With Medicaid expansion expected to fuel a shortage of primary care physicians, the West Virginia Nurses Association is pushing the Legislature to grant nurse practitioners more authority to operate without a doctor's supervision.
Bills proposed in both houses of the Legislature - Senate Bill 212 and House Bill 4342 - would expand prescription-writing ability for "advanced practice registered nurses", which includes nurse practitioners and nurse-midwives. The bill would also lift a requirement that such nurses sign collaborative agreements with physicians in order to receive prescriptive authority from the state Nursing Board.
But as West Virginia leads the nation with its rate of drug overdose deaths - many of them resulting from prescription drug abuse - the proposed legislation is raising concerns about the wisdom of allowing an additional 2,100 or more health professional to prescribe potentially addictive substances.
One of SB 212's co-sponsors, Sen. Rocky Fitzsimmons, said legislators likely will wait for the results of an independent study before making any changes to the current rules. That study isn't expected to be complete until the Legislature's interim sessions later this year.
"I really don't anticipate any action on either the Senate or the House bill this session. ... This is probably a 2015 issue, not a 2014 issue," Fitzsimmons, D-Ohio, said.
About 30 percent of West Virginia's 1,747 active primary care physicians are 60 or older, and the state estimates its Medicaid rolls will grow by more than 137,000 patients by 2016 - factors that could further strain the health care system in a state where 50 of 55 counties already are considered medically underserved.
One of HB 4342's sponsors, Delegate Phil Diserio, said the problem is not as great in the Northern Panhandle as in other areas of the state.
"We've got to look at what's good for the state as a whole. In our area, we've got a great amount of doctors - and good doctors," Diserio, D-Brooke, said. "But from what I understand, in the rural areas of the state, there is a shortage of primary care providers."
Current law forbids them from prescribing opiates and painkillers, and they may only prescribe a three-day supply without refills of stimulants, depressants, anabolic steroids and certain less addictive narcotics. House Bill 4342 would lift those restrictions entirely, allowing nurse practitioners to prescribe yearly supplies of all medications, including controlled substances. Senate Bill 212, on the other hand, would leave the restriction on controlled substances in place.
While Diserio believes additional autonomy for nurse practitioners will improve access to care for rural residents, the concept of allowing them to prescribe controlled substances troubles him.
"I am not really in favor of taking that out of the doctors' hands," Diserio said. "From what I understand, this has been put into a study, and we'll go from there and see what they come up with."
Fitzsimmons, however, is encouraged by the success of similar initiatives in 16 other states and the District of Columbia and believe the state's APRNs are qualified to handle the additional authority they are seeking.
"I don't think there have been any real reports of major abuses or things like that in those other states. Looking at that would lead me to believe there wouldn't be any difference here, but we know we have a prescription drug problem in West Virginia, and we are trying to combat that," he said.
In a recent report, legislative auditor Aaron Allred said the existing restrictions provide important protections for the public and should remain in place. The report did recommend, however, that nurse practitioners be allowed to prescribe medication independently following five years' experience with no actions against their licenses and a recommendation by their collaborative physician.