CNAP 09 Legislative Update #7 – The Challenge & the Message
Lynda Woolbert, Executive Director
Coalition for Nurses in Advanced Practice
March 30, 2009
Rep. Rodriguez Co-Authors HB 1107
We all owe a big thank you to Representative Eddie Rodriguez (D – Austin, HD #51). Last week he signed on as a joint author for HB 1107, our Nursing Board-Granted Prescriptive Authority Bill. Adding authors adds support for a bill. In this case, it is particularly significant because Representatives Christian and Rodriguez usually are not on the same side of most issues. Having legislators from both sides of the aisle support the same bill is important. Please send Rep. Rodriguez a note and thank him for authoring HB 1107. This is particularly important to do if you live or work in House District #51.
SB 532 Goes from Senate to House
You may remember from last week’s update that the Senate HHS Committee voted SB 532 (the retail clinic bill) favorably from the committee and recommended it for the Local and Uncontested Calendar. It did not take long for that to happen. SB 532 was placed on that Calendar last Thursday and passed the Senate. SB 532 now moves to the House of Representatives.
Before you start cheering, remember, that while this bill will be of some help to a few APNs, it maintains site-based prescriptive authority and does not even allow physicians to delegate Schedule II Controlled Substances as is allowed in 41 other states. Therefore, we have even bigger challenges ahead for us in the House.
Our Focus Turns to the House
Our intense efforts will now focus on the House of Representatives and specifically on the House Public Health Committee. To find the members of that committee, Click Here. We anticipate that the APN prescriptive authority bills will all be heard by the Public Health Committee on Tuesday, April 7th. This means that the Public Health Committee will hear the following bills.
· HB 1107 by Representatives Wayne Christian and Eddie Rodriguez would remove site-based delegated prescriptive authority and allow the Texas Nursing Board to grant APNs authority to diagnose and prescribe, including Schedule II Controlled Substances.
· HB 696 by Representative Rob Orr. This bill would maintain diagnosis and prescribing as delegated medical acts but would remove site-based restrictions and allow physicians to delegate prescribing of Controlled Substances, including Schedule II, without the current restrictions.
· HB 800 by Representative Rob Orr and HB 2907 by Representative Garnet Coleman are identical bills to SB 532, the retail clinic bill.
The fact that we know the hearing date for these bills gives APNs who live or work in the districts of members of the House Public Health Committee time to write a handwritten note to those members today. As discussed in the article, “Crafting Effective Letters to Legislators” in CNAP Update #4, select an example from your practice about how HB 1107 would help you or the patients you serve. We also want you to indicate your support for HB 696.
The Message:
H.B. 1107 by Representatives Wayne Christian and Eddie Rodriguez is by far the best bill for Advanced Practice Nurses. Most importantly, it is the best bill for Texans because it will do the most to improve access to care. As long as APNs are geographically tied to physicians there is no way for APNs to move to the counties in this state that are the most underserved. (There are a number of points in favor of HB 1107 outlined in the article referenced above on letter-writing.)
APNs should also indicate support for HB 696 by Representative Rob Orr. This bill could also improve access to care because it would permit physicians to delegate prescriptive authority, but it would remove the geographic ties and allow physicians to delegate to more APNs. Physicians would have more authority to decide what drugs they allow the APN to prescribe and what type of supervision that APN requires. This bill actually gives individual physicians much more authority than they have now with the current system of site-based prescriptive authority. For much more information on this bill, Click Here.
Remember that short letters are more effective than long ones. Enclosures are available on CNAP’s Website. As discussed in last week’s Update, we have two new handouts available for download. One is a summary of all the bills that legislators will find very helpful. The other is the fact sheet answering the medical associations’ misinformation about HB 696 / SB 680. For both handouts, Click Here, and scroll to the bottom of the page.
I cannot over emphasize the importance of individualizing your letter or email. Form letters and messages are always discounted, and form letters from non-constituents are thrown in the trash.
Registering your support in some fashion is absolutely essential. If 10 to 15 constituents in each district contact their representatives, that is enough to let the legislator know that constituents care about this issue. Remember, APNs are not the only constituents who can make these contacts. Letters from other constituents, including your patients, are just as powerful, if not more so. That is especially true if the constituent is a physician.
Physician Support for HB 1107 or HB 696
We know there are physicians who are willing to support HB 1107, and even more who would support HB 696 to get rid of site-based restrictions. If you know a physician who might lend his or her support to either of these bills, now is the time to ask them to make their support known.
We have heard repeatedly from legislators that one or two letters from physicians in their district supporting these bills go a long way to countering medical association opposition. Letters from any physicians, even if they are not constituents, should be written to the Chair of the House Public Health Committee. Then that letter can be copied to all members of the committee. Letters should be addressed as follows.
The Honorable Lois Kolkhorst
Chairman, House Public Health Committee
Texas House of Representatives
P.O. Box 2910
Austin, Texas 78768-2910
Dear Chairman Kolkhorst:
If physicians are hesitant to put their names on a letter, then encourage them to pick up the phone and call Chairman Kolkhorst’s office and express their support. They need to make it clear that they are a physician who wants Chairman Kolkhorst to know that the position of medical associations does not reflect the opinion of all physicians in Texas. They urge her support for HB 1107 or HB 696. Chairman Kolkhorst’s number is (512) 463-0600.
Obviously if the physician lives or works in one of the Public Health Committee members’ districts, it is even more important that they call or write that representative. Please review this list to see if a physician you know might be a constituent or have a practice in the district of one of these representatives.
Chairman Lois Kolkhorst (Brenham, HD #13)
Vice Chair Elliott Naishtat (Austin, HD #49)
Garnet Coleman (Houston, HD #147)
John Davis (Houston, HD #129)
Veronica Gonzales (McAllen, HD #41)
Chuck Hopson (Jacksonville, HD #11)
Susan King (Abilene, HD #71)
Jodie Laubenberg (Rockwall, HD #89)
Jim McReynolds (Lufkin, HD #12)
Vicki Truitt (Southlake, HD #98)
John Zerwas, M.D. (Katy, HD #28)
The Challenge in the Senate
Lat week, I discussed the hearing by the Senate Health and Human Services (HHS) Committee on SB 680. I need to clarify one point in Update #6. When discussing the hearing on S.B. 680, I stated that the Field Operation Director for Minute Clinic testified in favor of SB 532, the Retail Clinic Bill. That is true, but I did not include her name or the fact that she was from out of state. Her name is Cathy Clodfelter, FNP, and she is from Indiana. A former Field Operations Director is from Texas but recently left that position. I do not want her to receive any unwarranted comments.
If you are a constituent of a member of the Health & Human Services Committee, we encourage continued contact with those members. They need to continue hearing from constituents.
A neatly handwritten note sent by snail mail will get the most attention. If your handwriting is not legible, then a typed letter is next best. As always, put the message in your own words. Form letters are never given much attention and often land in the trash.
The Message:
SB 680 by Senator Glenn Hegar was heard in committee on March 17th and was left pending. This is an important bill for both Advanced Practice Nurses and the physicians that work with them. The committee members received a great deal of misinformation about that bill and you would like to set the record straight. Enclosed is a document that addresses the false and misleading information point by point. We encourage favorable consideration of S.B. 680.
The Enclosure: To access the enclosure referenced in your note, go to APNs Answer TAFP/TMA False Claims about SB 680 / HB 696. (If that link does not work, cut and paste http://www.cnaptexas.org/displaycommon.cfm?an=1&subarticlenbr=14 into your browser and scroll to the bottom of the page to find that handout.)