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Harwell: Using Legislation as Influence is ‘Wrong’

Speaker Beth Harwell said she has never used legislation to pressure a department or committee to do what she wants, and that anyone who has would be in the wrong.

The Nashville Republican was responding to questions Wednesday about what she knew about Reps. Tony Shipley and Dale Ford’s involvement in getting the state Nursing Board to reverse its decision to discipline three nurses accused of substandard care contributing to the death of two patients.

“We certainly don’t want in any way (to) appear abusive, and I don’t think that was anyone’s intent, and if it was, they were wrong,” said Harwell.

“I don’t know the particulars of it. I made a point not to know the particulars of it. If they have done something that is wrong or is inappropriate or unethical, they should receive punishment for it, but I don’t know that they have.”

Harwell refused to offer specific comment about the allegations because the issue is under investigation by the Tennessee Bureau of Investigation, although she said she’s not been contacted by the agency.

TBI launched an investigation June 22 into members of the General Assembly and employees within the state Health Department to determine if they had committed any crimes, including misconduct and false reporting, in pressuring the Nursing Board to revisit their decision to discipline the nurses. The complaint sparking the investigation came from District Attorney General Torry Johnson.

“TBI is currently ascertaining the facts surrounding the Board of Nursing reinstating the licenses of three nurse practitioners after two state representatives expressed an interest in the nurses getting their licenses back,” TBI spokeswoman Kristin Helm said in an emailed statement.

The department has been investigating the nurses involved, Bobby Reynolds II, David Stout Jr. and Tina Killebrew. The case began as an over-prescribing case in Johnson City and evolved into a death investigation, according to Helm. She said that case file is now being reviewed by District Attorney General Tony Clark’s office.

Shipley and Ford this year supported legislation to block the Nursing Board’s renewal, create a committee to oversee the board and reduce the number of members on the board in what they say were attempts to get the body to reconsider actions taken against the three nurses, who were accused of over-prescribing medication relating to the deaths of three patients at the now defunct Appalachian Medical Center in Johnson City.

According to the Kingsport Times-News:

In May, Shipley said that as an officer of the Government Operations Committee, he “took the position of blocking the extension of the board,” until they agreed to listen to their argument. He said a yearlong battle ensued before the board finally agreed to take another look at the evidence. During the last three or four months of that period of time, Shipley said he had someone from the Department of Health in his office – from the legislative coordinator “all the way up to a deputy commissioner” – engaged in “sometimes heated discussion” toward that end.

In April, Shipley advocated a House amendment to reduce the number of nursing board members and require having seven board members present before issuing a summary suspension.

Ford elaborated to the newspaper, saying he too has nothing to hide:

“It all stemmed from one thing: I wrote a bill to put in an oversight panel and when they issue a major fine or major penalty of any kind to close your doors, we would look at both sides of the evidence. (The nursing board) said if I would pull that bill they would reconsider the summary suspension on Bob Reynolds, and the state of Tennessee had 38 summary suspensions,” said Ford.

“They reconsidered that and I withdrew my bill. They can come after me all they want. They are welcome to investigate any aspect of my life,” he said. As of Tuesday morning, Ford said he had not heard from the TBI.

Both legislators spoke at length with WCYB News Channel 5 in the Tri-Cities area. Extended video interviews with Shipley can be viewed here, and Ford’s interview is here.

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Who Should Give Medications in Nursing Homes?

A proposal to expand the range of employees in long-term care facilities who can legally administer certain medicines to patients is running into opposition from some registered nurses.

The change is designed to lighten the heavy workloads often carried by nurses — or at least to possibly free up some of their time so they can use it on more challenging professional tasks, according to some lawmakers.

At issue is a measure to let a new class of nursing assistants give patients medications like commonplace pain relievers, topical creams and a limited number of prescription drugs. Lawmakers, including Gov. Phil Bredesen, OK’d that plan last year — but the Tennessee Board of Nursing shot it down.

The measure, which was up for debate Tuesday, will be heard again next week in a legislative sub-committee.

The nursing board — in what some lawmakers saw as open defiance of the legislature and the governor — adopted rules recently indicating that registered nurses be the only ones to decide which lower level workers will give medications to whom.

Lawmakers who passed the measure last year said the specific intent was for licensed practical nurses, who are a step below registered nurses, to also delegate that duty to certified medication aides.

Two Republicans introduced bills this year that would require both registered nurses and licensed practical nurses to delegate their medicine-giving authority. They would oversee the certified medication aides who could administer the drugs once they’d completed 75 hours of training.

Individuals can apply to become a certified medication aide only after working for at least year as a nursing assistant, which includes helping patients with tasks like getting out of bed, eating or using the bathroom.

There is a long list of medications the aides would not be allowed to give, leaving only oral drugs such as Tylonol, Advil, vitamins, laxatives, blood pressure and allergy medications or topical creams like Neosporin.

Sen. Diane Black, a registered nurse from Gallatin, led her bill to passage 27-1 last month in the Senate. Sen. Beverly Marrero, D-Memphis, was the only member to vote against it.

But the House bill is still in committee.

Sponsored by Rep. Debra Young Maggart of Hendersonville, House Bill 3368 was on hold last week in the Professional Occupations subcommittee after Rep. JoAnne Favors, D-Chattanooga, and Democratic Caucus Chairman Mike Turner, D-Old Hickory expressed opposition.

Turner asked Maggart to hit the brakes for a week to give members more time to figure out their vote. Although Favors indicated there’s little likelihood she’ll be changing her mind anytime soon.

“If we pass this, we can come back in a couple years and call it the Euthanasia Bill,” Favors said during last week’s committee meeting.

The new class of nursing assistants, created by a state law approved last year, lacks the medical training necessary to understand if a patient is having an adverse reaction to a medication, she said. And requiring an additional 75 hours of training will not prevent the increased potential for deadly medicine mix-ups that the proposed legislation may inadvertently encourage, said Favors.

“It really is the dumbing-down of administering drugs, and that should not happen,” she told TNReport.

Favors opposed last year’s legislation. Despite her efforts to derail it in 2009, the measure passed by comfortable bipartisan margins in the House and Senate.

But the Tennessee Board of Nursing, which was charged with writing the rules to implement the new law, agreed with her and decided the plan wasn’t a good idea.

At the Jan. 21 board meeting, members voted on rules to keep registered nurses in charge of deciding who will give out medications to patients — essentially erasing any new authority licensed practical nurses, LPNs, would have to assign the new aides to  issue the pills or rub on medical ointments.

“We did not arbitrarily go against the will of the legislature,” said Cheryle Stegbauer who has chaired the nursing board since 2004. After listening to hours of archived legislative committee meetings discussing the measure, she said members of the board believed lawmakers were referring to registered nurses, not LPNs.

“I don’t think the board really saw that they had a mandate. If we thought we had a legislative mandate to open it to LPNs as well as RNs, we would have. We would have complied, but I don’t think that’s our understanding,” she told a committee of lawmakers Tuesday. “If you talk about intent of the legislature, you can look at the tapes and a lot of things said were not exactly what happened in the law.”

She said the board will keep an eye on the bill if it moves through the legislature and continue to do what it believes is safest for the public — but doesn’t plan to try to stop the bill.

The Tennessee Nurses Association is backing the board’s rule-making decision.

“We’re trying to make this as safe as possible for our frail and elderly who can’t advocate for themselves,” said Sharon Adkins, association executive director. “LPNs are trained to give medications. And let me tell you, their training is more than 75 hours.”

AARP Tennessee, which represents retired persons, hasn’t taken a side in the bill debate.

“We see it really as a stop gap. What we really need to see in Tennessee nursing homes is more staff,” said Karin Miller, the state’s AARP spokeswoman. “The state overall is facing a nursing shortage that is expected to get worse in coming years, and that issue is only exacerbated in some of our long-term care institutions.”

Tennessee nursing homes have the second largest shortage of registered nurses in the U.S., according to a 2009 report titled “Quality of Care and Litigation in Tennessee Nursing Homes,” commissioned by AARP.

Tennessee was also one of the 10 worst states for time RNs spend with each patient, which averaged 30 minutes a day, compared to 36 minutes nationally.

According to the study, Tennessee licensed practical nurses ranked above the national average. The LPNs logged in an average of 54 minutes per patient each day, compared to the national average of 48 minutes.

There are 22,000 nurses and caretakers to manage patients in the 37,850 nursing home beds, according to the Tennessee Health Care Association, which wants the new nursing aides to administer medications.

“Clearly we do not want to reduce the licensed nursing staff. It’s to use nursing staff more efficiently in the building,” said Deborah Heeney, THCA’s government relations director who predicted the nursing board will “fight us to the end.”

“It’s just because the nurses don’t believe anyone else should be able to give medication besides the nurses,” she said.

Maggart says she has the votes to push her bill through the House, but said she may consider officially asking the state attorney general to weigh in.

“There’s a lot of ways to skin a cat. There’s other ways we can go at this if, for some reason, it doesn’t pass,” said Maggart.