of amendments were proposed based off a state Performance Evaluation and Research Division audit released in 2014 regarding APRNs but were defeated.

The amendments –most of which were similarly proposed and defeated in the House Health Committee– included moving the collaborative practice regulations from the board of nursing to the boards of Medicine and Osteopathic Medicine, adding an APRN to both of those boards, increasing the number of years required in a collaborative partnership with a physician from two to five and restricting the ability to prescribe Schedule II narcotics.

Del. Chris Stansbury (R – Kanawha, 35) proposed a majority of the amendments, fearing that additional individuals with prescription authority would add to the state’s issues with pill addiction.

“It’s not because I don’t value what nurses do, it’s not because I don’t have respect for the profession,” he said. “It’s just because I believe that it’s taking a step too far, too fast, given the current state of the drug crisis here in West Virginia and the other issues we’re facing.”

The bill as proposed would allow APRNs that meet the requirements to prescribe 72 hours worth of a Schedule II drug with no refill, 30 days worth of a Schedule III drug with no refill and 30 days of an ADD drug with no refill

Wondering just how many APRNs there were in the state, how many would have prescription authority and what safeguards were put in place to prevent doctor shopping, the committee requested that the president of the WV Nurses Association answer questions during discussion.

Beth Baldwin said that there were approximately 2000 APRNs in the state, 860 of those would meet the requirements to have prescriptive authority and 70 percent of that number would have a licence from the DEA to prescribe Scheduled II drugs.

The majority of delegates felt that the number of those with prescription authority might not be the root of the state’s drug problems.

“It’s something that concerned me when I saw this bill, this piece of legislation last year,” Mike Pushkin (D – Kanawha, 37) said. “That’s something I really struggled with, allowing more people to prescribe. Is that something that’s going to move the needle one way or the other? I really don’t think so. I think addiction is deeper than that.”

During her opportunity to speak, Baldwin also made her case as to why the collaborative practice regulations from the board of nursing should remain with the board of nursing.

“Nurses aren’t physicians, that’s the first kind of conflict,” she said. “I would think that the Federal Trade Commission and their letter to West Virginia was very good at articulating what those conflicts are.”

Earlier this month, the FTC sent a letter addressed to Senator Kent Leonhart based on debate over the bill in last year’s session urging the state to “avoid restrictions on APRN practice that are not narrowly tailored to address well-founded patient safety concerns.”

After all five amendments failed, committee members gave their reasons for supporting or rejecting the bill.

Michael Ihle (R – Jackson, 13) was among those urging passage of the bill, not only because of the opportunity to expand primary health care in the state’s rural areas, but it also may provide the chance to create jobs.

“I think it’s a job bill,” he said. “We lose these NPs to other states and we have an opportunity to create competition in our healthcare industry. As we know from all the jobs bills we deal with, competition lowers costs.”

The bill passed without amendment on a voice vote to be sent to the House floor. If it passes through the entire body, it heads over to the Senate and any committee it may be assigned to.

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