SECTION TEN (APRN and PA)
This section is tricky because it deals with Physician Assistants (PA)
and Advanced Practice Registered Nurses (APRN). The EMERGENCY REGULATIONS are from the Medical Licensing Board of
Indiana, which only has jurisdiction over PHYSICIANS. Physician
Assistants and Advanced Practice Registered Nurses each have
separate licensing boards.
Regarding Physician Assistants, Section 10 notes that PA duties and
responsibilities must be “within the supervising physician’s scope
of practice.” Thus, one interpretation is that physician assistants are
required to follow the Board of Medical Licensure’s Regulations.
Regarding Advanced Practice Registered Nurses, Section 10 does
not mention “scope of practice.” Thus, APRNs (considered more
independent of physician supervision than PAs) might not be required to follow the Board of Medical Licensure’s Regulations.
Requisite supervisory agreements allow PHYSICIANS to place limits
on prescriptive practices for the PA’s and APRN’s they supervise.
To emphasize this point, Indiana physicians received an email on
December 12, 2013 sent by the Indiana Professional Licensing
Agency stating:
I believe it is wise to review INSPECT reports and drug screens
“early and often.” Include reports from border states (e.g. Kentucky’s
KASPER) when available.
SECTION TWELVE (These “Emergency” Regulations Are
Effective as of December 15, 2013)
In the coming months there will be more discussion and the emergency regulations will likely be revised to some degree. Permanent
regulations must be adopted by November 1, 2014.
In Conclusion…
DRAMATIC at the start (Section 4);
FACE-TO-FACE every 2 – 4 months (Section 6);
INSPECT & DRUG SCREEN annually (Sections 7 & 8);
REVIEW, REVISE & REFER at higher doses (Section 9).
All physicians who practice in the Hoosier State should take a look
at the actual Emergency Regulations (only 4 pages long) available
online at: http://www.in.gov/pla/files/Emergency_Rules_Adopted_10.24.2013.pdf
“Professionals that hold a license to practice should review all collaborative agreements with Advance Practice Nurses and Physician’s
Assistants to assure that they are in compliance with the new rule.”
Indiana’s “First Do No Harm” prescriber took kit (essentially an
interactive online textbook) is informative and available online at:
http://www.in.gov/bitterpill/docs/First_Do_No_Harm_V_1_0.pdf
Adding to the narrative is language from Indiana Senate Bill 246,
passed by the 2013 Indiana State Legislature, that states:
The Indiana State Medical Association has a summary posted online at:
“The s ]H