HOUSE COMMITTEE ON RULES AND PUBLIC AFFAIRS

 

May 27, 2003 Hearing Room E

1:00 PM  Tapes 66 - 67

 

MEMBERS PRESENT:            Rep. Dan Doyle, Chair

Rep. Linda Flores, Vice-Chair

Rep. Laurie Monnes Anderson, Vice Chair

Rep. Phil Barnhart

Rep. Betsy L. Close

Rep. Joanne Verger

 

MEMBER EXCUSED:            Rep. Vic Backlund

 

STAFF PRESENT:                  Cara Filsinger, Administrator

Annetta Mullins, Committee Assistant

 

MEASURE/ISSUES HEARD:  SB 708 A – Public Hearing

                                                SB 709 A – Public Hearing

                                                SB 886 A – Public Hearing

                                                SB 538 A – Public Hearing

 

 

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 66, A

004

Chair Doyle

Calls meeting to order at 1:40 p.m., announces order agenda items will be considered, and opens a work session on introduction of Speaker-approved committee bills.

INTRODUCTION OF COMMITTEE BILLS

013

Rep. Flores

MOTION:  Moves LCs 3614 (SEE EXHIBIT C OF COMMITTEE MINUTES DATED MAY 6, 2003), 3641 (SEE EXHIBIT A OF COMMITTEE MINUTES DATED MAY 22, 2003), AND 3645 (EXHIBIT G) BE INTRODUCED as committee bills.

018

 

VOTE:  5-0-2

EXCUSED:  2 - Reps. Backlund, Close

 

Chair Doyle

Hearing no objection, declares the motion CARRIED.

 

020

Chair Doyle

Closes the work session on the introduction of committee bills and opens public hearings on SB 708 A and SB 709 A.

SB 708 A AND SB 709 A – PUBLIC HEARINGS

028

Rep. Laurie Monnes Anderson

District 50.  Testifies in support of SB 708 (EXHBIIT A).

 

Susan King

Oregon Nurses Association.  Testifies in support of SB 708 and SB 709 (EXHIBIT B).  Explains that the bills relate to two different categories of “advanced practice nurses.”  SB 708 covers nurse practitioners.  SB 709 covers clinical nurse specialists.  Comments on practice of clinical nurse specialists. 

067

King

States that both bills deal with “dispensing.”  States that currently both can administer medications, as can any registered nurse.  Nurse practitioners can prescribe medications, distribute samples, and can dispense in certain circumstances.  SB 708 would broaden that dispensing authority with certain safeguards that have been worked out in discussion with the pharmacists.  Gives examples of dispensing by nurse practitioners and clinical nurse specialists.  States that requirements of most of the drug companies are that the prescribing provider also have the authority to dispense.  If these bills pass, we will have an opportunity for both nurse practitioners and clinical nurse specialists to help their patients participate in what has become a very critical program, particularly given the state of the economy here in Oregon. 

087

Rep. Close

Asks witness to respond to e-mail about impact of the bills because nurses are not as well trained as pharmacists and this is a safety issue.

 

King

Responds the amendments in the bills put in place safeguards related to training, labeling, and adequate reference materials.  Adds that neither nurse practitioners nor clinical nurse specialists intend to dispense all drugs.  They are more likely to dispense some limited prescriptions for certain problems.  Gives examples of dispensing in cases of acute infection, acute bank injury, and seizures.  States that the clinical specialists can already prescribe drugs and would be able to dispense them under this bill. 

113

Rep. Verger

Comments that she has no problem with nurse practitioners but does not understand the clinical nurse practitioners.  Asks what clinical nurse specialists do.

131

King

Explains clinical nurse specialist qualifications and the differences between them and nurse practitioners.

140

Rep. Verger

Comments on referring indigent people to programs for services.  Asks if the drugs could go to Ms. King and she would then dispense the drugs.

 

King

Explains that most companies require that whoever writes the prescription must have the authority to dispense the drugs.  Explains that she can write a prescription, the person can take it to a pharmacy or together she and the patient could apply to the drug company.  The drugs would then be delivered to her to be given to the patient; the drugs would be packaged with the patient’s name. 

 

Rep. Verger

Asks if they can do that now.

 

King

Responds that clinical nurse practitioners cannot dispense.  Nurse practitioners can dispense in certain circumstances.

177

Rep. Monnes Anderson

Comments that these bills are important to the nursing profession.  States she is a proponent because of access.  Asks that King address the types of access issues that the nurse practitioners and clinical nurse practitioners are encountering.

 

King

Responds that issues are financial, geographical, or a combination of the two.

183

Rep. Monnes Anderson

Clarifies that a nurse practitioner can have medications in the clinic or office and would dispense to those who cannot afford to have a prescription filled.

 

King

Comments that the dispensing authority is for the unusual circumstances.  Gives examples. 

226

Rep. Monnes Anderson

States that she has received concerns about SB 709-Aand the training.  Asks for explanation of training of nurse specialists.

 

King

Explains training required for clinical nurse specialists. 

258

Tom Holt

Executive Director, Oregon State Pharmacists Association (OSPA).  Reports that SB 708 A and SB 709 A reflect conversations between their association and the nurse’s association.  The OSPA is neutral on the bills. 

273

Gary Schnabel

Executive Director, Oregon Board of Pharmacy.  Testifies in opposition to SB 708 A and SB 709 A.  Reads from  letter sent to Chair Doyle (EXHIBIT C).

330

Schnabel

Cites problems with SB 708 A, proposes amendments, and asks the committee to vote no on SB 708 A and SB 709 A.

418

Rep. Monnes Anderson

Asks if Schnabel has been in negotiations with the Oregon Nurses Association on these two bills.

 

Schnabel

Responds they have not since the bill passed the Senate.

426

Rep. Monnes Anderson

Asks if his suggested changes would make the bill more palatable to his board.

 

Schnabel

Responds he cannot speak for the board and the changes would allow him to go back to the board with a recommendation.

438

Rep. Monnes Anderson

Asks how many nurse practitioners are practicing independently.

 

Schnabel

Responds he does not know.

443

Rep. Monnes Anderson

Asks how they respond to those nurse practitioners who have been prescribing and dispensing samples, and are able to give the quality of care to those who really need the medication.

 

Schnabel

Responds he doesn’t want to speak negatively about nurse practitioners or the need for nurse practitioners.  The concern is with the way the bill is written.  The Board of Pharmacy believes the dispensing authority that currently exists along with the emergency provision with some changes in the language would take care of those situations.

475

Rep. Flores

Comments that Schnabel indicates one of his concerns is risk of patient injury due to prescribing and dispensing errors by nurse practitioners or nurse specialists.  Asks if they have data that suggests what the level of injury or malpractice might be.

490

Schnabel

Responds that they only have data from consumer complaints. 

TAPE 67, A

031

Rep. Flores

Asks what the numbers might look like.

 

Schnabel

Comments that the Institute of Medicine put out a report about medical errors.  A fraction of those errors were referred to as medication errors.  That report indicates somewhere around 7,000 people die every year from medication errors.  States that from his reading of the report, it did not set out who was doing the dispensing, or whether it was a dispensing error, or an administration error in the hospital.

046

Rep. Close

Asks what percentage of dispensed drugs are opium-based.

050

Schnabel

States it would fluctuate with different practices.  Comments on patients served by the pharmacy, and states that in some cases 50 percent of the drugs could be opium-based.  In an average drug store, it is probably 30 percent. 

058

Rep. Close

Comments this opens it up to drugs that are illegal in other circumstances and she is concerned about abuse.

 

Schnabel

Responds it is a concern of the Board of Pharmacy.  States that statistics indicate that around 10 percent of their profession is chemically dependent.

068

Rep. Verger

Comments that the statutes give the board the authority to visit dispensing sites and authority over the person that is dispensing the medicine.  Asks what it tells the board if the board receives a complaint and they visit a dispensing site.

083

Schnabel

Responds they inspect pharmacies annually and they can only visit drug outlets that are registered with the board, and that is one of the concerns with the bills.  Explains their procedures when they receive a complaint.

099

Rep. Barnhart

Comments that he assumes there is a security issue in dispensing and storing drugs.

 

Schnabel

Comments on security requirements of a licensed pharmacy.

111

Rep. Barnhart

Asks if those areas are addressed in the two bills.

 

Schnabel

Responds that nothing in the bills address security.

 

Rep. Monnes Anderson

Asks what the most commonly prescribed drug is in a nurse practitioner clinic setting.

 

Schnabel

Responds the list is on the worldwide web by dollars and number of doses. Lists drugs that are high on the list.

139

Schnabel

States that drug samples are not considered dispensing and nurse practitioners can distribute drug samples in any setting.

 

Chair Doyle

Closes the public hearings on SB 708-A and 709-A and opens a public hearing on SB 886 A.

SB 886 A – PUBLIC HEARING

 

Sen. Frank Shields

District 24.  Submits a prepared statement (EXHIBIT D).  Testifies in support of SB 886 A (EXHIBIT D).  States he thinks we ought to find ways where faith-based and community-based organizations can help people who come to the Department of Human Services (DHS) for services.

211

Sen. Shields

Submits proposed SB 886-A3 amendments (EXHIBIT E).  Explains the amendments.

243

Rep. Monnes Anderson

Asks where funding would come from.

 

Sen. Shields

States that DHS has numerous volunteer programs.  The only place this might have a fiscal impact is for training.  They do not want it to cost more money.  Contends that recipients of funds do better when they have support of a community- or faith-based organization.  It would help the state’s dollars go farther and would help people.

255

Chair Doyle

Comments that the purpose of the hearing today was to have an airing of the subject and the committee will be able to revisit it again.

285

Rep. Close

Comments she appreciates what Sen. Shields has done.  It is a new area that needs work and appreciates his trying to bring more aspects into the discussion and will study it more.

300

Ramona Rodamaker

Department of Human Services Director’s office.  Testifies in support of the concept behind SB 886 A (EXHIBIT F).

348

Rodamaker

Comments the estimated fiscal impact is about $44,000, which is for training.  Suggests if there is way to modify the language to allow representatives of faith- and community-based organizations into existing training, rather than creating new training, they believe the fiscal issue would be alleviated.

 

Rep. Monnes Anderson

Comments on clinics in churches in rural Virginia.  Asks if state services go into churches.

372

Rodamaker

Responds they have a variety of relationships with faith-based and community organizations but is not aware of clinics in faith based clinics; they do provide child care.

 

Chair Doyle

Comments the committee has a statement indicating the impact is minimal.

 

Chair Doyle

Closes the public hearing on SB 886 A and opens a public hearing on SB 538 A.

SB 538 A – PUBLIC HEARING

390

Dave Hunnicutt

Oregonians in Action.  Testifies in support of SB 538 A.  Explains the bill is to exempt from the zoning ordinance gatherings that do not exceed 3,000 people cumulatively or 120 hours in any consecutive three-month period.  Those who use their places regularly for weddings, etc. would not be subject to the land use laws.  Explains that he cannot answer technical questions because he has not been working on the bill.  Explains that Ross Day worked very closely on the amendments with Ron Ebert of the Department of Land Conservation and Development Department (DLCD).

492

Chair Doyle

Asks that Hunnicutt relay to Day the question whether this bill would authorize events such as the hemp festival

496

Rep. Barnhart

Adds that the Country Fair in Lane County is another question for Day.

TAPE 66, B

009

Hunnicutt

Comments on a bed and breakfast that holds weddings.   Believes the concern should be regulated under the health and safety codes rather than the land use laws.

030

Rep. Verger

Asks if Hunnicutt can explain the case Fence v. Jackson County.

 

Hunnicutt

Responds he believes the Land Use Board of Appeals (LUBA) and the Court of Appeals held that mass gatherings are not part of the land use code; they are not zoning decisions.  Comments on legislation introduced in 1999.

043

Rep. Verger

Comments that the reason it caught her eye is because of a gathering in Jackson County every weekend at an outdoor church service.

 

Hunnicutt

Comments on history of mass gathering statute.

063

Chair Doyle

Closes the public hearing on SB 538 A and adjourns meeting at 2:42 p.m.

 

 

EXHIBIT SUMMARY

 

A – SB 708, prepared statement, Rep. Monnes Anderson, 1 p

B – SB 709, prepared statement, Susan King, 13 pp

C – SB 708 and SB 709, prepared statement, Gary Schnabel, 3 pp

D – SB 886, prepared statement, Sen. Shields, 3 pp

E – SB 886, SB 886-A3 amendments, Sen. Shields, 1 p

F – SB 886, prepared statement, Ramona Rodamaker, 2 pp

G – Introduction of Committee Bills, request, staff, 4 pp