STAND. COM. REP. NO. 565

                                   Honolulu, Hawaii
                                                     , 1999

                                   RE:  S.B. No. 498
                                        S.D. 1




Honorable Norman Mizuguchi
President of the Senate
Twentieth State Legislature
Regular Session of 1999
State of Hawaii

Sir:

     Your Committee on Commerce and Consumer Protection, to which
was referred S.B. No. 498 entitled: 

     "A BILL FOR AN ACT RELATING TO PRESCRIPTIVE AUTHORITY FOR
     ADVANCED PRACTICE REGISTERED NURSES,"

begs leave to report as follows:

     The purpose of this measure is to delete restrictions on
granting advanced practice registered nurses (APRNs) prescriptive
authority and to add controlled substances in schedules II to V
to their prescriptive authority.

     The Hawaii Nurses' Association, the Hawai'i State Primary
Care Association, the National Association of Social Workers
Hawai'i Chapter, and an individual presented testimony in support
of the measure.  The Hawai'i Chapter of the American Psychiatric
Nurses Association, the Hawaii Long Term Care Association, the
Hawaii Government Employees Association, and eight individuals,
though not present at the hearing, submitted written testimony in
support of the measure.  The Board of Nursing presented testimony
in support of the measure with a proposed amendment.  

     The Department of Health, though not present at the hearing,
submitted written testimony expressing deference on the measure
to the Department of Commerce and Consumer Affairs (DCCA).  The
Board of Medical Examiners presented comments on the measure.
The DCCA presented testimony in opposition to a provision in the
measure and proposed an amendment.  


 
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     The Hawaii Medical Association presented testimony in
opposition to the measure.  The Hawaii Federation of Physicians
and Dentists, though not present at the hearing, submitted
written testimony in opposition to the measure. 

     Your Committee finds that currently thirty-three states
grant APRNs the authority to prescribe Schedules II to V
controlled substances and no state has reversed its decision to
grant APRNs prescriptive authority.  Your Committee further finds
that a 1993 Meta-Analysis of Studies on Nurses in Primary Care
Roles that included a review of nine hundred documents concluded
that nurses practicing in advanced practice roles are cost-
effective providers of primary care services.  

     Your Committee recognizes that the administrative rules
implementing the current law that grants restricted prescriptive
authority to APRNs were approved a few months ago, and that some
may argue that it is premature to revise the law.  However, it
has been more than four years since the current law was enacted
and your Committee believes that the decision to grant APRNs the
authority to prescribe controlled substances should be guided
foremost by considerations of consumer safety, professional
competency, and the efficient, cost-effective, and timely
delivery of medical care.

     Your Committee has amended this measure by:

     (1)  Replacing the Department of Commerce and Consumer
          Affairs with the Board of Nursing as the entity
          granting prescriptive authority;

     (2)  Providing that an advisory committee be established by
          the Director of Commerce and Consumer Affairs, to make
          recommendations to the Board of Nursing regarding
          prescriptive authority-related issues, including the
          prescribing of controlled substances in schedules II to
          V by recognized advanced practice registered nurses;
          and

     (3)  Making technical, nonsubstantive amendments. 

     As affirmed by the record of votes of the members of your
Committee on Commerce and Consumer Protection that is attached to
this report, your Committee is in accord with the intent and
purpose of S.B. No. 498, as amended herein, and recommends that
it pass Second Reading in the form attached hereto as S.B.
No. 498, S.D. 1, and be placed on the calendar for Third Reading.


 
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                                   Respectfully submitted on
                                   behalf of the members of the
                                   Committee on Commerce and
                                   Consumer Protection,



                                   ______________________________
                                   BRIAN KANNO, Co-Chair



                                   ______________________________
                                   BRIAN T. TANIGUCHI, Co-Chair

 
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