Bill Summary for Bill Number SB09-239

Date: 03/05/2009

Final
BILL SUMMARY for SB09-239

SENATE COMMITTEE ON HEALTH AND HUMAN SERVICES

Votes: View-->	Action Taken:
Adopt prepared amendment L.001 (Attachment B). Th	Pass Without Objection

04:33 PM -- Senate Bill 09-239

Senator Tochtrop introduced Senate Bill 09-239. Amendments L.001, L.003, L.005, L.006, L.009 (Attachments B through F), were distributed to the committee. A letter concerning the bill was also distributed to the committee (Attachment G). The bill implements the recommendations of the Department of Regulatory Agencies (DORA) contained in its sunset review of the Nurse Practice Act. The committee previously held a hearing on the sunset report and its recommendations on Thursday, February 19. Senator Morse suggested that the committee limit its discussion to amendments L.005 and L.006, which both concern a definition of advanced practice nursing, stating that there was likely to be committee agreement on amendment L.001, which addresses the prescriptive authority of advanced practice nurses, and other issues raised in the sunset report. Senator Tochtrop stated that nurses do not have a problem defining advanced practice nursing for the statutes, but that they strongly believe that nurses should be developing the definition. The committee discussed the amendments.

04:45 PM -- Dr. Lynn Parry, representing the Colorado Medical Society (CMS), testified regarding amendments addressing "delegated medical functions". She testified that amendment L.005 does not restrict access to providers, limit competition, or limit choice of providers. She stated that legal liability in situations in which physicians and advanced practice nurses are sharing care needs to be clarified. She responded to questions from Senator Carroll regarding the differences between the two amendments. She responded to questions from Senator Mitchell regarding delegated medical functions. Senator Morse and Dr. Parry further discussed the definition of advanced practice nursing in the amendments and issues related to delegated medical functions. Senator Tochtrop commented on amendment L.001, which concerns prescriptive authority for advanced practice nurses. She responded to questions from Senator Newell regarding the legal liability in situations involving delegated medical functions. Senator Carroll asked for clarification regarding language concerning delegated medical functions that was included in a definition of licensed practical nursing within the bill.

05:11 PM -- Dr. Luke Casias, representing the Colorado Academy of Family Physicians and Colorado Medical Society, testified regarding amendment L.005. He gave examples of situations in which physicians would delegate medical functions to advanced practice nurses. He responded to questions from Senator Morse regarding why it was important to define advanced practice nursing to include delegated medical functions, and Dr. Casias stated that as advanced practice nurses gain more experience and training, the lines between medical and nursing care can become blurred.

05:25 PM -- Sue Townsend, representing the American Academy of Pediatrics, described how she develops medical care plans that are implemented by advanced practice nurses. A handout regarding independent prescriptive authority for advanced practices nurses was distributed to the committee (Attachment H). She stated that amendment L.005 is an attempt to define the interface between the functions of doctors and nurses. She responded to questions from Senator Tochtrop regarding articulated plans for advanced practice nurses with prescriptive authority.

05:30 PM -- Kari Hershey, representing the Colorado Medical Society, testified in support of amendment L.005. She stated that advanced practice nurses working in integrated care settings perform delegated medical functions. She stated that even if the acts are performed by nurses, physicians retain legal liability for the acts by operation of law. She stated that a definition of advanced practice nursing that does not include delegated medical functions could confuse patients and that amendment L.005 does not impede an advanced practice nurse from performing independent nursing functions. Ms. Hershey responded to previous questions from Senator Carroll regarding language in the bill that includes delegated medical functions in a definition of practical nursing. Ms. Hershey clarified that the articulated plans outlined in amendment L.001 only apply to advanced practice nurses with prescribing authority, and the issue with delegated medical functions involves both advanced practice nurses with and without prescribing authority. She discussed her concerns with amendment L.006. She responded to questions from Senator Newell regarding CMS's reasons for supporting a definition of advance practice nursing that includes delegated medical functions. Senator Newell asked if the relationship between advanced practice nurses and doctors would be changed by adopting an amendment that defines advanced practice nursing to include delegated medical functions.

05:45 PM -- Tay Kopanos, representing the Colorado Nurses Association, testified that the nurses are open to defining advanced practice nursing, but that the definition should come from the nursing community. She stated that the language in amendment L.005 limits and constrains the practice of advanced practice nursing. She stated that the practice of advanced practice nursing is independent and that advanced practice nurses do not practice under delegated medical authority. She stated that any definition of advanced practice nursing needs to be fluid and flexible. She responded to question from Senator Carroll regarding what the harm was in including delegated medical functions in the definition of advanced practice nursing. She stated that advanced practice nursing is an autonomous profession, and when an advanced practice nurse chooses to perform a delegated medical function, he or she is no longer practicing under his or her authority as an advanced practice nurse; he or she is practicing under his or her authority as a professional nurse.

06:04 PM -- Linda Pearson, representing the Colorado Nurses Association, described data concerning malpractice actions involving nurse practitioners and physicians. She responded to questions from Senator Newell regarding whether advanced practice nurses who are exercising a function at the request of a physician are performing functions as a professional nurse or as an advanced practice nurse. Senator Mitchell asked for clarification about the boundaries of advanced practice nurses' scope of practice. Ms. Pearson stated that it was essential for nurses to define nursing and physicians to define medicine. Senator Lundberg asked if the nursing scope of practice was self-regulating.

06:20 PM -- Linda Siderius, representing the Colorado Nurses Association, stated that there are independent and dependent pieces to nursing. She stated that even in an dependent situation, a professional nurse is independently obligated to execute the duties within his or her scope of practice. She stated that there is an exemption within the Medical Practice Act for the practice of nursing. Ms. Siderius responded to questions from Senator Schultheis regarding how conflicts between advance practice nurses and physicians are resolved. Senator Carroll asked if there would be any benefit to defining "advanced practice nurse" separately from "advanced practice nursing." Ms. Kopanos discussed the qualifications for advance practice nurses. The committee discussed whether there would be any benefit in defining the terms separately. Ms. Siderius responded to committee questions regarding the boundaries of advanced practice nursing scope of practice and the liability of nurses.

06:42 PM -- Marion Thornton, President of the Colorado Society of Advanced Practice Nurses, testified that including delegated medical authority in the definition of advanced practice nursing will limited advanced practice nurses' scope of practice.

06:43 PM -- Lieutenant Colonel Larry Shovelton, representing the Colorado Association of Nurse Anesthetists, stated that whether an act is nursing or medicine is defined by the person who performs the act. He stated that he supported L.006 because nurses do not perform medical functions.

06:47 PM -- Doug Warnecke, representing the Colorado Association of Nurse Anesthetists, testified that doctors and advanced practice nurses have overlapping scopes of care. He stated that any restrictions on the scope of care for advanced practice nurses is bad for Colorado.

06:50 PM

Various individuals who were not able to testify indicated their support for amendment L.006.

06:52 PM -- Charlie Hebeler, representing the Colorado Nurses Association, testified regarding amendment L.001 (Attachment B).


BILL:	SB09-239
TIME:	06:53:16 PM
MOVED:	Tochtrop
MOTION:	Adopt prepared amendment L.001 (Attachment B). The motion passed without objection.
SECONDED:
		VOTE
	Carroll M.
	Lundberg
	Mitchell	Excused
	Morse
	Newell
	Schultheis
	Tochtrop
	Boyd

Not Final YES: 0 NO: 0 EXC: 0 ABS: 0 FINAL ACTION: Pass Without Objection

06:55 PM

The bill was laid over for further action at the next meeting of the Senate Health and Human Services Committee.