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Senate President Says No to More Authority and Prescription Power For Nurse Practitioners

| February 26, 2014

Medicine's second-class profession still has a long way to go to overcome old prejudices.

Medicine’s second-class profession still has a long way to go to overcome old prejudices.

Don Gaetz, president of the Florida Senate,  could present a formidable obstacle to passage of a bill that would  increase the powers and independence of nurse practitioners.

Don Gaetz

Don Gaetz

News Service of Florida, which interviewed Gaetz last Friday, reported he opposes a House bill that would give advanced-practice nurses more authority, including prescribing of controlled substances. The bill would also set up a pathway to independent practice, not supervised by physicians.

The House Select Committee on Health Care Workforce Innovation passed the bill (PCB SCHCWI 14-01) 13-2 last Tuesday, drawing bipartisan support, as Health News Florida reported.  Gaetz, R-Niceville, offered his opinion four days later.

It raises the question: Will Gaetz play the same role with the nurse bill this year that House Speaker Will Weatherford played last year with Medicaid expansion (and likely will do so again)? In other words: Will he play spoiler?

As Senate president, Gaetz can kill legislation. But when News Service of Florida asked if the House proposal is dead in the Senate, he did not give a direct answer. “I’ll vote against it if it gets to the floor,” he said.

He objected to the bill using the same phrases as physicians and medical students who testified against it last week. “I think if you want to be a doctor, go to medical school,” Gaetz said.

House supporters argue, in part, that allowing nurse practitioners to work independently could help address a shortage of primary-care physicians in the state. Also, they say nurse practitioners already provide much of the care that physician groups bill for and that nearly half the states allow independent practice, without horror stories to report.

If nurse practitioners could earn certification to practice independently, they would still collaborate with physicians, supporters say. They just wouldn’t be “supervised” by them, a status that rankles many.

But Gaetz said the state should address primary-care shortages in other ways, such as expanding medical-residency programs to train and keep doctors in Florida. This is one of the planks in the Florida Medical Association proposal.

The chief architect of the bill, Rep. Cary Pigman, R-Sebring, said Monday in an e-mail that he had not yet read the Senate President’s comments. Pigman, an emergency room physician, said, “I will fully respect his informed opinions and observations.”

But he said he continues to believe that independence for nurse practitioners — who would be called Advanced Practice Registered Nurses, or APRNs — is an important step to improve Floridians’ access to quality primary care.

Pigman said he has scrutinized numerous studies and found a good record of safety in the 23 states that already allow independent practice.  Also, Florida is the only state that prohibits nurse practitioners from prescribing of controlled substances, according to a map in the committee packet.

Pigman offers a libertarian argument for the bill, saying he’s concerned that Florida regulations force one group of health professionals (nurses) to pay another group (physicians) for the privilege of being able to work. He calls it “rent-seeking.”

Government shouldn’t play favorites that way “when there are no demonstrated nor compelling public safety concerns,” said Pigman, vice chair of the select committee. He said he’ll keep pressing the issue.

Last year, Weatherford, R-Wesley Chapel, blocked a Senate bill that would have accepted federal Medicaid money to expand private coverage to almost 1 million low-income uninsured adults in the state who are below the poverty level.  As a result, Florida did not receive $51 billion in federal funds over a decade — money that researchers and business interests say is vital for the state’s economy. As Health News Florida reported last month, nearly every newspaper editorial board in the state has renewed calls for Medicaid expansion.

Weatherford said the issue is not expected to be considered during the upcoming Legislative session.

–Carol Gentry, Health News Florida

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10 Responses for “Senate President Says No to More Authority and Prescription Power For Nurse Practitioners”

  1. pc says:

    Since only physicians can currently prescribe in Florida, that leaves only one class of practitioner who created the prescriptive drug abuse problem:

    The physicians.

    The FMA and its supporting physician base have effectively plead guilty to the charge. The supreme irony is that they admit the problem is pervasive, but won’t own up to the fact that it is they, and they alone, who created the problem. So, by adding NPs to the prescriptive network is going to create a larger problem by the percentage of increased prescriptive care givers? Not according studies and empirically, by the 48 states who presently allow NPs to prescribe.

    Let’s call this what it is: “turf protection.” It’s human nature not to allow anyone else to encroach on what you have, even if, and indeed especially if, the data supports change.

  2. Which Doctor says:

    You know, its has become a real “losing” deal for medically disabled people to NOT be harassed about their medication…..To HELL with these Nazi witch doctors and judicial idiots. America, read and learn how to make your own meds from mother nature. All meds can be made and you don’t have to pay a dime or ask permission from any of these IDIOTS.

  3. sue says:

    Nurse practitioners are needed They know just as much as Doctors Do. As a nurse they do all thework for the doctor anyway, so why not just get paid more for it.

  4. A.S.F. says:

    In some cases, Drs. are already telling their nurse practitioners to write prescriptions for them, even though it is not (yet) legal. If I were a nurse practitioner, I would be refusing, for liability reasons, unless and until the law changes. However, many nurses in this situation are afraid to refuse for fear of losing their jobs.

    • Nancy N. says:

      Nurse Practitioners can write prescriptions now. It’s just certain drugs classified as controlled substances under state law – like painkillers – that they are restricted from writing prescriptions for in Florida (but not any other state, according to the article).

  5. tulip says:

    I have the utmost respect for nurse practitioners and they serve a very useful purpose in the medical field. However, I do not think they should be given any leeway in being able to prescribe certain drugs,especially controlled substances. This would provide way to much opportunity for misuse of the privilege.

    Also, the nurse practitioners and ARPNS should not be allowed to have a private practice, but continue working under the umbrella of a doctor’s license so that the doctor can make sure the right kind of patient care is being done.

    Let them still be allowed to prescribe some kinds of simple meds and that’s it.


    Dangerous idea. Let me tell you a story.

    About a year ago I went to a nurse practitioner locally. I was sent out for some tests and when they came back was told to come in and get some medication samples. I thought they’d be samples like the drug companies hand out so people can try a new medication.

    I took the bag home without opening it and only then discovered they were partially-used prescriptions written for other people. The names of the prescribing physicians were redacted on the labels, but one of the medications was prescribed in Palm Coast and the other in Tampa. Right on the labels it said it was against Federal law to distribute the drugs to anyone other than the person for whom they were prescribed.

    So not only was this nurse violating Federal law, but because of the wide difference in the source of the drugs, there appears to be a consortium acquiring these drugs from across the state. Remember, one was from Palm Coast the other from Tampa.

    I didn’t take the drugs. Turned them over to the authorities and have not been back to that particular practitioner.

    If they do this with ordinary, everyday medications, heaven knows what would happen if they get access to controlled substances.

    • Nancy N. says:

      And doctors are constantly getting arrested for running pill mills…and getting sued for malpractice…does that mean that we shouldn’t let them prescribe controlled substances?

      There’s bad apples in every bunch. You had the misfortune of biting one. It doesn’t mean the entire tree needs to be cut down.

    • Rick says:

      VOICE OF REASON, I find your story a little difficult to believe or comprehend the way you tell it.
      Just because I’ve never had this happen to me doesn’t mean it might not but, there are two sides to a story…..every story.

  7. A.S.F. says:

    @The Voice of Reason says–That sounds so totally awful! I am glad you reported it to the authorities. I hope two of those authorities included the State Medical Board and the Florida state licensing bureau for nurses. I know that there are collection programs for used drugs but I thought those drugs were supposed to be disposed of in a safe and tightly controlled manner.

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