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.

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  • David M. Jenkins

    I think first the house and senate are taking it on their selves to diagnose overall patients needs,which they are wrong because people with chronic pain that can not be cured one being neuropathy in both legs that causes terrible chronic pain 24 hours a day without medications. also i have chronic severe pain with a disease called Distal Distrophy, a type of muscular distrophy which can not be cured, only controlled by medications. the medication gives me a normal daily life as it posably can. the medication does not completely stop pain but it gets me thru the day. with this 90 day law is absolutely insane, what am i going to do the other nine months?,hurt, yes i will and it will be because what the state passed. iam a former police officer who served mt towm with pride and focused on the illegal sale of prescription drugs, i also taught drug and alcohol counseling so im aware what using medications wrong can do to a person. people are bringing prescription medicines into tenn as i write this letter and from expierence passing this law will increase the sale of drugs on the street many fold. why are you punishing people like myself over a few that slips thru the cracks and gets medicine from clinics, you are wrong, you cant stop it its too big for all law enforcment. i predict the illegal sales of prescrition medicine will double in a very few short months.florida, our own chattanooga south carolina is bringing these drugs in to east tenn and law enforcement cant stop it and passing this law will only make it worse, i know what im talking about im trained to know these things, you people are not. i was diagnosed at our own great hospital vanderbilt, and i have to take pain medicine more than 90 days a year, that is simply crazy.if you are concerned about the selling of prescription medicine on the street now, just wait, you havent seen nothing yet. this law is denying me my medications to live as normal life as i can and you take it away from me and thousands of others who need the medicine,you will hear from me and many others in court, not one of you can diagnose and decide what type and how much medications people like me need,but you passed the law and i dont think all of you down in nashville are doctors. the state made a big mistake this time and it will come back to haunt you one way or another, probably where it will hurt you the worst, the election. myself and many like me knows who was pushing this law one being my rep. tony shipley who is running for re-election. i sent shipley an e-mail on this issue and no response, thats not representing me the right way tony, i hope you respond and talk to me in person on this law and i will tell you what your voters think including me. i ask you to repeal this law and let people who need medicine have it not just 90 days thank you, David Jenkins