Reply by Senator Jay Costa to My Statement on Nurse Practitioner Independent Prescribing, and my Response

Dear Dr. Behar:

Thank you for contacting me to relate your opposition to Senate Bill 25, legislation that would amend Pennsylvania law to change the scope of practice for certified registered nurse practitioners in our state. I appreciate your interest in this matter and I understand that you are concerned about this bill.

As you are likely aware, Senate Bill 25 has passed the Senate Committee on Consumer Protection and Professional Licensure and was considered by the Senate for the first time on March 29, 2017. I signed on as a co-sponsor on this bill because I believe it is time for Pennsylvania to join the twenty-one states and the District of Columbia in allowing CRNPs to have full authority to practice. This change to our law will help us to reduce health care costs, to ensure that our law is in step with modern medical practice and to assist in ensuring quality care to the nearly 35 per cent of Pennsylvanians who have inadequate primary care access. I recognize that there is a significant difference in training between physicians and CRNPs. This bill does not make light of that difference and requires that CRNPs meet a three-year, 3,600-hour collaboration requirement before practicing more independently. I will consider your thoughts on this legislation and your reservations about it as it moves through the legislative process.

I could not disagree more strongly with your assertion that this legislation is motivated by racism. Pennsylvania has underserved populations of all races that could benefit from the broader practice authority of nurse practitioners, in rural and urban areas, and increasingly in suburban areas as well. Patients throughout the Commonwealth will benefit from cost savings created by this legislation, and I believe it is important that we pursue this course of action.

Again, thank you for taking the time to contact me about this legislation. Please feel free to contact me if I can assist you in any way.

Sincerely yours,

Senator Jay Costa, Jr.

43^rd District

JC/jlg

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Jay. I demand you add an amendment. "All Pennsylvania legislators, all their staffs, and all their first degree family members are prohibited from seeing doctors for medical care." Save some money. Experience the inferior care of black patients on Medicaid that you will be forcing on them.

I also request that you reveal all campaign contributions by insurance companies. It is they who are driving this movement. 

Letter to the Reading Eagle About the Inferior Care of Nurse Practitioners and the Racial Motivation to Grow their Ranks

Here.

This is the original submission, softened by the editor:

Force Legislators, Their Families To See Only Nurse Practitioners

David Behar, MD

A patient commented, a nurse practitioner insisted the growing lesion on his arm was an "age spot."  The patient demanded to see the dermatologist, after a year. From the door, the doctor stated, “That is a squamous cell carcinoma. It has to come out.”

Would a member of the legislature with crushing chest pain, shortness of breath, want to be seen by a cardiologist or by a nurse practitioner typing an  electronic record? The lives of black people on Medicaid are worth no less than that of the white legislator. The movement to allow nurse practitioners to prescribe unsupervised, will result in a two tiered health system, one for whites, one for blacks. There is no doctor shortage, only of doctor time. Half of that time is consumed by worthless procedure so that fewer payments are made for  patient care by government and by insurance companies. It is the greatest fraud crime in history, netting $trillions.

People with perfect grades get into nurse practitioner programs. All could go to medical school. They choose to make money earlier. That corner cutting should not be rewarded with independent prescribing privileges. They know one quarter what specialists know, and half as much as primary care physicians do. They are fit only to prescribe for patients doing well, under supervision.

Statement on Nurse Practitioners with Independent Prescribing

 

 

If any member of the legislature were having crushing chest pain, and had shortness of breath, with a family history of premature  deaths by heart attacks,  would they want to be seen by a cardiologist or by a nurse practitioner filling out a form on the electronic record? Why are the lives of black people on Medicaid worth any less than that of the legislator? If should be part of any nurse practitioner enabling statute, that legislators, their families, their staffs, their families may only be seen by nurse practitioners. 

The movement to allow nurse practitioners to prescribe unsupervised, will result in a two tiered health system, one for whites, one for blacks. It stems from racial animus. The aim is to raise the mortality of black people even higher than it is already.

Their role is falsely justified by lack of access to medical care. There is no doctor shortage. There is a shortage of doctor time. Half of that time is consumed by regulatory quackery. Regulatory quackery is a rule that has not been shown to improve patient outcomes. Its intention is take up doctor time with worthless procedure so that fewer payments are made for real patient care by government and by insurance companies. Because regulatory quackery has consumed $trillions and prevented the real care of millions of patients, it is the greatest financial fraud crime  in the history of mankind. Examples of regulatory quackery include, the electronic medical record, pre-authorizations with all out, implacable resistance to paying for any care, including cheap generic medications, almost all accreditation standards, privacy destroying patient registries, such as those for pain medications, pseudo-scientific and false practice guidelines.

Nurse practitioner programs are so competitive that only people with nearly perfect grades get in. Most qualify to get into medical school. They have chosen to bypass that harder road to clinical competence, to begin making money earlier, and with less student debt. That corner cutting should not be rewarded with independent prescribing privileges.

As a result, they know one quarter that specialists know, and half as much as primary care physicians. They are fit only to prescribe for patients doing well, needing routine refills without any change. They are fit to diagnose routine, common and mild disorders. They are fit to administer first aid and nursing care.

New patients with serious or life threatening conditions should not be evaluated by them. They can read off checklists, but have none of the skills that come from the experience of doctors.

Even after 5 years of experience, because they have not been challenged by difficult experiences of physicians, they will require supervision.

A patient commented on the internet. A nurse practitioner insistently called the growing lesion on his arm  an "age spot" for a year. The patient demanded to see the dermatologist. The doctor arrived at the door, and from that distance, stated, “That is a squamous cell carcinoma. It has to come out.” Squamous cell carcinoma is a common skin lesion in the elderly.