Proposal to let nurse practitioners practice independently advances

A controversial proposal that would allow nurse practitioners to practice independent of doctors cleared the legislature’s Public Health Committee Monday.

Legislators voted 22 to 4 to advance the bill to the Senate floor.

Some members of the committee indicated that they believed the bill should move forward, but that it would need fine-tuning before becoming law. In particular, committee members raised concerns about malpractice insurance requirements for nurse practitioners and “truth in advertising” that would make clear to patients whether they’re seeing a doctor or a nurse practitioner.

Current state law requires that nurse practitioners -- referred to as advanced practice registered nurses -- practice in collaboration with a licensed physician. The proposal, which originated with Gov. Dannel P. Malloy’s administration, would require nurse practitioners to have a collaborative agreement with a physician for the first three years after getting their licenses. But after that, they would be allowed to practice independently.

The Malloy administration has framed the proposal as a way to improve access to primary care at lower costs, and supporters say there’s no evidence to suggest the change would cause safety concerns.

But opponents note that doctors have significantly more training and say lawmakers shouldn’t reduce the level of training needed to provide medical care.

Rep. Prasad Srinivasan, a physician, said the concept behind the proposal is one “whose time has come.” But he said he worried that the details needed to make a major change in health care aren’t in the bill as written.

In particular, Srinivasan, a Republican from Glastonbury, said he had questions about ensuring that nurse practitioners had adequate malpractice insurance, making sure their patients would be able to access care after hours, and making clear to patients if they’re seeing a doctor or nurse practitioner.

Another critic, Sen. Anthony Musto, D-Trumbull, said the bill didn’t address his concerns about ensuring that patients would receive the both levels of care and access they require. He said he wasn’t optimistic that underlying issues could be addressed during this year’s short legislative session.

“Realistically, I think we need to almost start from scratch in this system, and this bill doesn’t get us there, although it’s a good way to start,” he said.

Srinivasan and Musto were among four legislators who voted against the proposal.

Seventeen other states and Washington D.C. currently allow nurse practitioners to practice independently, according to the American Association of Nurse Practitioners. Twenty-one states, including Connecticut, require a collaborative agreement with another type of health care professional. And in 12 states, nurse practitioners must work under the supervision of another health care professional.

About Arielle Levin Becker

Arielle Levin Becker was a finalist in 2009 for the prestigious Livingston Award for Young Journalists, a recipient of a Knight Science Journalism Fellowship and the third-place winner in 2013 for an in-depth piece on home caretakers from the National Association of Health Journalists. Arielle previously worked for The Hartford Courant, most recently as its health reporter. She also has covered education and municipal beats for The Courant and for the Home News Tribune of East Brunswick, N.J. She is a 2004 graduate of Yale University. E-mail her at alevinbecker@ctmirror.org.

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