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While the novel coronavirus continues to spread in the U.S. — and in Florida — the Florida Legislature voted Wednesday to expand the roles of pharmacists and some nurses to test and treat certain conditions and perform certain acts without the supervision of a physician.
After debate that weighed access with quality of care, the Senate passed two expanded practice bills that have been a top priority of House Speaker José Oliva.
HB 389 allows pharmacists to test and treat patients for the flu and strep throat and also give them authority to treat chronic medical conditions. HB 607, a scaled-back version of Oliva’s wish, allows highly trained advanced practice registered nurses to provide primary care and practice independently of doctors.
Both bills will now go to Gov. Ron DeSantis for approval.
Seventeen other states have expanded the roles of pharmacists, who would now be able to order and interpret tests and change medication on a variety of conditions, said Sen. Travis Hutson, who presented the bill. The bill will also require pharmacists to recommend patients follow-up with a doctor if necessary.
He said amid a coronavirus outbreak, it’s best to give people more options for treatment than fewer.
“The flu has killed more people in this state than coronavirus,” said Hutson, R-Elkton, who noted that he would rather have the option to see a pharmacist if his doctor is busy and his kids are sick.
Sen. Kevin Rader, D-Delray Beach, said the bill “may not be perfect” but that it addresses a population he believes the Legislature is responsible for taking care of.
“For me, if we can give more access and get more people to see a healthcare professional, then it’s absolutely worth it,” he said. “If we can help people get access, let’s do it. That’s what we’re supposed to be doing in this chamber.”
But those who voted against the bill said giving responsibility to practitioners who don’t report to the state Board of Medicine was a “real danger to patients.”
“This should not be called the practice of pharmacy bill,” said Sen. Gayle Harrel, R-Stuart. “This should be called the practice of medicine of pharmacists ... this is what physicians do. They treat patients.”
The other top Oliva priority, allowing highly trained advanced practice registered nurses to practice independently of physicians, also passed with some contentious debate. Throughout the legislative session, the Senate has been reluctant to allow the level of autonomy.
To qualify, the APRNs would have to take at least 3,000 clinical practice hours in the five years before practicing autonomously, which is a dialed-back version of what the speaker wanted.
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During the Tuesday debate, Harrell quizzed sponsor Sen. Ben Albritton, R-Wauchula, noting that the Senate compromise with the House moved oversight from the Board of Medicine to the Board of Nursing.
“We are putting our trust in the Board of Nursing and their rulemaking,’‘ Albritton said. “I would suggest the board of nursing has something to lose if they do this the wrong way ... I would expect there will be accountability.”
He added “these are minimum qualifications” and they will have to set the rules as to what they qualifications are “but we’re not saying they are doctors. They are advanced medical practitioners” but “they’re not doing an appendectomy.”
The scope of practice for registered nurses and licensed practical nurses is not addressed in the bill.
The debate extended off the floor, as well.
The Florida Medical Association, which represents doctors, came out against the bills on Twitter, writing that with the current spread of the novel coronavirus, it’s dangerous to encourage “potentially infected individuals” to visit grocery stores and local pharmacies for healthcare and treatment “by individuals not trained to practice medicine.”
Oliva punched back, calling it “shameful and unprofessional” for a special interest group like FMA “to attempt to use a potential international pandemic to further a baseless political agenda.”
“Timely access to high-quality care and the world’s best pharmacists are vital as we fight coronavirus,” he tweeted. “Thirty states demonstrated that advanced registered nurse practitioners can provide this high-quality care and pharmacists across the country do the same. This statement by the FMA only contributes to unnecessary panic and is as irresponsible as it is wrong.”
What APRNs are saying
Stan Whittaker, a family nurse practitioner and the current chair of the Florida Association of Nurse Practitioners’ legislative committee, said while he wishes others like nurse anesthetists were included in the bill, he is encouraged by what APRNs will now be able to do. In addition to treating patients, he said APRNs will also now be able to sign death certificates to spare families autopsy costs and issue “do not resuscitate orders” to people with terminal illnesses who request them.
Whittaker said he even plans on opening his own clinic with another APRN in Blountstown, a rural Panhandle town with little access to primary care physicians.
“They can offer services they already do every day,” he said. “This gives us the ability to do what we need to do.”
Herald/Times staff writer Mary Ellen Klas contributed to this report.
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