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serve), it seems as if it needs at least two, and preferably all three,
of the following key components: a champion in Government (for
the purposes of this article, Government will refer to the legislature,
although executive and judicial champions are needed as well);
effective professional lobbying; and robust member (physician)
engagement across the specialties and in partnership with other
groups and organizations. Our local pediatric colleagues in the
Kentucky chapter of the American Academy of Pediatrics and at the
University of Louisville benefited from a strong grassroots movement, negotiation and cooperation with other physician groups,
and a dedicated legislative champion as they succeeded in helping
Pediatric Abusive Head Trauma become law. Prescription eye drops,
not as overwhelmingly popular with legislators initially, ultimately
benefited from all three key components: a great lobbying team with
McBrayer, McGinnis, Leslie and Kirkland (MMLK), actively engaged
ophthalmologists of the Kentucky Academy of Eye Physicians and
Surgeons and other physicians of the GLMS Policy and Advocacy
Team and other groups, and Senator Julie Denton, who sponsored
the bill energetically. Although the bill had an excellent chance of
passing from the outset because it offered to help many people with
little cost to the state, it is still a great model to follow for all of our
legislative and regulatory goals.
Politically charged issues, where there is division among lawmakers, professionals, organizations, and the public, are stressful and
challenging. However, the right combination of legislative leadership,
professional lobbying, and grass roots physician involvement can
make all the difference in these areas as well. The story of the Advanced Practice Registered Nurse (APRN) compromise legislation
(SB 7) speaks to this concept on many levels. Most all Kentucky
physicians are by now somewhat aware of the new state law that
significantly expands the prescriptive authority of APRN’s in the
Commonwealth. Our Policy and Advocacy Team did not actively try
to influence this legislation during the session because lengthy negotiations between the Kentucky Medical Association, the Kentucky
Academy of Family Physicians (KAFP), and the Kentucky Coalition
of Nurse Practitioners and Nurse Midwives (KCNPNMW) were
finalized well before the 2014 session began in January. However,
since the GLMS took the initiative in moving KMA policy toward
developing a model for the physician-led team approach to patient
care several years ago, and also considering that 2 GLMS members
-- myself and Dr. Ron Waldridge, II -- were very involved in the
process that led to the compromise legislation, a few more details
of the behind-the-scenes events that led to SB 7 deserve reporting
in this context. I have devoted several paragraphs in an attempt to
tell the story.
KCNPNMW has displayed a fantastic effort, strong and persistent,
over many years in its aim to eliminate the statutory requirement
for collaboration between APRNs and physicians in the area of prescription writing. (The group had already won the right for APRNs
to practice and order tests independently without physician collaboration or supervision in 1996.) Their organization has extremely
strong member participation at the grass roots level. Most every state
legislator and regulatory leader has heard repeatedly from APRNs
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on this issue. The group also works with very effective lobbyists - a
retired psychologist Democrat who believes fully and passionately
in the organization’s mission and a Republican who enjoys strong
relationships with most every GOP legislator in both the House
and Senate. Both of them are respected and hard-working. Also
critically important, KCNPNMW has had legislative champions on
this and other issues. Representative Mary Lou Marzian, a Louisville
Democrat and nurse, was devoted to the effort from the time the
collaborative prescribing agreement was established as a condition
of independent practice in 1996 until well after the first call for its
elimination in 2010. Later, Senators Gary Tapp and Paul Hornback,
both Republicans from Shelby County, were tireless and vocal leaders
in the legislature and helped sway a bipartisan effort on the issue.
The proposal to move away from supervisory and collaborative
requirements steadily became accepted