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HB 495: Dividing some in the medical community

Louisiana State Capitol Building
Posted at 3:15 AM, May 27, 2021

Matthew Hargrave said that without the help of Mark deClouet he does not know where he would be today.

"It's meant everything to me," Hargrave said. "I'm doing a lot better now. I'm 60 days clean."

DeClouet is a Psychiatric Nurse Practitioner. He has worked with Hargrave for a little over two months.

"I was addicted to heroin," Hargrave said. "I was just sitting on my couch everyday not doing anything for the past three or four years. I found Mark and he helped me out a lot."

But Hargrave is not the only person deClouet has helped. He commutes back and forth from Lafayette to Alexandria to offer those services. His Lafayette clinic opened during the pandemic.

During that time, the state eased rules that required nurses to collaborate with physicians.

"In this area we're the only clinic that provides a lifesaving drug, insurance accepted, in a 60-mile radius, and 67 people got access to that level of care like that," deClouet said.

Mark said what he does is no different from what other nurse practitioners across the state have done.

He said he is offering care that his patients may have a hard time getting elsewhere.

"The majority of all of Louisiana is an access to care problem," deClouet said. "Try finding a primary care provider in Lafayette, right now, that accepts Medicaid and who is willing to do an initial evaluation for entry into the practice--you're talking weeks, maybe months. You'd be hard pressed to find one who would see you in 30 days."

Currently, deClouet is collaborating with a doctor; someone he can call on if he has questions about treatment.

He said he does not mind doing that because health care is a team effort.

But added, the collaboration rule sometimes holds him back from doing his job.

"There are more than one way to solve problems and this is one of them," deClouet said. "It's working in a number of states across the country, and we should jump on board."

If passed, House Bill 495 would give full practicing authority for advanced practice registered nurses. This means they would no longer need to collaborate with a physician to practice.

"We're in rural Louisiana," Kathy Baldridge, president of the Louisiana Association of Nurse Practitioners, said. "I'm in Alexandria and work in an indigent care clinic. This is a place where citizens with no insurance, Medicaid, or Medicare come. We have people that drive more than two hours to be seen; that is not access to care. Access to care means timely, convenient in your community, and quality care."

Baldridge said she has heard from colleagues about the challenges they face when trying to develop collaborative relationships.

Among the problems is high costs and doctors being available only by phone, she said.

Many physicians in Louisiana believe that House Bill 495 should not pass.

KATC has reached out to doctors and physician organizations to hear from those in the medical field who say that the bill could put the lives of patients at risk, especially in rural areas.

"A Hippocratic oath is to do no harm. My impetus is to make sure that the public has the same level of protection throughout my career as a physician. I think this bill challenges that. The physicians go through some intense training to practice medicine," said Dr. Robert J Aertker III. "That is concerning because the bill allows a nurse practitioner, who is important to our care, to practice medicine and diagnose especially in the rural context, I don't think it is a good idea."

Aertker is the president of the Acadia Parish Medical Society and a board certified internal medicine specialist with a small primary care clinic in Crowley.

He says that while some nurse practitioners are out in rural communities, many are concentrated in urban areas. The bill, he thinks, does not provide incentives to get those nurse practitioners out into those more rural communities to help.

"There are resourceful nurse practitioners who work in rural areas but most are in urban, metropolitan areas. The concentration of nurse practitioners are all metropolitan and I don't think that this bill will change that. I think boards need to sit down and provide incentive, get them out in the countryside...give them incentives."

For doctors, the level of education and training nurse practitioners receive is troubling when considering the scope of work those individuals will take on when seeing patients without the collaborative help of a doctor.

An Amendment added to House Bill 495 would require advanced practice registered nurses to collaborate for at least 6,000 hours with a licensed physician or be employed in a clinic that has a medical director who is a licensed physician before they can transition to independent practice.

Any nurse practitioner, certified nurse midwife, or clinical nurse specialist who practices in any specialty and transitions to independent practice would also be required to do so in collaboration with a physician who practices in that same specialty, according to the amendment.

And while a new board would be set up to provide oversight to nurse practitioners operating independently, many doctors say this would not be sufficient since nurses and doctors are governed by different boards with differing standards.

"This bill has been rushed through. I think they need to be aware of the fact that we need to sit down as a group, a board of nursing and medical examiners and work on a collaboration from a top-down approach," Aertker said.

To read more on House Bill 495, click here.