Legislature(2021 - 2022)DAVIS 106
03/29/2022 03:00 PM House HEALTH & SOCIAL SERVICES
Note: the audio and video recordings are distinct records and are obtained from different sources. As such there may be key differences between the two. The audio recordings are captured by our records offices as the official record of the meeting and will have more accurate timestamps. Use the icons to switch between them.
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 |