Special Report: Fight for the Right
By Jeffrey P. Hazzard, NP
Last updated on: April 29, 2010 | Posted on: April 23, 2010
|TALLAHASSEE, Fla. - Nearly 300 nurse practitioners, NP students and their supporters converged on Florida's capitol on March 24, for a rally aimed at revising the state's controlled substance (CS) prescribing laws. For the past 16 years, Florida NPs have been unsuccessful at gaining the authority to prescribe scheduled medications. The powerful Florida Medical Association (FMA) has been the main obstacle to passage. During the 15-year FMA blockade, every other state in the nation except Alabama has granted CS prescribing authority to NPs.
The Florida Nurse Practitioner Network (FNPN) sponsored the rally, chartering several buses to bring NPs from throughout the state. "We also had support from the Florida Nurses Association and many local NP groups from around the state," said Chris Saslo, NP, president of FNPN.
Several politicians spoke at the rally on behalf of NP prescribing. Sen. Michael Bennett and Rep. Yolly Roberson reminded NPs that legislators in key committee positions need to hear repeatedly from them. Rep. Michelle Rehwinkel Vasilinda, the daughter of a nurse, spoke in strong support of the bills. Lisa Loscalzo, president of The Little Clinic, and Doreen Cassarino, NP, Florida representative to the American Academy of Nurse Practitioners, also appeared to voice their support for the law changes being sought. Elizabeth Markovich, NP, brought two patients who shared their experiences with delays in care due to current law. And Marilyn Wills of the League of Women Voters, and Andrea Gregg, president of the Florida Nurses Association, spoke out in support of changing the law.
Nurse practitioners say they are being underutilized in Florida even as they are being called upon to provide primary care and other health services in a greater variety of practice settings. Florida NP Maureen Kapatkin explains, "We regularly have our patients present with conditions such as cough, pain, male hypogonadism, attention deficit disorder, restless leg syndrome, seizures, anxiety, postherpetic neuralgia and insomnia. It is imperative that we be given the authority to treat these illnesses. The authority to prescribe controlled substances has never been rescinded in a state, ever, anywhere in the country."
Stan Whitaker, NP, head of the Florida Council for Advanced Practice Nurses Political Action Committee (CAP-PAC), pointed out that NP curricula, licensure and specialty certification are standardized nationally, "so to say that NPs in one state are qualified to prescribe controlled medications but NPs in another state are not qualified is simply silly. In fact, many Florida NPs are dual-licensed in other states, as am I, where they have this authority. The greatest irony of all is that those dual-licensed NPs can write a controlled substance prescription in the other state and the patient can legally fill that prescription in a Florida pharmacy!"
The FMA warns that diverted prescriptions will increase if NPs are given full prescribing authority. Many NPs see this as ironic because Florida has the highest per capita number of diverted and fraudulent prescriptions of any state in the nation, and only physicians and dentists are able to prescribe them under current law. Further, the Florida Board of Medicine is widely criticized for laxity in enforcing standards of practice related to controlled substances.
Susan Lynch, NP, pointed out, "Nurses are the most trusted professionals in the nation. Physicians should be ashamed of themselves for failing to police their own. . It is unfair for a profession that is failing at regulating a problem within its ranks to assert control over an entire other profession solely for economic gain."
The FMA has voiced various objections to full NP prescribing over the years, asserting that NPs are not trained or educated to prescribe scheduled medications and asserting that drug-drug interactions are beyond the understanding of nurses. "A registered nurse at the bedside must have a strong understanding of the pharmacokinetics and interactions before they administer medications to their patients," Saslo said. "Logically then, why would NPs not have that same skill set further enhanced by advanced pharmacology courses we must take for our certification?"
He added that physician focus needs to be on addressing the lack of available providers and the injustice of patients having to seek out a physician's signature when their trust in the NP has already been established in practice.
"We NPs are entrusted to prescribe antiarrhythmics, anticoagulants, chemotherapeutic agents, lithium and insulin - all of which can kill patients without comprehensive education on pharmacokinetics and drug interactions. Yet, according to physician groups, controlled substances are only safe in their hands and hold a mystery that NPs cannot understand."
"The issues are economic, not medical," said Jean Aertker, NP, of FNPN. "Common sense loses to the power of a special interest. It's an old story." She said the real losers in this battle are the Floridians who pay millions in unnecessary costs and lack access to care.
Ying Mai Kung, an NP from Tallahassee, spoke for many in a news interview when she noted that "Politicians such as Senator Don Gaetz and Representative Nick Thompson are both heavily supported by FMA. They refused to hear both sides of issues and have blocked SB 188 and HB 677 on their committees' agendas. Meanwhile, patients are suffering, lacking access to care, and healthcare costs increase as a result."
She added that passing the legislation would help fulfill the Institute of Medicine recommendations of high-quality, safe, patient-centered, timely, efficient, cost-effective, evidence-based, and interdisciplinary care.
"It is time that FMA and elected officials put patients first to improve access to care and reduce healthcare costs. All NPs who were on the steps of the Capitol plead with our colleagues to keep the pressure up, to write e-mails, attend events and post patient stories," she said.
As of early April, neither the House nor Senate versions of the bill were scheduled for hearing by a committee. A committee hearing and vote are required for a bill to be considered by either chamber.