Governor Jerry Brown will speak at the National Nurses United (NNU) union's convention this evening, Lieutenant Gov. Gavin Newsom is scheduled to address the organization tomorrow morning, and filmmaker Michael Moore is slated to speak to at the conference on Friday.  Over 1,000 nurses are scheduled to attend the convention in San Francisco.

NNU is also actively engaged in a "campaign for a tax on Wall Street financial speculation in order to provide revenue for  Main Street reforms, including jobs at living wages, guaranteed healthcare for all, and freedom from hunger, homelessness, and retirement insecurity." (NNU, Media Advisory, 9/13/11)

Both political parties are joining forces to oppose one of the key features of President Obama's deficit reduction plan, the Independent Payment Advisory Board. US Dept. of Health & Human Services Services Secretary Kathleen Sebelius has described the purpose of the IPA Board to "ensure that health costs are reduced." However, several large groups, including AARP, oppose creation of the Board and claim that arbitrary spending targets do not lead to good healthcare policy.

"Obama Panel to Curb Medicare Finds Foes in Both Parties," (Pear, NY Times 4/19/11)
 

 The Supreme Court of the United States has taken no action on Virginia Attorney General's request to expedite the resolution of the pending Healthcare Reform Legislation litigation, in attempt to skip appellate judicial review despite President Obama's objection. "High court takes no action on Va. health care case" (Associated Press, 4/19/11)

The California Board of Medicine makes Accusations against physicians available to the public. Check Doctor License status here. The Medical Board's search system has been touted as one of the best in the country [Dahlberg, Sacramento Bee 7/12/10]. Patients seeking to learn more about their doctors/potential doctors can easily view discipline Accusations lodged against physicians, which can lead to a more informed decision.

However, medical professionals, healthcare practitioner advocacy groups and defense attorneys protest the disclosure of Accusations prior to any final action being taken against a physician. The exposure of Accusations, prior to any final action being taken, creates a situation where a doctor can be judged on the basis of unproven complaints or allegations.

The ultimate goal is to protect the public, and allow patients to access a practitioners' history, while simultaneously protecting physician privacy and due process rights under the law. The disclosure of unsubstantiated Accusations has the potential to mis-inform patients and ruin reputations of healthcare professionals, but also allows patients to make more informed decisions based on the nature of the allegations. It is a "Catch 22" for everyone involved, but the physicians bear the brunt of the detriment to their careers and profession if patients make judgements based on untruthful accusations.

Nurse Practitioners prime candidates for Primary Caregivers in the face of Dr. Shortages:

Nurse practitioners are going to play an integral role as primary caregivers, filling the void left by massive physician shortages throughout the United States. (Stuart, 4/28/10). The Association of Medical Colleges reports that the U.S. may be facing a 150,000 doctor shortage by 2025. (Chapman, 4/18/10 Chicago Tribune "Nursing our way out of a doctor shortage"). The American Medical Association estimates the doctor shortage to equal a deficit of 85,000 by the year 2020. Regardless, the data is evident that doctors are facing extraordinary understaffing difficulties at the same time they are facing astronomical increases in their patient loads.

28 States currently have introduced legislation designed to expand the role of advanced practice nurses to that of Primary Caregiver. ("Fewer doctors may lead to more patients seeing nurse practitioners") Several states already allow independent advanced nursing practice, and many other states are currently seeking to fill the void left by a lack of physicians. Oklahoma is currently seeking to expand nurse practitioners' roles (Coburn 4/21/10 "Officials look to PAs, nurse practitioners for aid in physician shortage"), as well as Oregon, Washington, California. (Johnson AP 4/14/10 "Shortage may mean a bigger role for nurse practitioners"), New York (Gordon 4/25/10 "Take advantage, New York, of our nurse practitioners)

Nurse practitioners, or "advanced practice nurses," are highly trained registered nurses who usually possess a masters degree or a doctorate in a specialized nursing discipline. Nurse practitioners have advanced education, experience and training in the diagnosis, treatment and management of common illnesses (Parker, ehow "Nurse Practitioners & Patient Education). The American Academy of Nurse Practitioners indicates that 95% of advanced practice nurses already prescribe medications, writing an estimated 19 prescriptions per day.  

Healthcare Reform impact on doctor shortages:

32 Million more Americans are anticipated to be included in the healthcare patient pool as a result of the recently passed healthcare reform legislation. (4/14/10 "Use nurse practitioners to reduce doctor shortage") This large number of additional patients will further exacerbate physician shortages across the country. Medicare typically reimburses nurse practitioners at a lower rate than doctors are reimbursed, which could end up saving millions of dollars at a time when our economy is in dire need of reducing government spending. Maryland columnist Jay Hancock explains that nurse practitioners should be allowed to practice completely independently from physician supervision, and that they are already allowed to practice independently in Washington, Oregon, Alaska, Washington D.C. (Hancock, The Baltimore Sun "Md. should make nurse practitioners independent").(Stuart, 4/28/10 "Nurse practitioners key to unlocking healthcare access").

Doctors are beginning to mount opposition to such measures arguing that allowing nurse practitioners to usurp physicians' roles will place patients at risk. Dr. Daniel Carey, President of the Medical Society of Virginia, has stated, "When you talk about increasing the scope of practice of nurse practitioners...we have problems with that. They are not acknowledging the significant difference in training." (Smith 4/26/10 "Health reform may expand non-physician roles") The American Medical Assoc. (AMA) President James Rohack has said, "increasing the responsibility of nurses is not the answer to the physician shortage." (Bagg, 4/19/10) "Doctors have shown up in white coats to testify against nurse practitioner bills. The AMA, which supported the national health care overhaul, says that a doctor should supervise an NP at all times and in all settings. Just because there is a doctor shortage, the AMA argues, is no reason to put nurses in charge and endanger patients." Associated Press; Maher 4/19/10 "Hey Nursie!" The Battle over Letting Nurse Practitioners Provide Primary Care"). One critic claims "doctors went to their medical schools for a reason, and allowing a nurse to take over their roles is a short-sighted way of solving these shortages." (Joyner, 4/18/10 "Let doctors, not nurses, doctor")

Nurse practitioners have accumulated their own support, and are beginning to form their own professional associations across the nation. (Gallaher, 4/22/10 "Whatcom County nurse practitioners form new professional association"). Univ. of Southern Indiana Professor Daniel Lucky describes the difference between Nurse Practitioners and Physicians as not being education or professional qualifications but instead it is their healthcare approach, "NP practice is based on the nursing model of care -- not the medical approach...Nursing teaches us that we should not reduce human beings to mere signs and symptoms, place a disease on someone, give them a pill and send them off. As nurses we are trained to look at the entire patient from a holistic perspective and then, actively partner with the patient and family to not only correct problems, but also enhance optimal health. Nursing care places the patient -- not the provider -- as the central focal point." (Beaulieu, 4/14/10 "Expanding roles of nurse practitioners stir controversy"). In fact, the Josiah Macy, Jr. Foundation recently released a report recommending immediate removal of legal and financial barriers preventing advanced practice nurses from providing primary care. (Glenn, 4/20/10 "Nurse practitioners new primary care providers?") Nurse practitioners assert that they are not trying to infringe on doctors' specialities, but are a critical resource in providing patient care in this time of dire need. (West, 4/27/10 "Not looking to replace doctors") In actuality, nurse practitioners do not commit malpractice as often as physicians or, at least, they are not sued as often -- only 1.4% of Nurse Practitioners are named as a primary defendant in medical malpractice lawsuits. (Stuart, 4/28/10 "Nurse practitioners key to unlocking health care access")

Conclusion -- Let the Nurses Doctor!

Murphy Jones LLP represent nurses in licensing, discipline and malpractice matters and are intimately familiar with the nursing profession, and have full confidence in nurses' abilities to render superb healthcare to patients.As healthcare attorneys, we support the expansion of nurse practitioners' primary care roles provided that they do not usurp the proper functions of physicians. Physicians are adept with dealing with advanced diseases and treatments for complex disorders; whereas advanced practice nurses are more than capable of diagnosing common diseases and disorders, and prescribing medications to treat patients. A 2000 study published by the Journal of the American Medical Association reported that patients of nurse practitioners recovered as well or better than patients under the supervision of a primary care physician. A main benefit of expanding nurse practitioners' roles is that they manage patients with current illnesses and simultaneously teach patients how to stay healthy. This is exactly the type of care America needs if we are going to improve the overall health of our citizens and simultaneously lower health care costs. Often times, patient satisfaction is higher among patients receiving care from an advanced practice nurse as opposed to a licensed physician. (British Medical Journal 4/6/10 "Systemic review of whether nurse practioners working in primary care can provide equivalent care to doctors") So with happier and healthier patient results coupled with reduced costs and government spending, allowing nurse practitioners to use their knowledge helping patients while reducing the doctor shortage voids is common sense and good business judgment. 

As the old adage says, "Doctors diagnose, Nurses HEAL!" So why not let nurse practitioners do both?!

View related videos:

• "Doctor of Nursing Degree Changes Healthcare"
• "The Congressional Report: Health Care and the Nursing Shortage"
• "Nurse Practitioners look for a bigger role in health care" Feb. 10, 2011

California Assemblywoman Mary Hayashi has publicly criticized the California Board of Pharmacy for supporting legislation that allegedly conflicts with the Board of Pharmacy’s duty to regulate pharmacy operations and it’s duty to protect the public. As healthcare attorneys who defend pharmacists in disciplinary investigations and proceedings before the Office of Administrative Hearings, we are very concerned and interested in preserving impartiality of the Board of Pharmacy during the development of legislation making it easier for the public to get flu shots.

The Board of Pharmacy is endowed with the power to regulate the profession, discipline pharmacists who violate their duties, and to protect the public. The legislation in question is designed to expand the ability of pharmacists, especially independent operators, to provide flu vaccinations to Californians. Assemblywoman Hayashi has publicly stated, “Their (the Board of Pharmacy) legislative actions on behalf of the profession they are supposed to regulate have raised questions about industry influence, which compromises their role as a regulator.” Assemblywoman Hayashi has introduced legislation, Assembly Bill 2104 (AB 2104), designed to require the California Board of Pharmacy to secure approval from the California Department of Consumer Affairs before sponsoring legislation.

Currently, none of the California Boards (Board of Medicine, Board of Registered Nursing, Board of Dental Examiners, Board of Occupational Therapy, Board of Vocational Nursing and Psychiatric Technicians, Board of Chiropractic Examiners, etc.) are required to seek approval by the Dept. of Consumer Affairs prior to sponsoring legislation. Other lawmakers criticize Assemblywoman Hayashi”s AB 2104 for only focusing on the Board of Pharmacy. “What’s good for one board should be good for all the boards.” said Bob Stern, President of the Center for Governmental Studies.

Assemblywoman is a former member of the California Board of Registered Nursing, which opposed the flu vaccine legislation, Assembly Bill 977 (AB 977) in 2009. Many nurses are still worried about the procedures for providing flu vaccinations to the public. AB 977 passed the California State Assembly in January 2010 and is currently pending action in the California State Senate.

For a full account see: Sacramento Bee article

Review legislation at: California State Assembly legislative inquiry

California Board of Nursing replacements were elected August 12, 2009, and discussed raising licensing fees in 2010 and addressing the backlog of disciplinary actions. New Board members meet with the committees today in Sacramento.

Nursing Licensure fees have not been altered for the past 18 years, and will be increased by almost 50%. The increase in fees is necessary to fund the 63 positions created to handle complaints and investigate disciplinary actions. Renewal rates will increase to $150 (+ an additional $10 for the RN Educational Fund), interim & temporary license fees will rise to $50, and initial fees for NPs, nurse midwives, CNAs and clinical nurse specialists will also cost $150. The Board moved to support the increase of fees and will set a public hearing date shortly. The soonest the Board could vote on the increased fee schedule is November 2009.

Gov. Schwarzenegger appointed Brian Stiger as the new director of the Dept. of Consumer Affairs. Stiger has ordered an internal review of the Cal. Board of Nursing disciplinary process, and reform is a top priority. Stiger’s goal is to streamline the process so that complaints are investigated, prosecuted and resolved within a 12 – 18 month timeframe.

http://nursing.advanceweb.com/Editorial/Content/Editorial.aspx?CC=205077

Calif. to start dropping children from state plan – Modern Healthcare

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Aspiring nurses must complete fingerprinting with LiveScan, and the board must receive the results from the Dept. of Justice and the Federal Bureau of Investigation which can take 3 – 6 weeks.

http://www.rn.ca.gov/

Dr. Howard Dean wants to speak directly with nurses and doctors about the role they must play during this critical phase in new healthcare system legislative process. The conference, which is co-sponsored by the American Nurses Association, is intended to discuss elements of the House and Senate bills and how they will impact health care professionals.. Murphy Jones LLP healthcare attorneys will attend the tele-conference in effort to contribute to the development of legislation that furthers interests of the nursing profession. All nurses and people wanting to learn more about the actions each individual can take to make nurses’ needs a legislative and national priority are encouraged to attend and contribute.

The conference call will take place July 22, 2009, at 6:30 pm EST. In order to complete registration and review additional details related to the national conference call visit:

http://www.rnaction.org/site/PageServer?pagename=EmergencyCallwithDrDean

Murphy Jones LLP has created a Twitter account generating tweets providing up to the minute news and developments relating to professional practice of medicine, the nursing profession, State Boards of Nursing, medical malpractice litigation impacting professionals’ rights and responsibilities, and other interesting legal developments in the healthcare industry. With our administrative law healthcare attorneys staying informed of trends, changes in the law and case precedent, we post information relevant to medical practitioners and the legal industry.

Visit us at http://twitter.com/NurseAttorneys , and start following today to keep informed about recent developments.

Did you know that in Nevada and California a first time criminal conviction for driving under the influence, or other misdemeanor, can lead to disciplinary action by the State Board of Nursing?

Both the State Boards of Nursing in Nevada and California may view a conviction of D.U.I., and certain other misdemeanors, as "unprofessional conduct" under each state's Nurse Practice Act. [Nev.: NRS 632.120, 632.320, NAC 632.890; Cal.: Bus. & Prof. Code 2761(f), et. al.]. Both Nevada and California have adopted regulations requiring nurses to submit fingerprints when applying for, or renewing, a nursing license. The State Boards are now receiving information regarding prior convictions of licensees. The Boards review matters on a case-by-case basis, and consider several factors when evaluating an appropriate course of action, including, but not limited to: the nature and severity of the act; the harm to public; the harm to patient; the prior criminal &/or disciplinary history; any time elapsed between convictions &/or Nurse Practice Act violations; any mitigating circumstances; and any, rehabilitation evidence.

Often times criminal attorneys, under a mistaken impression, instruct a nurse that he/she need not disclose misdemeanor convictions on their RN License/Renewal Application -- this is incorrect. Nevada and California require nurses to disclose all "criminal convictions"  which include misdemeanors such as D.U.I. If a nurse is convicted of a misdemeanor and fails to disclose that on the License Application, the Board of Nursing may Deny or Revoke a license for fraudulent application. [N.R.S. 632.320; Cal.: Bus. & Prof. Code 2761(b)].

Other states have legal precedent indicating that a D.U.I. is not "unprofessional conduct relating to the practice of nursing" based on the particular facts of a nurse's situation, which may be utilized by an attorney to help protect a nurse's license after a conviction. [See: In the Matter of Charles S. Phillips, Docket No. 507-05-6929 [Texas]; Ross v. State Board of Nurse Examiners, Docket No. 507-06-0911 [Texas]. You should consult a nurse-attorney regarding the specific facts of your matter, and the laws of your state, to determine the best course of action for your particular situation.

What should a nurse who is convicted of a D.U.I., or other misdemeanor, do? Consult an attorney specializing in State Board of Registered Nurses licensing & disciplinary matters. Depending on the time, type and factual basis of a conviction, various options are available to the nurse. The worst thing a nurse can do is fail to disclose a criminal conviction and hope that the Board does not find out.