Nurses Fight for Lawmakers to Relax Laws Requiring Doctors to Oversee Their Work

CCS Blog LabelBy Carole C. Schriefer, R.N., J.D., The Health Law Firm and George F. Indest, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law

There’s a controversial tug-of-war in the health care industry. According to The Washington Post, in 11 states nursing groups are pushing legislation that would permit nurses with master’s degrees or higher to order and interpret diagnostic tests, prescribe medications and administer treatments without the supervision of a physician. Similar legislation is likely to be introduced in three other states. Currently, each state decides how much supervision nurses must receive from physicians.

This legislation faces strong opposition from physicians, led by the American Medical Association (AMA). This is according to an article in The Washington Post, published on March 24, 2013. Click here to read that article.

The Fight for Autonomy.

According to The Washington Post, the American Association of Nurse Practitioners (AANP) and other nursing groups are coordinating this legislation effort. These groups are receiving support from consumer advocates and state officials concerned about the possible doctor shortage.

Physicians’ groups are arguing that with little or no supervision, patient care will be compromised, according to a Bloomberg News article. The physicians’ strongest argument is the difference in education between them and advanced practice nurses (APNs). To read the Bloomberg News article, click here.

Difference in Education.

Advanced practice nurses obtain a bachelor’s degree in nursing, then spend between two and three years studying for a master’s degree. A master’s program includes extensive clinical training in addition to class work. One additional year of school is needed to get a Doctor of Nursing Practice (D.N.P.) degree.

Physicians obtain a bachelor’s degree, then continue on with four years of medical school. This is followed by at least three years in a residency program.

Laws for Nurse Supervision Differ State-by-State.

Each state regulates how much oversight nurse practitioners must have. According to Bloomberg News, in 16 states, including Colorado, New Hampshire, New Mexico and Washington, nurses can evaluate and diagnose patients, order diagnostic tests and prescribe drugs. Nurses in these states can start a practice or work in a clinic with no physician present.

Florida and Alabama nurses can’t prescribe controlled substances, including medications for pain, insomnia and attention deficit disorder and must have a supervisory agreement in place with a physician supervisor. Their practice is limited by what the physician places in the agreement.

Court Cases of Nurses vs. Doctors.

According to Bloomberg News, physicians in Iowa sued the state in 2010, after it allowed nurses with advanced training to perform a fluoroscopy, which is a radiographic procedure that takes pictures inside the body. The physicians do not believe nurses have the proper training to carry out this procedure. The case is before the Iowa Supreme Court after a lower court sided with the physicians.

Physicians sued the state of Colorado when the governor allowed nurse anesthetists to work without supervision. An appeals court sided with the nurses in 2012. There is a discussion of this case on our blog. Click here to read it.

Contact Experienced Health Law Attorneys.

The Health Law Firm routinely represents physicians, nurses, nurse practitioners, pharmacists, pharmacies and other health providers in investigations, regulatory matters, licensing issues, litigation, inspections and audits involving the DEA, Department of Health (DOH) and other law enforcement agencies. Its attorneys include those who are board certified by The Florida Bar in Health Law as well as licensed health professionals who are also attorneys.

To contact The Health Law Firm, please call (407) 331-6620 or (850) 439-1001 and visit our website at www.TheHealthLawFirm.com.

Comments?

Do you think nurses with advanced degrees should be allowed to practice without the supervision of physicians? Do you think it is necessary for patient care for physicians to be present? Please leave any thoughtful comments below.

Sources:

Pettypiece, Shannon. “Nurse Practitioners, Doctors in Tug-of-War Over Patients.” Bloomberg Business Week. (March 7, 2013). From: http://www.businessweek.com/printer/articles/100802-nurse-practitioners-doctors-in-tug-of-war-over-patients

Aizenman, N.C. “Nurses Can Practice Without Physician Supervision in Many States.” The Washington Post. (March 24, 2013). From: http://www.washingtonpost.com/national/health-science/nurses-can-practice-without-physician-supervision-in-many-states/2013/03/24/98b241cc-8745-11e2-999e-5f8e0410cb9d_story.html

About the Authors: Carole C. Schriefer is a nurse-attorney with The Health Law Firm, which has a national practice. Its main office is in the Orlando, Florida, area. www.TheHealthLawFirm.com The Health Law Firm, 1101 Douglas Avenue, Altamonte Springs, Florida 32714, Phone: (407) 331-6620.

George F. Indest III, J.D., M.P.A., LL.M., is Board Certified by The Florida Bar in Health Law. He is the President and Managing Partner of The Health Law Firm, which has a national practice. Its main office is in the Orlando, Florida, area. www.TheHealthLawFirm.com The Health Law Firm, 1101 Douglas Ave., Altamonte Springs, FL 32714, Phone: (407) 331-6620.

 

“The Health Law Firm” is a registered fictitious business name of George F. Indest III, P.A. – The Health Law Firm, a Florida professional service corporation, since 1999.
Copyright © 1996-2012 The Health Law Firm. All rights reserved.

Florida Senate Delays Broadening Baker Act Powers for Nurse Practitioners and Physician Assistants-Calls for a Study

5 Indest-2008-2By George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law

Florida’s nurse practitioners and physician assistants were hopeful the Senate would vote to allow them to have the authority to order the involuntary commitment of a patient for mental-health evaluation under the Baker Act. However, instead on April 15, 2013, the Children, Families and Elder Affairs Committee passed the formation of a work group to figure out how to improve the more than 40-year-old Florida mental health act.

Nurse Practitioners and Physician Assistants Want to Broaden Their Powers.

Currently, nurse practitioners and physician assistants can perform an evaluation, but cannot sign off on voluntary or involuntary examination paperwork to admit someone to treatment under the Baker Act. Instead, they must wait for a physician or law enforcement official to perform another evaluation and sign the paperwork. As this process is going on, the patient is free to go, meaning that person may leave the health facility before receiving the care they need.

Work Group Will Measure the Efficiency and Effectiveness of Baker Act.

The work group established by the senate must determine the necessary revisions that need to be made to improve the Baker Act. The group must file a report on their findings by January 14, 2014.

In a Tampa Bay Times article, senators voiced their concerns about the Baker Act, but said they wanted to know exactly what happens after a person is committed and the type of treatment patients receive. In the same Tampa Bay Times article, members of the Florida Association for Nurse Practitioners said the state’s 1,300 nurse practitioners are hoping for a decision this year. To read the entire article from the Tampa Bay Times, click here.

Contact Health Law Attorneys Experienced in Representing Health Professionals and Providers.

The attorneys of The Health Law Firm provide legal representation to physicians, physician assistants, nurses, nurse practitioners, cardiologists, CRNAs, pain management doctors, dentists, pharmacists, psychologists and other health providers in Department of Health (DOH) investigations, Drug Enforcement Administration (DEA) investigations, FBI investigations, Medicare investigations, Medicaid investigations and other types of investigations of health professionals and providers.

To contact The Health Law Firm, please call (407) 331-6620 or (850) 439-1001 and visit our website at www.TheHealthLawFirm.com.

Comments?

Do you think nurse practitioners and physician assistants should have the right to order involuntary commitment of a patient? Please leave any thoughtful comments below.

Sources:

Koff, Rochelle and Stone, Richard. “Senate Committee Calls for Study of Baker Act Instead of Expanding Roles of Nurse Practitioners.” Tampa Bay Times. (April 15, 2013). From: http://www.tampabay.com/blogs/the-buzz-florida-politics/senate-committee-calls-for-study-of-baker-act–instead-of-expanding-role/2115307

Curington, Jennifer. “Measure Would Broaden Powers Under Baker Act.” Orlando Sentinel. (April 11, 2013). From April 11, 2013, issue of Orlando Sentinel, Local News, B3.

About the Author: George F. Indest III, J.D., M.P.A., LL.M., is Board Certified by The Florida Bar in Health Law. He is the President and Managing Partner of The Health Law Firm, which has a national practice. Its main office is in the Orlando, Florida, area. www.TheHealthLawFirm.com The Health Law Firm, 1101 Douglas Ave., Altamonte Springs, FL 32714, Phone: (407) 331-6620.

 

The Health Law Firm” is a registered fictitious business name of George F. Indest III, P.A. – The Health Law Firm, a Florida professional service corporation, since 1999.
Copyright © 1996-2012 The Health Law Firm. All rights reserved.

Indiana Nurses Fired for Refusing to Get Flu Shots

George F. Indest III is Board Certified by The Florida Bar in Health Law

George F. Indest III is Board Certified by The Florida Bar in Health Law

By George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law

The warnings have been loud and clear from the Centers for Disease Control and Prevention (CDC). This influenza season is off to an early and serious start. With that in mind, a number of states are requiring all health professionals in the state to receive the flu vaccination. Some of those opposed to getting vaccinated are being fired by hospitals and health facilities. Because of this, a controversy is arising between employee rights and patient safety, according to a number of news sources.

Click here to read more on this year’s flu season from the CDC.

Agenda Calls for a 90% Average Vaccination Rate of Health Professionals by 2020.

In December 2010, the Department of Health and Human Services (DHHS) announced a 10-year agenda to improve the nation’s health. It’s called Healthy People 2020. A part of this agenda calls for a ninety percent (90%) average vaccination rate of health professionals. Click here to read the press release on the Healthy People 2020 initiative from the DHHS.

According to an American Medical News article, there’s a push in the medical community to meet this goal as soon as possible. The CDC states that as of November 18, 2011, close to eighty-four percent (84%) of doctors in the U.S. had been immunized against influenza. The CDC is praising these doctors for this high number, hoping other health professionals and the public will follow suit.

The safety of patients is the chief reason for the mandate. In an ABC News article, one Indiana hospital said that it implemented the mandatory vaccine in September of 2012, to promote patient safety. Of the hospital’s 26,000 employees statewide, ninety-five percent (95%) have complied.

Two Indiana Nurses and Others Fired for Not Getting Vaccinated.

A large majority of employees at the Indiana hospital complied with the mandate; however, 1,300 employees did not. According to ABC News, eight employees, including at least three veteran nurses, were allegedly fired because they refused to get a flu vaccine.

The fired nurses are standing their ground, saying they should have the right to refuse the flu vaccine. One nurse had filed two medical exemption requests, a religious exemption request and two appeals. All were denied by the hospital. To read more on this story from ABC News, click here.

In October 2012, Rhode Island mandated immunizations for all health care workers who have patient contact. On December 6, 2012, a health care worker union filed a federal lawsuit against the Rhode Island Department of Health (DOH) to prevent it from implementing the regulations, according to a Fierce Healthcare article. Click here to read the entire Fierce Healthcare article.

Fighting the Mandate.

The attorney representing the Indiana nurses, who were fired, states that his clients had the right to refuse their flu shots. He argues Title VII of the Civil Rights Act of 1964 prohibits religious discrimination against employees. The attorney is suggesting religion is legally broad under the First Amendment, so it can include any strongly held belief. According to a Chicago Tribune article, in 2009 New York mandated flu shots for all health workers, during the H1N1 outbreak. Unions fought the issue in court, and the state has since relaxed the rule.

Florida Health Care Professionals Worried About Jobs.

I’ve recently received calls from several local health care professionals working in different Florida hospitals, regarding refusing flu shots and other vaccinations. I’ve also read the news stories about Tampa General Hospital and Moffitt Cancer Center in Tampa requiring employees to receive the influenza vaccine. According to the news articles, the two Tampa health facilities require employees who refuse the flu shot to wear surgical masks.

However, the states and hospitals may not back down in this case. The issue may have to be decided by the courts. I promise to write more on this topic later.

Contact Health Law Attorneys Experienced in Representing Health Care Professionals and Providers.

At the Health Law Firm we provide legal services for all health care providers and professionals. This includes physicians, nurses, dentists, psychologists, psychiatrists, mental health counselors, Durable Medical Equipment suppliers, medical students and interns, hospitals, ambulatory surgical centers, pain management clinics, nursing homes, and any other health care provider. We represent facilities, individuals, groups and institutions in contracts, sales, mergers and acquisitions.

The services we provide include reviewing and negotiating contracts, business transactions, professional license defense, representation in investigations, credential defense, representation in peer review and clinical privileges hearings, Medicare and Medicaid audits, commercial litigation, and administrative hearings.

To contact The Health Law Firm, please call (407) 331-6620 or (850) 439-1001 and visit our website at www.TheHealthLawFirm.com.

Sound Off.

What do you think of mandated flu shots for health care workers? Is receiving a flu shot mandatory at your job? As a health care professional, do you think it is important to receive a flu shot? Is there enough medical evidence to justify firing health care professionals for not receiving the flu shot? Please leave any thoughtful comments below.

Sources:

Lupkin, Sydney. “Nurses Fire for Refusing Flu Shot.” ABC News. (January 3, 2013). From: http://abcnews.go.com/Health/indiana-hospital-fires-nurses-refusing-flu-shot/story?id=18116967

Moyer, Christine. “More Physicians on Track to get Flu Shots.” American Medical News. (December 14, 2012). From: http://www.ama-assn.org/amednews/2012/12/10/hlsb1214.htm

Cheung-Larivee, Karen. “Health Unions Sue Over Mandated Flu Shots.” Fierce Healthcare. (December 10, 2012). From: http://www.fiercehealthcare.com/story/health-unions-sue-over-mandated-flu-shots/2012-12-10

About the Author: George F. Indest III, J.D., M.P.A., LL.M., is Board Certified by The Florida Bar in Health Law. He is the President and Managing Partner of The Health Law Firm, which has a national practice. Its main office is in the Orlando, Florida, area. www.TheHealthLawFirm.com The Health Law Firm, 1101 Douglas Ave., Altamonte Springs, FL 32714, Phone: (407) 331-6620.

“The Health Law Firm” is a registered fictitious business name of George F. Indest III, P.A. – The Health Law Firm, a Florida professional service corporation, since 1999.

Copyright © 1996-2012 The Health Law Firm. All rights reserved.

Nurse Practitioner Arrested in New York Crackdown on Prescription Drug Abuse

By George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law

A New York law enforcement crackdown on prescription drug abuse has resulted in the arrests of 98 people. Among those charged are a nurse practitioner and two doctors.

Brooklyn federal prosecutors joined with the Drug Enforcement Administration (DEA), district attorney’s offices, and local law enforcement agencies, to carry out a series of raids that began June 5, 2012 and resulted in the arrests.

To view the DEA’s press release concerning the raid, click here.

Doctors Accused of Overprescribing.

One of the doctors is accused of conspiring to distribute oxycodone to patients that were not legitimate. Allegedly, the doctor surrendered his DEA registration. This terminated his authority to prescribe controlled substances such as oxycodone. However, he allegedly attempted to use other health care practitioners to continue to prescribe drugs, which the government contends is illegal.

Another doctor involved in the crackdown is charged with illegal distribution of oxycodone. During the execution of a federal search warrant at his offices on March 1, 2012, the doctor voluntarily surrendered his DEA registration. However, he allegedly continued to issue prescriptions to those whom he knew were not legitimate patients.

We continually warn against “voluntarily relinquishing” DEA registrations or medical licenses with any investigation pending as this is treated the same as a revocation in most cases. For an article we have written on this, click here.

Florida Has Experienced Similar Prescription Drug Abuse Crackdowns.

Beginning about two years ago, Florida health providers involved in narcotics precribing became routine targets for law enforcement. This was part of a concerted effort by state and federal officials to crackdown on “pill mill” operations. Regulations increased. Lawmakers enacted severe penalties for doctors and other health professionals accused of over-prescribing. Most physicians were banned from dispensing drugs in their offices. The governor created a Florida drug “strike force” with a mission to eliminate any pain clinics that were found to be breaking the law. The Florida Surgeon General and the Board of Medicine made announcements about the “crackdown” on “over-prescribing.”

Since the implementation of the new pain management and prescribing laws, the Florida strike force has made thousands of arrests and seized millions of pills of narcotics. This has resulted in serious concerns by those in the pain management profession.

Law Enforcement will Continue to Pursue Physicians, Pharmacists, Nurses and Other Health Providers.

The recent raid in New York and ongoing actions in Florida demonstrate that law enforcement will continue to pursue health professionals who prescribe large amounts of narcotics.

Contact Health Law Attorneys Experienced with Overprescribing Charges and DEA Cases.

The Health Law Firm represents pharmacists, pharmacies, physicians, nurses and other health providers in investigations, regulatory matters, licensing issues, litigation, inspections and audits involving the DEA, Department of Health (DOH) and other law enforcement agencies. Its attorneys include those who are board certified by The Florida Bar in Health Law as well as licensed health professionals who are also attorneys.

To contact The Health Law Firm, please call (407) 331-6620 or (850) 439-1001 and visit our website at www.TheHealthLawFirm.com.

Sources Include:

Allen, Jonathon. “Doctors Arrested in New York Prescription Drug Crackdown.” Reuters. (June 7, 2012). From
http://in.reuters.com/article/2012/06/06/usa-crime-painkillers-idINL1E8H6E3J20120606

CBS News. “98 Arrested in NY Prescription Drug Sweep.” CBS News. (June 6, 2012). From
http://www.cbsnews.com/8301-201_162-57448268/dozens-arrested-in-ny-prescription-drug-bust/

McKenzie-Mulvey, Erin. “U.S. Attorney Lynch, District Attorneys, DEA, Other Law Enforcement Announce Prescription Drug Initiative.” Drug Enforcement Administration. (June 7, 2012). Press Release. From:
http://www.justice.gov/dea/pubs/states/newsrel/2012/nyc060712a.html

About the Author:  George F. Indest III, J.D., M.P.A., LL.M., is Board Certified by The Florida Bar in Health Law.  He is the President and Managing Partner of The Health Law Firm, which has a national practice.  Its main office is in the Orlando, Florida, area.  www.TheHealthLawFirm.com  The Health Law Firm, 1101 Douglas Ave., Altamonte Springs, FL 32714, Phone:  (407) 331-6620.