In the midst of the coronavirus outbreak, the Florida Legislature on Wednesday passed bills that would expand the roles that advanced nurses and pharmacists play in the state’s health-care system, including allowing pharmacists to test and treat patients for the flu and strep throat and treat people with chronic medical conditions.
The bills, which now go to Gov. Ron DeSantis, were a top priority of House Speaker Jose Oliva and passed after an intense lobbying tug-of-war between health care groups. Physician groups, including the Florida Medical Association, have long fought proposals such as allowing advanced practice registered nurses to practice independently of doctors.
One of the bills passed Wednesday would expand the role of pharmacists, allowing them to enter agreements with physicians to treat patients for chronic illnesses, including arthritis, asthma, chronic obstructive pulmonary diseases, Type 2 diabetes, HIV, AIDS, obesity or "any other chronic condition" adopted in rules. The measure also would allow pharmacists to treat for influenza, streptococcus, lice, skin conditions and minor, uncomplicated infections.
The Senate passed the pharmacy bill (HB 389) in a 28-12 vote, with the measure then getting final approval in a 98-17 vote in the House.
Senate sponsor Travis Hutson, R- St. Augustine, said the bill would provide additional options for people who require health care.
"All I want to be able to do in this bill, is allow individuals if they don’t want to go to an urgent care clinic and wait, to (instead) go to a simple pharmacy, have them do a simple test and then order up a treatment," Hutson said.
But Sen. Gayle Harrell, R-Stuart, noted physicians and pharmacists receive different training and that the training reflects in how they deliver care.
"I have a great deal of concern with the educational level (of pharmacists) and the ability to diagnose, the ability to recognize what you don’t know when you see a patient," said Harrell, whose late husband was a physician.
Senate Minority Leader Sen. Audrey Gibson said she understands that increasing access to health care is a priority for Oliva, R-Miami Lakes, but said the pharmacy bill wasn’t the best way to accomplish that.
"We don’t give more access to sick people, people with chronic diseases or the indigent in any community, if they don’t have access to a doctor," said Gibson, D-Jacksonville. "I just don’t think this is going in the right direction."
Health care attorney and lobbyist Chris Nuland said the pharmacy bill caught people off guard. Nuland’s clients include the Florida Society of Plastic Surgeons and the Florida Chapter, American College of Surgeons, among others. Nuland said physicians were expecting a push by Oliva to allow advanced practice registered nurses to practice independently but not the push for more authority for pharmacists.
The pharmacist bill, Nuland said, "has kind of been the surprise of the session."
Shortly after passing the pharmacist bill, the Senate and House backed a bill (HB 607) that would allow advanced practice registered nurses to provide primary care independently of physicians and for certified nurse midwives to work autonomously.
The bill also includes $5 million for a loan repayment program for advanced practice registered nurses who work in primary-care health professional shortage areas or county health departments, community health centers, migrant health centers or any other publicly funded health care programs designated by the state.
The advanced nurse bill cleared the Senate in a 30-10 vote and was approved by the House in a 107-8 vote..
Independent practice for advanced nurses has been a longstanding priority for Oliva, and the bill had overwhelming support in the House. The Senate has traditionally had strong relationships with physician groups and was more hesitant to move ahead with the changes.
But Senate Health and Human Services Appropriations Chairman Aaron Bean, R-Fernandina Beach, said the state needs to expand the roles that advanced practice registered nurses play.
"Doctors can’t be everywhere all the time. So, members, we are going to allow Floridians better access and increased access to getting treatment," he told senators.
But Harrell said the expansion of authority for advanced practice registered nurses would violate the No. 1 rule for physicians.
"This presents a real danger to patients," she said. "The first rule in medicine, members, is to do no harm. And I am very concerned that we are really doing harm to patients."
The lobbying battles over the bill spilled over from the Capitol to social media, winding up with Oliva on Wednesday demanding the top executive of the Florida Medical Association issue an apology to Rep. Cary Pigman, an Avon Park Republican who spearheaded the advanced practice registered nurse bill. The speaker’s demand came after FMA Chief Executive Officer Tim Stapleton tweeted a reminder that Pigman had once been charged with driving under the influence.
The final version of the advanced nurses bill was something of a compromise between the House and Senate. For instance, the bill doesn’t include independent practice for physician assistants or certified registered nurse anesthetists, which Oliva had sought.
The Florida Association of Nurse Anesthetists released a statement after the bill’s passage calling it a good first step.
"Although we are disappointed that the legislation did not include certified registered nurse anesthetists … we are pleased that some of Florida’s (advanced practice nurses) will be able to practice autonomously," the group said in a prepared statement. "Passage of this bill demonstrates Florida’s commitment to modernizing the way health care is being delivered in our state by ensuring that Floridians have full access to health care, particularly in rural areas that are often underserved."
Nevertheless, Nuland said his physician clients don’t support the measure.
"We’re asking for a veto," Nuland said.
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