Lawmakers Refereeing ‘Turf Battle’ Over Pain-Management Care

The question of who exactly should be legally authorized to shoot powerful medications into easily injured areas of the body, like a patient’s spine, dominated talk on Capitol Hill Thursday.

Lawmakers heard testimony from the medical community about rules governing the tricky job of pain management.

Members of a House Health and Human Resources subcommittee are studying the implications of HB1896, a bill that limits when nurse practitioners and other caregivers with advanced training can administer “interventional” pain medications, which are injected within a half-inch of the spinal cord.

Under the proposal, which won committee approval in the Senate but stalled in the House, these nurses would only be able to perform the procedures under the supervision of specialists.

Lawmakers walked away from their four-hour discussion generally in agreement to add government mandates for better training of nurse practitioners, assistants and physicians alike as they try to defuse a war among the competing health care occupations.

“Sometimes though, these are turf battles, and money’s involved. And it’s whether which side is going to end up with the most procedures to make the most money,” said Rep. Mike Turner, the House Democratic Caucus chairman and a member of the panel examining who can perform the pain-management procedures.

“We have to determine which is which, whether this is the best medical procedure or we’re just settling a dispute between two or three occupations,” Turner said. The debate among the medical professionals is “pretty volatile,” he added, with physicians on one side and the nurse practitioners and physician assistants on the other.

“We do not believe that a few weeks of training can possibly equate a three-year residence and a year of fellowship in training,” said Dr. Joe Browder, speaking for the Tennessee Medical Association. The TMA argues that the procedure should be done by doctors, not nurses or assistants.

Opponents of HB1896, including state associations of physician assistants and nurse anesthetists, argue that restricting non-physicians from performing the procedures is anti-competitive and unnecessary. Opponents believe such a move would reduce options for patients at a time when more people will begin seeking health care as Baby Boomers age and the Patient Protection and Affordable Care Act is scheduled to start taking effect.

“This bill is a solution to a problem that doesn’t exist,” said Sharon Adkins, executive director of the Tennessee Nurses Association. “Our focus needs to be on access to the provision of quality patient care, not the pocketbook of the provider.”

The nursing industry is no stranger to debates on Capitol Hill. Last year it went to blows with the Legislature after the state Nursing Board refused to implement new laws regarding lower-level nurses issuing medications in the way the General Assembly intended.

Rep. Matthew Hill, who chaired the subcommittee meeting, called Thursday’s discussions a “starting point.” The Jonesborough Republican said he expects to amend the original bill with an eye toward requiring more extensive training for anyone performing the procedures while hoping the two sides will seek to meet each other halfway.