Senate President Says No to Nurses

Feb 24, 2014

Don Gaetz, president of the Florida Senate,  could present a formidable obstacle to passage of a bill that would  increase the powers and independence of nurse practitioners.

Senate President Don Gaetz

News Service of Florida, which interviewed Gaetz last Friday, reported he opposes a House bill that would give advanced-practice nurses more authority, including prescribing of controlled substances. The bill would also set up a pathway to independent practice, not supervised by physicians.

The House Select Committee on Health Care Workforce Innovation passed the bill (PCB SCHCWI 14-01) 13-2 last Tuesday, drawing bipartisan support, as Health News Florida reported.  Gaetz, R-Niceville, offered his opinion four days later.

It raises the question: Will Gaetz play the same role with the nurse bill this year that House Speaker Will Weatherford played last year with Medicaid expansion (and likely will do so again)? In other words: Will he play spoiler?

As Senate president, Gaetz can kill legislation. But when News Service of Florida asked if the House proposal is dead in the Senate, he did not give a direct answer. "I'll vote against it if it gets to the floor,'' he said.

He objected to the bill using the same phrases as physicians and medical students who testified against it last week. "I think if you want to be a doctor, go to medical school," Gaetz said.

House supporters argue, in part, that allowing nurse practitioners to work independently could help address a shortage of primary-care physicians in the state. Also, they say nurse practitioners already provide much of the care that physician groups bill for and that nearly half the states allow independent practice, without horror stories to report.

Rep. Cary Pigman, R-Sebring

If nurse practitioners could earn certification to practice independently, they would still collaborate with physicians, supporters say. They just wouldn't be "supervised" by them, a status that rankles many.

But Gaetz said the state should address primary-care shortages in other ways, such as expanding medical-residency programs to train and keep doctors in Florida. This is one of the planks in the Florida Medical Association proposal.

The chief architect of the bill, Rep. Cary Pigman, R-Sebring, said Monday in an e-mail that he had not yet read the Senate President's comments. Pigman, an emergency room physician, said, "I will fully respect his informed opinions and observations."

But he said he continues to believe that independence for nurse practitioners -- who would be called Advanced Practice Registered Nurses, or APRNs -- is an important step to improve Floridians' access to quality primary care. 

Pigman said he has scrutinized numerous studies and found a good record of safety in the 23 states that already allow independent practice.  Also, Florida is the only state that prohibits nurse practitioners from prescribing of controlled substances, according to a map in the committee packet.

Pigman offers a libertarian argument for the bill, saying he's concerned that Florida regulations force one group of health professionals (nurses) to pay another group (physicians) for the privilege of being able to work. He calls it "rent-seeking."

Government shouldn't play favorites that way "when there are no demonstrated nor compelling public safety concerns," said Pigman, vice chair of the select committee. He said he'll keep pressing the issue.

Last year, Weatherford, R-Wesley Chapel, blocked a Senate bill that would have accepted federal Medicaid money to expand private coverage to almost 1 million low-income uninsured adults in the state who are below the poverty level.  As a result, Florida did not receive $51 billion in federal funds over a decade -- money that researchers and business interests say is vital for the state's economy. As Health News Florida reported last month, nearly every newspaper editorial board in the state has renewed calls for Medicaid expansion. 

Weatherford said the issue is not expected to be considered during the upcoming Legislative session.