Public Health Committee

JOINT FAVORABLE REPORT

Bill No.:

SB-67

Title:

AN ACT CONCERNING THE AUTHORITY AND RESPONSIBILITIES OF ADVANCED PRACTICE REGISTERED NURSES.

Vote Date:

3/16/2016

Vote Action:

Joint Favorable Substitute

PH Date:

2/16/2016

File No.:

SPONSORS OF BILL:

Public Health Committee

REASONS FOR BILL:

To give Advanced Practice Registered Nurses additional authority and responsibilities within their scope of practice.

RESPONSE FROM ADMINISTRATION/AGENCY:

Raul Pino MD, MPH Commissioner Department of Public Health,: The Department supports the ability of APRNs to practice to the full extent of their education and training. However, due to the large nature of this bill, the multiple parties and agencies involved, the Department will be conducting a deeper review and will provide its findings at a later date.

NATURE AND SOURCES OF SUPPORT:

Mary Jane Williams PhD RN Chair, Government Relation, Connecticut Nurses' Association: This is an opportunity to prevent a crisis in providing care across the continu um by allowing APRNs to have full Signatory Authority. “Full Signatory Authority” is essential to the provision of uninterrupted health care and this proposed legislation supports the Full Implementation of Public Act 14-12 calling for Increased Access to Health Care.

Monte Wagner, MSN MPH FNP-BC APRN DNP (candidate), Connecticut Advanced Practice Registered Nurse Society: This bill has become necessary to update statutes to meet current practice. This bill addresses many issues including basic evaluations affecting individuals involved with evictions, health clubs, motor vehicle operations, fishing, glucose monitoring in schools, jury duty, certifications for insurance coverage for rehabilitation and home care, certification of inability to care for oneself or manage affairs, directing the care of a nursing home resident, as well as treatments for serious illnesses and end of life decisions by patients.

Nora Duncan, Staff Director, AARP Connecticut: This bill would improve outdated Connecticut health care rules law by allowing APRNs to sign documents which includes disability forms, Do Not Resuscitate Orders, certificates for Connecticut's Homecare Option Program for the Elderly, home health and hospice services coverage under individual health insurance and Medicare supplement policies, certification for medical leave of absence and family leave of absence, and nursing home transfer and discharge forms. AARP supports full practice authority and direct access to APRNs, including the issue of signature authority.

Lynn Rapsilber, Chair, Connecticut Coalition of Advanced Practice Nurses: This bill is necessary since CT statutory language is obsolete in frequently naming only a physician to sign certain forms. This bill addresses many issues including basic evaluations affecting individuals involved with evictions, health clubs, motor vehicle operations, fishing, attending schools, jury duty, as well as end of life decisions by patents and treatments for serious illnesses. In addition, there are four sections of the bill that are not appropriate APRN issues and recommends deletion: section 18, section 27, section 29, section 75. Furthermore, recommendation to amend DNR and living will statutes for conformity.

Donna Sanchez, Chair-Government Relations Committee, Connecticut Association of Nurse Anesthetists: The passage of this bill will allows APRNs to legally sign, certify and order all aspects of care that removes the barrier to practice, allows for continuity of care, eliminates repetitive and costly step in the process of getting Connecticut's people the services and care they need.

Jonathan Weber, MA, PA-C Legislative Committee Co-chair and Jason Prevelige, MHS, PA-C, President , Connecticut Academy of Physician Assistants (ConnAPA): There is support for the nature of the bill, however we recommend the inclusion of the title “physician assistant” in most instance where the title “advanced practice registered nurse” appears, “physician assistants is also added. The exclusion of PAs will negatively impact current PA practice and CT residents' access to health care. In addition, the ConnAPA does not seek authorization to prescribe medicinal marijuana.

Connecticut Association of Optometrists: Requests the addition of Optometric Doctors in four specific sections of the bill: Section 3 which pertains to ABLS accounts and the certification that the individual is blind, section 64 and section 69 which pertains to individual and group health insurance plan coverage of prescription eye drops, and section 76 which relates to a “hold” on the eviction of a tenant who is blind.

Connecticut Psychiatric Society: There is support for the bill's intent to expand access to health care, however, we are in agreement with the Connecticut State Medical Society's testimony that changing statutes referring to physicians by adding APRNs across the board requires scrutiny. There are concerns where APRNs are being added to statutes involving situations where the added training and medical expertise of a physician is crucial.

The following individuals support the bill as it will allow APRNs to further serve the residents of CT by removing barriers to practice. It will have significant daily impact on patient care and access to care across the state of CT:

Melinda Dolan RN, BSN, CEN

Everol Ennis, APRN

Elizabeth Esstman, APRN

Sheri Peabody, MSN, APRN-BC

Tracy Powell, FNP-BC

Lynn Saphire, APRN

Maryanne Strindberg, APRN

Christine Waszynski BSN, MSN, GNP-C, DNP-C

Ines M. Zemaitis APRN, BC

NATURE AND SOURCES OF OPPOSITION:

Connecticut State Medical Society: Agrees that most of this bill is a natural progression of the independence of APRNs. However, the Society opposes the bill because this is such a broad legislation and will have a dramatic impact on care delivery without a thorough review of the implications of each of the statutory changes requested. The Society believes that it is imperative that health care professions and the Public Health Committee work together to review the legislation in detail to ensure that all are acting in the best interest of the patients.

Connecticut State Society of Anesthesiologists: This bill erodes the interdisciplinary team-based approach of the practice of medicine, led by a physician and supported by an array of health care professionals including nurses, physician assistants and APRNs. In addition, this bill is contrary to current practice of medicine in Connecticut and across the country and dismantles a team approach to medicine that is based on safe patient care and works for the healthcare system.

New London County Medical Association (NLCMA): This bill should have gone through the scope of practice process pursuant to CGS Sec. 19a-16d, giving all sides the opportunity to introduce impact statements and evidence. NLCMA urges the committee to reject the bill so that it can go through the proper process and the proposed changes can be fully evaluated.

Waterbury Medical Association: Urges the Committee to reject this bill as it did not go through the scope of practice process pursuant to CGS Sec. 19a-16d. Given the size and magnitude of this bill, it should go through the appropriate process so that its impact can be fully studied.

Reported by: Walter L. Morton

Date: 03/31/2013