SENATE COMMITTEE ON HEALTH AND HUMAN SERVICES

February 7, 2001 Hearing Room B

1:00 PM Tapes 22 - 24

MEMBERS PRESENT: Sen. Bill Fisher, Chair

Sen. Margaret Carter, Vice-Chair

Sen. Gary George

Sen. Frank Shields

Sen. Ken Messerle

STAFF PRESENT: Rick Berkobien, Administrator

Andrew Morris, Committee Assistant

MEASURE/ISSUES HEARD: SB 235 Public Hearing

SB 245 Public Hearing and Work Session

SB 246 Public Hearing

Introduction of committee bill (LC 2574 will be SB 659)

These minutes are in compliance with Senate and House Rules. Only text enclosed in quotation marks reports a speaker’s exact words. For complete contents, please refer to the tapes.

TAPE/#	Speaker	Comments
TAPE 22, A
004	Chair Fisher	Calls meeting to order at 1:10 p.m. and opens a public hearing on SB 235.
SB 235 PUBLIC HEARING
006	Rick Berkobien	Administrator. Explains SB 235 to the committee.
025	Susan King	Oregon Nurses Association (ONA). Testifies in support of SB 235. Presents (EXHIBIT A) to the committee. States that have been proposed by the Health Division which the ONA is in agreement with.
041	Jeff Metcalf	Family Nurse Practitioner. Testifies in support of SB 235. Comments on his practice. States that it is difficult to get death certificates signed in rural areas where doctors are not readily available. Relates a personal experience. Explains the process of having a death certificate signed.
083	Chair Fisher	Asks if a death certificate must be signed before a body can be transported.
091	Metcalf	Responds he is unsure.
104	King	States that bodies are often transferred without a signed death certificate, but many funeral homes do not accept the body without the signed certificate.
120	Chair Fisher	States the bill could save time and money.
131	Sen. Carter	Asks why only doctors have been able to sign death certificates.
136	King	Responds current law states that only physicians may sign death certificates.
140	Chair Fisher	Asks about practitioners role in assisted suicide.
148	King	Responds that practitioners are not involved with assisted suicide, and this bill would not change that.
170	Grant Higginson	Health Division. Presents testimony on SB 235 (EXHIBIT B). Comments on proposed language changes. Explains the requirements in filling out death certificates. States there are agreements on the proposed amendments.
229	Chair Fisher	Comments on nurse practitioners and physician assistants and asks if physician assistants could also sign a death certificate.
243	Higginson	Responds that nurse practitioners work independently and physician assistants work under physicians.
264	Sen. Carter	Asks if hospice nurses sign death certificates.
268	Higginson	Responds that is not legal under the current law.
280	Chair Fisher	Introduces letters provided by King in (EXHIBIT A).
302	Chair Fisher	Closes the public hearing on SB 235 and opens a public hearing on SB 245
SB 245 PUBLIC HEARING
305	Berkobien	Explains SB 245 to the committee.
341	King	Testifies in support of SB 245. Explains the background behind the bill.
373	Metcalf	Testifies in support of SB 245. Comments on patient care. States that people recover faster when they can receive services in their home. Relates a personal experience. Discusses current procedures.
TAPE 23, A
000	Metcalf	Explains home health care.
020	Chair Fisher	Asks about patients that receive Medicaid services.
025	Metcalf	Responds he is willing to work with physicians to get approval for Medicaid. Discusses having doctors sign orders after services were delivered.
046	Sen. Carter	Asks about the financial impact of the bill.
048	Metcalf	Responds the bill would allow for time and money to be saved.
063	Carolyn Concia	Geriatric Nurse Practitioner. Testifies in support of SB 245. Comments on her practice of making home visits to people who are homebound. States there are 12,000 people in Multnomah County who are homebound. States there is a delay while patients wait for a doctor to sign orders.
100	Hersh Crawford	Office of Medical Assistance Programs (OMAP). Presents testimony on SB 245 (EXHIBIT C). States that SB 245 does not apply to the Medicaid because in order to receive matching funds, a physician must sign the medical orders. States that besides the Medicaid issue, OMAP does not have any issue with the bill.
118	Chair Fisher	Asks if a physician could sign orders at a later date to receive Medicaid funds.
125	Crawford	Responds that federal requirements do not call for a physician to authorize services ahead of time.
129	Sen. Carter	Asks about funds coming from the general fund.
131	Crawford	Responds if the bill required Medicaid to be included in the bill, then the state could not receive matching funds for services prescribed by nurse practitioners only. States the bill does not intend this, so there will not be a fiscal impact.
145	Chair Fisher	Comments on the intent of SB 245. Closes the public hearing on SB 245 and opens a work session on SB 245.
SB 245 WORK SESSION
150	Sen. Carter	MOTION: Moves SB 245 to the floor with a DO PASS recommendation.
		VOTE: 5-0 AYE: 5 – Carter, George, Messerle, Shields, Fisher
178	Chair Fisher	The motion CARRIES. SEN. CARTER will lead discussion on the floor.
180	Chair Fisher	Closes the work session on SB 245 and opens a public hearing on SB 246.
SB 246 PUBLIC HEARING
195	Berkobien	Explains SB 246 to the committee.
235	King	Testifies in support of SB 246 (EXHIBIT D). Gives personal background. Comments on the background of SB 246. States the bill seeks to extend the authority of the Board of Nursing. Comments on commitment to treatment.
315	King	Comments on the scope of practice for nurse practitioners.
328	Sue Davidson	Ph.D., Oregon Nurses Association. Testifies in support of SB 246 (EXHIBIT F). States the bill would allow for the Board of Nursing to have influence over curriculum.
398	Metcalf	Reads testimony in support of SB 246 (EXHIBIT E). States concerns over the current system.
TAPE 22, B
000	Metcalf	Continues testimony.
027	Chair Fisher	Asks how internet diplomas affect Oregon.
032	Metcalf	Responds that he is unsure, but internet diplomas are becoming a trend.
053	King	States that the ONA supports the Board of Nursing on SB 246. Comments on the board’s responsibilities.
075	Chair Fisher	Asks for the financial impact on the board of nursing.
079	King	Responds the board would need consulting fees. Comments on her past work on the board and accrediting undergraduate programs. Comments on current requirements. States the board supports current graduate programs.
150	Kathleen Potempa	Ph.D., Dean, Oregon Health Sciences University (OHSU). Reads testimony against SB 246 (EXHIBIT G). Reviews the boards and associations that accredit OHSU’s nurse practitioner programs. States that the accreditors have the expertise that is required to make curriculum decisions. States that curriculum changes depending on the needs of the field.
237	Potempa	Continues reading testimony.
280	Carol Howe	Director, nurse-midwifery, OHSU. Reads testimony against SB 246 (EXHIBIT H). States OHSU is in the top ten for nurse practitioner programs in the country. Explains the accreditation process. States that OHSU already meets the required standards.
372	Sen. Messerle	Asks about other schools in Oregon that have nurse practitioner programs.
375	Potempa	Responds that the University of Portland also has nurse practitioner programs.
391	Sen. Shields	Asks how the bill affects nurse practitioner programs.
410	Potempa	Responds that it give the board of nursing the power to not allow new program development.
421	Sen. Shields	Asks if the board of nursing would disagree with accrediting entities.
430	Potempa	Responds she is unsure, but accrediting boards and associations are more qualified to make accrediting decisions. States the board members may not have the experience to make accrediting decisions.
TAPE 23, B
014	Sen. Carter	Asks about people that may enter into a practitioner program, but are not qualified.
021	Potempa	Responds by explaining the admission process. Comments on the educational requirements.
083	Sen. Carter	Asks about people who may enter the program without having undergraduate degrees.
095	Howe	Responds that the students would have to complete an intense three-year program before entering and graduating from the practitioner program. Comments on accreditation. States that a local board may not have an understanding of the national requirements and activities.
133	Chair Fisher	Asks for the education requirements to be on the Board of Nursing.
134	Potempa	Responds they are not required to have advanced degrees. States that when a person graduates from a practitioner program, they have seven and a half years of education.
169	Katharine Parker	Mid-wife. Presents testimony in opposition to SB 246 (EXHIBIT I). Gives personal background. States disagreement with the proposal. Explains the board wants to prevent OHSU from developing a new program.
270	Parker	Asks for continued support from the state legislature.
288	Chair Fisher	Closes SB 246 and opens a work session to introduce committee bills.
INTRODUCTION OF COMMITTEE BILLS
296	Berkobien	Explains LC 2574 to the committee.
302	Sen. Carter	MOTION: Moves LC 2574 BE INTRODUCED as a committee bill.
		VOTE: 3-0-2 AYE: 3 - Carter, Messerle, Fisher EXCUSED: 2 - George, Shields
305	Chair Fisher	Hearing no objection, declares the motion carried.
310	Chair Fisher	Closes the work session to introduce committee rules and reopens the public hearing on SB 246.
SB 246 PUBLIC HEARING
317	Fran Hicks	Professor, OHSU. Reads testimony in opposition to SB 246 (EXHIBIT J). States that current statutes provide sufficient oversight. States that Oregon is a leader in the nation in nursing programs and the bill could change that.
389	Anita Lee Wynn	University of Portland. Testifies in opposition to SB 246. Comments on people who enter nurse practitioner programs without a lot of experience. Relates a personal experience. States that if the board of nursing became involved, it may take away the flexibility the school has.
TAPE 24, A
030	Chair Fisher	Asks if there is a possibility of developing a program to make sure that graduates are capable completing assigned work.
035	Wynn	Responds no. States that faculty should make decisions about if a student is capable or not or participating in a program.
050	Sen. Shields	Asks if a nurse practitioner should have a nursing background.
063	Wynn	Responds it would be helpful, but it is not necessary.
094	Hicks	States that 25 percent of nurses by 2007 will be second career people.
114	Pamela Harris	Dean, Linfield-Good Samaritan School of Nursing. Presents testimony against SB 246 (EXHIBIT K). States agreement with previous testimony.
133	Brian DeLashmutt	Representing the ONA. Testifies in support of SB 246. Reviews the language in SB 246. States the board would not be involved with more than approving curriculum. States that the board should be able to have the same role in graduate programs that it has in undergraduate programs. States the bill is not about a particular program, but covers future programs.
190	Chair Fisher	Asks why it has taken so long for this issue to come up.
195	DeLashmutt	Responds the issue came up when a new program was proposed at OHSU. Reviews the function of the board of nursing.
217	Chair Fisher	Asks if other professions do not need a law like this, why should this be pursued.
228	DeLashmutt	Responds there is only one medical and dental school in the state.
248	Chair Fisher	States he does not want to hold back the educational process.
255	Sen. Shields	Asks if the issue should be litigated.
263	DeLashmutt	Responds that if the committee does not pass the bill he will seek other avenues, such at the attorney general, to change the statute.
272	Sen. Shields	Suggests working on a compromise.
293	Chair Fisher	Enters letters against SB 246 into the record (EXHIBIT L). Adjourns the meeting at 3:24 p.m.

Submitted By, Reviewed By,

Andrew Morris, Rick Berkobien,

Committee Assistant Administrator

EXHIBIT SUMMARY

A – SB 235, Letters, Susan King, 5 pp.

B – SB 235, Written testimony, Grant Higginson, 2 pp.

C – SB 245, Written testimony, Hersh Crawford, 1 p.

D – SB 246, Letters, Susan King 2 pp.

E – SB 246, Written testimony and letter, Jeff Metcalf, 2 pp.

F – SB 246, Written testimony, Sue Davidson, 2 pp.

G – SB 246, Written testimony, Kathleen Potempa, 2 pp.

H – SB 246, Written testimony, Carol Howe, 2 pp.

I – SB 246, Written testimony, Katharine Parker, 2 pp.

J – SB 246, Written testimony, Fran Hicks, 2 pp.

K – SB 246, Written testimony, Pamela Harris, 1 p.

L – SB 246, Letters, Staff, 2 pp.