Legislature(2021 - 2022)DAVIS 106
03/29/2022 03:00 PM House HEALTH & SOCIAL SERVICES
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| Audio | Topic |
|---|---|
| Start | |
| HB392 | |
| HB292 | |
| Adjourn |
* first hearing in first committee of referral
+ teleconferenced
= bill was previously heard/scheduled
+ teleconferenced
= bill was previously heard/scheduled
| += | HB 292 | TELECONFERENCED | |
| *+ | HB 392 | TELECONFERENCED | |
| + | TELECONFERENCED |
HB 392-EXPAND ADV. PRAC. REG. NURSE AUTHORITY
3:09:23 PM
CO-CHAIR SNYDER announced that the first order of business would
be HOUSE BILL NO. 392, "An Act relating to advanced practice
registered nurses; and relating to death certificates, do not
resuscitate orders, and life sustaining treatment."
3:10:51 PM
CO-CHAIR SNYDER, as prime sponsor of HB 392, began by providing
the motivation behind HB 392. She explained that there have
been concerns over delays in government benefits that require
death certificates, as well as an increased cost of those
services to families. She mentioned further concern for
obstruction of care for the seriously ill and patient harm
resulting from inadequate documentation of care preferences.
She described the purpose of the bill as expanding the signature
authority for death certificates, do not resuscitate (DNR)
orders, and physician orders for life-sustaining treatment
(POLST) to advance practice registered nurses (APRNs). She
explained that APRNs are registered nurses with additional,
specialized training that have been able to practice
independently as primary care practitioners in Alaska since
1984. She highlighted that although APRNs regularly oversee end
of life care and help families make important care decisions,
they cannot sign any of the documents finalizing those choices.
In current statute, only licensed physicians were able to sign
this paperwork, which she reported has caused administrative
delays and undue stress for the families. She emphasized that
HB 392 will simply allow ARPNs to sign off on a type of care
that they have provided for years.
3:14:41 PM
ALLIANA SALANGUIT, Staff, Representative Liz Snyder, Alaska
State Legislature, on behalf of Representative Snyder, prime
sponsor, gave the sectional analysis for HB 392 [included in the
committee packet], which read as follows [original punctuation
provided]:
Sec. 1: Amends AS 08.68.700(a) Determination of death
by registered nurse by allowing a Registered Nurse
(RN) to pronounce or determine a death of a person if
a physician or advanced practice registered nurse
(APRN) has documented in the person's medical or
clinical record that the person's death is
anticipated.
Sec. 2: Amends AS 08.68.700(b) by allowing an RN to
sign a determination of death if a physician or APRN
has previously documented the person's condition.
Sec. 3: Amends AS 08.68.700(c) by allowing an APRN to
certify a death determined by an RN within 24 hours of
the determination of death.
Sec. 4: Amends to 08.68.700(d) by adding "an advanced
practice registered nurse" as a conforming change to
statute regarding health care facilities' policies and
procedures for determination and pronouncement of
death by a registered nurse.
Sec. 5: Amends AS 13.62.065 Do not resuscitate
protocol and identification requirements (a) by
allowing APRNs to issue a do not resuscitate order.
Sec. 6 & 7: Adds conforming language to AS 13.62.065
Do not resuscitate protocol and identification
requirements to ensure APRNs are subject to the same
rules and protocols as physicians.
Sec. 8: Adds language to AS 13.62.065(f) Do not
resuscitate protocol and identification requirements
allowing APRNS to revoke a do not resuscitate order.
Sec. 9: Adds "or an advanced practice registered
nurse" to 13.52.080(a)(5) Immunities as a conforming
change.
Sec. 10: Amends AS 13.52.100(c) Capacity by adding "an
advanced practice registered nurse" to language
regarding protocols and how do not resuscitate orders
govern decisions regarding cardiopulmonary
resuscitation and other life-sustaining procedures.
Sec. 11: Amends AS 13.52.300 Optional Form by adding
"an advanced practice registered nurse" to the
Advanced Health Care Directive Form.
Sec. 12: Amends AS 13.52.390(12) Definitions by adding
"an advanced practice registered nurse" to language
defining "do not resuscitate order."
Sec. 13: Amends AS 13.52.390(23) Definitions by adding
n advanced practice registered nurse" to language
defining "life-sustaining procedures."
Sec. 14: Adds a new paragraph to AS 13.52.390(38)
defining an "advanced practice registered nurse" by
referring to the definition in AS 08.68 Nursing.
Sec. 15: Amends AS 18.15.230(c) by adding an "advanced
practice registered nurse" to the instructions for
completing a death certificate.
3:16:28 PM
CO-CHAIR SNYDER proceeded with invited testimony.
3:17:02 PM
MARIANNE JOHNSTONE-PETTY, Alaska Advance Practice Registered
Nurses (APRN) Alliance, explained that "APRN" was an umbrella
term for a variety of practitioners, including certified nurse
practitioners (CNPs), adding that all APRN's must have a
master's or doctorate degree and additional specialty training.
She mentioned that the bill focuses on CNPs in their role as
independent practitioners. As independent practitioners in the
state, she explained that CNPs were able to give diagnoses,
initiate and manage treatment plans, and prescribe medication,
all under their own license without need for supervision or a
collaborative agreement. She listed the many places throughout
the state's medical system where APRNs practice, including the
many practitioners who own their own clinics as trusted primary
care providers. However, she reported that APRNs with clients
facing severe illness were unable to sign off on DNRs, POLST, or
death certificates, and must instead coordinate with a physician
to do so for them. She stated that out of the 24 states that
license ARPNs as independent practitioners, Alaska was the only
one without signature authority for those three documents. She
explained that a POLST was a medical order that requires
emergency care providers be informed of DNR orders, and that it
was a new program for Alaska that has been worked on by many
members of the state's medical community to incorporate it into
the national POLST program. She said that national POLST policy
actively encourages APRNs to have the ability to sign POLST
orders to increase patient access. She voiced her belief that
the bill would align APRN signature authority with already
existing licensure and statue, which she opined would decrease
costs and reduce other barriers to proper health care, including
untimely processing of death certificates, obstruction of
serious illness care for those living rurally, and inadequate
document completion. She emphasized her support for HB 329 and
the importance of correcting statute so that ARPNs have the
appropriate signing authority to care for their patients with
serious illnesses.
3:22:26 PM
STEPHANIE BIRCH, as a practicing APRN, explained that the
primary care clinic she works for has a focus on adults with
chronic illness, many of whom are elderly and relying on
Medicaid or Medicare. She shared that Alaskans facing chronic
illness have to navigate a complex healthcare system and often
struggle to get appropriate care. She explained that because
her clinic is run entirely by APRNs, when a patient passes away,
the APRNs are unable to sign the necessary documents, even
though they may have been that person's primary provider for
many years. She noted that there is reluctance from consulting
physicians to sign death certificates due to their limited
involvement with the patient, which forces the APRN to pay out
of pocket for a physician to sign the certificate. She
described the extra time and cost this takes as a burden on both
the families and the practitioners. She urged the committee to
pass HB 392 out of committee to allow APRNs to provide the care
that Alaska families deserve.
3:26:11 PM
SHANNON HILTON, American Association of Nurse Practitioners,
stated that APRNs served a critical role in providing high
quality care across the state and that outdated statutes
preventing signing authority on end-of-life documents impeded
the work APRN's already do. She described the importance of
these documents in providing care that aligned with the
patient's wishes and emphasized that the lack of signing
authority for nurse practitioners (NPs) created undue stress and
delay of process. She opined that the disconnect between the
statute-given ability to treat patients and inability to sign
these important documents meant that her extensive knowledge and
advanced care planning expertise was unrecognized by the law.
She emphasized her belief that passing HB 392 would honor the
autonomy of Alaskans and respect patient choice. She reiterated
that other states have seen great success in giving APRNs the
additional signing authority and urged the State of Alaska to do
the same.
3:29:26 PM
PRIYA KEANE, Doctor of Nursing Practice, informed the committee
that she is a CRN that specializes in hospice and palliative
care in a hospital setting. She explained that in this setting,
she cares for patients and their families who are either newly
receiving serious diagnoses or dealing with an exacerbation of
an existing illness, and that her team often liaisons with
primary care physicians to navigate the difficult discussions
around patients' goals of care, including DNRs and POLST. She
described these conversations as "nuanced and understandably
emotional" and expressed her firm belief that as the participant
in these conversations, she should also be the one responsible
for signing and preparing the orders. She said that there is an
undue burden of wasted time and rehashing emotional
conversations placed on physicians and families by this outdated
law. She voiced her belief that the bill would streamline care
for all Alaskans and asked for an expeditious passing of HB 392.
3:31:38 PM
CO-CHAIR SNYDER opened public testimony on HB 392.
3:32:04 PM
CHRISTINE KRAMER, representing self, testified in support of HB
392, as an ARPN working in an intensive care unit. She
explained that part of her role is to converse with patients and
their families upon admission to determine their preferred "code
status," which includes DNR orders. She reported that NPs are a
critical part of a patient's care team and are usually the ones
who care for a patient if their condition worsens and document
their passing with a "death summary" report. She stated that
passing HB 392 would allow the person responsible for
documenting a patient's death to sign the death certificate.
She restated her support for the proposed bill.
3:33:33 PM
CO-CHAIR SNYDER, after ascertaining that there were no one else
who wished to testify, closed public testimony on HB 392.
[HB 392 was held over.]
| Document Name | Date/Time | Subjects |
|---|---|---|
| 5. HB 392 Research - POLST FAQ 3.28.22.pdf |
HHSS 3/29/2022 3:00:00 PM HHSS 4/14/2022 3:00:00 PM |
HB 392 |
| 4. HB 392 Research - One Pager, 3.28.22.pdf |
HHSS 3/29/2022 3:00:00 PM HHSS 4/14/2022 3:00:00 PM |
HB 392 |
| 6. HB 392 Research - POLST Signature Requirement by state 3.28.22.pdf |
HHSS 3/29/2022 3:00:00 PM HHSS 4/14/2022 3:00:00 PM |
HB 392 |
| 3. HB 392 Sectional Analysis version A.pdf |
HHSS 3/29/2022 3:00:00 PM HHSS 4/14/2022 3:00:00 PM |
HB 392 |
| 2. HB 392 Sponsor Statement version A.pdf |
HHSS 3/29/2022 3:00:00 PM HHSS 4/14/2022 3:00:00 PM |
HB 392 |
| 8. HB 392 LOS since 3.28.22.pdf |
HHSS 3/29/2022 3:00:00 PM HHSS 4/14/2022 3:00:00 PM |
HB 392 |
| 7.HB 392 Research - APRN Practice Maps 3.28.22.pdf |
HHSS 3/29/2022 3:00:00 PM HHSS 4/14/2022 3:00:00 PM |
HB 392 |
| 1. HB 392 version A.PDF |
HHSS 3/29/2022 3:00:00 PM HHSS 4/14/2022 3:00:00 PM |
HB 392 |
| HB 292 Amendment Packet, 3.22.22.pdf |
HHSS 3/22/2022 3:00:00 PM HHSS 3/29/2022 3:00:00 PM |
HB 292 |
| HB 292 Amendments with votes.pdf |
HHSS 3/29/2022 3:00:00 PM |
HB 292 |