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From YouTube: House Standing Committee on Licensing, Occupations, & Administrative Regulations (3-9-22)
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A
C
C
D
Welcome.
Thank
you,
mr
chairman,
appreciate
you
having
me
here
and
and
letting
me
present
this
important
bill
appreciate
all
these
people
coming
to
watch
me
present.
This.
D
Maybe
they
might
be
here
for
a
different
reason.
Mr
chairman,
this
is
just
a
very
simple,
simple
legislation
that
basically
allows
the
ophthalmic
dispensers
to
be
able
to
set
their
fees
by
their
own
board.
We've
done
quite
a
few
of
these.
I
think
most
of
your
members
are
are
familiar
with
them,
and
the
ophthalmic
dispensers
would
like
to
be
included
this
time.
Also.
E
B
C
Floor
is
yours,
please,
have
your
guests
introduce
yourself
themselves.
F
C
F
Mr
chairman,
again
I'm
pleased
to
present
house
bill
354
today,
and
I
have
with
me
representative,
patty
mennor,
who
is
the
primary
co-sponsor.
We
also
have
40
other
co-sponsors
on
this
bill
and
I
see
quite
a
few
that
are
on
this
committee,
and
I
want
to
thank
you
for
your
sponsorship
of
this
legislation.
F
We
strongly
support
this
legislation
because
of
our
concern
that
kentuckians
across
the
commonwealth
do
not
have
access.
They
need
to
quality
health
care.
I
know
personally
that
advanced
practice
registered
nurses
provide
the
kind
of
health
care
because
my
family
and
I
see
a
nurse
practitioner
for
our
primary
care.
F
Like
all
of
you,
I'm
very
concerned
about
the
opioid
epidemic
in
our
commonwealth,
I
would
not
be
bringing
this
bill
if
I
thought
that
there
was
any
outcome
of
this
legislation
that
would
add
to
that
problem.
House
bill
354
does
not
increase
the
number
of
aprn
prescribers
of
controlled
substances
or
opioids.
F
F
F
In
response
to
a
recommendation,
and
in
my
working
with
the
speaker,
we
were
able
to
add
an
important
component
that
is
included
in
the
committee
substitute.
We
add
a
board
here
that
has
teeth
to
look
at
the
those
prescribers
of
opioid
opioids
in
this
state,
and
I
think
this
is
a
good
addition
to
this
bill.
F
We'll
hear
people
talk
about
the
opioid
epidemic
and
those
writing
prescriptions,
and
this
is
a
good
first
start
to
enforcing
that,
finding
those
that
are
responsible
for
that
and
then
reporting
those
individuals
to
their
respective
boards,
and
I
think
it
was
a
good
recommend,
a
good
addition
to
this
bill
and
I
strongly
support
it.
F
We
believe
that
this
additional
oversight
will
give
us
a
greater
comfort
level
that
controls
substances
prescribing
is
being
carefully
monitored
by
the
board,
as
actions
are
tracked.
In
addition,
in
the
committee
substitute
there's
language
that
representative
mccoy
suggested
to
me,
I
looked
at
it
talked
with
the
folks
involved
and
believed
that
that
was
good,
a
good
addition
to
the
bill,
and
that
was
added
to
the
committee
substitute
as
well
and
is
before
you.
My
goal
is
to
make
this
a
strong
bill
that
helps
the
folks
in
the
commonwealth
really
receive
the
care
they
need
before.
F
While
we
have
house
bill
354
before
us
before
you
today
and
you'll,
be
voting
on
this
you've
actually
voted
on
this
issue.
Twice
before,
with
the
executive
orders
issued
by
the
governor
in
march
april
of
2020
and
again
in
the
special
session
of
september
2021.,
we
passed
legislation
or
we
passed
the
executive
orders
and
and
put
those
in
place
allowing
nurse
practitioners
to
write
controls,
substance
prescriptions
from
un
from
being
on
not
being
under
the
kappa
cs.
F
There
are
s,
and
folks
will
talk
about
their
wanting
data
and
that
they
can
quantify
that
by.
We
have
seven
quarters
seven
quarters
of
casper
reporting
data
that
indicates
that
there
was
no
substantial
increase
in
the
number
of
of
control
substance
prescriptions
written
by
aprns,
so
that
data
is
there
seven
quarters
since
march
of
2020,
and
there
is
no
evidence
to
suggest
that
passing
this
legislation
today
will
be
a
problem.
H
H
Just
a
few
miles
from
the
clinic
I
now
co-own,
I
chose
to
become
a
nurse
practitioner
after
watching
my
mother
endure
four
difficult
years
of
breast
cancer
treatment
surrounded
day
and
night
by
a
dedicated,
well-educated
and
skilled
nursing
staff
who
stood
by
her
in
hospitals,
infusion
clinics,
radiation
treatment
facilities
and
eventually,
on
her
hospice
bed
20
year
old
me,
then,
a
biology
and
chemistry
major
had
seen
enough
medicine
first
hand
to
know
that
holistic,
nursing
practice,
not
medicine,
was
what
I
wanted
to
do
with
my
life.
It
is
more
than
my
vocation.
H
H
We
chose
nursing
because
we
care
we
chose
nursing
because
we
are
skilled
and
well
educated
and
many
of
us
with
terminal
doctorate
degrees
and,
like
70
percent
of
my
colleagues,
who
recently
responded
to
a
survey
from
our
association
about
their
practice
environments.
In
recent
years
I
live
and
or
work
within
50
miles
of
the
place
of
my
birth
kentucky
aprns,
like
many
of
you,
are
literally
taking
care
of
the
folks
back
home.
H
C
H
I
currently
practice
in
a
multi-disciplinary
clinic
providing
a
full
array
of
primary
care
services,
including
the
management
of
opioid
use
disorder
with
a
mental
health
nurse
practitioner
and
a
certified
drug
and
alcohol
counselor.
We
provide
case
management
and
counseling
services,
and
today
we
celebrate
a
milestone
of
our
seventh
patient
in
the
last
18
months
to
hit
her
one
year.
H
In
its
current
version
house,
bill
354
has
42
co-sponsors
on
the
house
floor
alone.
This
is
important
legislation
to
improve
access
to
care,
as
according
to
the
national
health
resource
and
service
administration.
One
more
than
1.4
million
kentuckians
live
in
a
designated
health
provider
shortage
area.
H
H
Let
me
alleviate
any
fears
you
may
have
heard
about
this
bill
by
providing
you
with
a
few
facts
house
bill.
354
is
not
a
scope
of
practice.
Expansion
prescribing
controlled
substances
has
been
within
our
scope
for
16
years.
We
have
always
been
and
will
continue
to
be,
held
accountable
for
our
own
actions
under
the
law.
H
H
Even
our
own
office
of
drug
control
control
policy
has
issued
public
warnings
about
illicit
and
synthetic
fentanyl
products
and
other
street
drugs.
Fear
kentucky
has
a
drug
problem.
Aprns
make
it
worse
fact.
It
is
well
documented
that
purdue
pharma
and
other
opioid
manufacturers
targeted
states
like
vermont,
west
virginia
and
kentucky
due
to
our
high
populations
of
coal
miners
and
manual
laborers.
And
yes,
we
are
still
seeing
the
aftermath
of
over-prescribing
of
opioids
from
the
1990s
and
early
2000s,
but
this
happened
before
aprns
in
kentucky
even
had
prescribing
privileges
for
controlled
substances.
H
H
This
bill
does
not
eliminate
the
kappa
cs
for
new
nurse
practitioners
in
their
first
four
years
of
practice,
which,
by
the
way,
is
the
longest
transition
to
independent
prescribing
of
any
state
with
prescribing
agreements
house
bill
354
does
not
change
the
hard
stops
already
in
law
surrounding
schedule.
2
opioid
prescriptions
that
have
been
in
place
since
2006,
including
prescribing
limits
set
forth
in
previous
legislation.
H
It
does
not
interfere
with
any
employer
or
hospital
contract
for
employment
agreements
with
an
aprn.
It
does
not
increase
access
to
opioids
house
bill.
354
does
not
eliminate
any
regulatory
oversight
on
aprns,
but
it
does
mandate
a
review
of
licensure
and
a
designation
of
good
standing
by
the
kentucky
board
of
nursing
before
the
kappa
can
be
lifted.
H
H
The
general
assembly
voted
twice
during
those
22
months
to
extend
executive
orders
allowing
nurse
practitioners
to
prescribe
without
the
kappa
when
compared
to
the
previous
two
years
of
data.
There
was
no
significant
difference
in
the
average
number
of
opioid
prescriptions
written
by
aprns.
Without
the
kappa
in
place.
H
H
H
That's
35
220
fewer
patients
with
dirty
needles
on
the
street,
spreading
hiv
or
hepatitis.
That's
35
220
families
with
the
opportunity
to
reconnect
to
their
loved
ones
on
the
road
to
recovery,
35
220
potential,
new
members
of
the
workforce
that
kentucky
so
desperately
needs
house
bill
354
will
maintain
kentucky
aprns
as
master
account
holders
in
casper.
The
state
prescription
drug
monitoring
program,
where
prescribing
reports
will
be
routinely
reviewed
and
generated
with
this
bill.
C
C
H
Okay,
physicians
wrote
1.9
million
prescriptions
for
schedule,
2
opioids
in
2021
alone,
averaging
198
prescriptions
each.
This
was
actually
down
22.8
percent
from
their
previous
year.
For
that
same
time
period,
the
number
of
aprns
in
kentucky
nearly
doubled
and
our
average
number
of
prescriptions
dropped
from
152
to
99..
H
That's
a
drop
of
34.9
percent,
but
we
still
have
a
need
for
providers
in
kentucky.
According
to
the
hipsa
data,
this
bill
does
not
add
new
prescriptions,
but,
as
representative
weber
mentioned,
it
does
create
a
new
advisory
panel
for
prescriber
oversight,
headed
up
by
the
office
of
inspector
general.
H
What
house
bill
354
does
is
simply
this.
It
allows
safe
and
judicious
apr
and
prescribers
in
good
standing
with
the
board
of
nursing,
to
request
permission
to
eliminate
barriers
to
patient
care
that
has
zero
scientific
evidence
of
improving
outcomes
or
decreasing.
The
cost
of
health
care
in
our
state.
H
G
Okay,
so
thank
you,
chairman
and
committee
members
for
allowing
us
to
speak
today.
I've
already
been
introduced,
so
I
will
cut
that
part
out.
I've
practiced
in
adair
county
for
the
past
30
years,
where
I
own
a
practice.
My
clinic
provided
nearly
7
000
visits
in
the
past
year,
medicaid
and
medicare
patients
make
up
72
percent
of
my
practice.
I
provide
primary
care
to
children,
adults
and
elders,
and
I
manage
acute
chronic
health
conditions
and
provide
health,
education
and
preventive
care.
G
I
would
like
to
share
with
you
a
story
about
one
of
my
patients
that
kind
of
illustrates
the
the
type
of
of
care
that
we
give.
A
long-time
patient
of
mine
came
to
me
because
he
was
having
abdominal
pain.
I
examined
him
ordered
some
tests
and
it
turned
out.
He
had
advanced
cancer.
We
discussed
his
condition
and
he
declined
any
treatment
because
he
said
he
wanted
to
enjoy
the
rest
of
his
life
without
suffering
the
effects
of
chemo.
G
So
he
asked
me
if
I
would
treat
his
pain,
which
I
did.
He
also
declined-
referral
to
hospice
on
subsequent
visits.
His
pain
was
controlled.
He
enjoyed
spending
christmas
with
his
family
and
celebrated
the
birth
of
a
grandson
after
new
year's,
his
pain
worsened
and
he
became
weak
and
he
agreed
to
go
to
hospice,
but
only
if
I
would
continue
to
provide
care
for
him.
Hospice
laws
authorized
nurse
practitioners
to
be
attending
providers
for
hospice
patients,
so
I
was
able
to
continue
his
care
and
then
my
patient
died
two
weeks
later.
G
Nurse
practitioners
have
taken
a
big
step
to
open
a
practice.
They
have
invested
their
own
money
or
taken
out
significant
small
business
loans.
I
had
to
borrow
a
hundred
and
twenty
five
thousand
dollars
to
open
my
practice,
it's
expensive
to
purchase
medical
equipment
and
pay
staff,
and
it
can
take
up
to
three
months
before
insurance
companies
begin
reimbursing
for
services.
G
Some
insurers
have
refused
to
credential
and
reimburse
nurse
practitioners
unless
the
collaborating
physician
is
also
credentialed
with
that
insurer,
and
this
is
another
way
that
the
kappa
cs
requirement
blocks
access
to
care.
Nurse
practitioners
live
in
fear
that
they
will
lose
their
kappa
cs,
because
the
physician
withdraws
charges
a
fee.
They
can't
afford
moves
out
of
state
or
passes
away,
and
this
has
happened
to
nurse
practitioners
that
I
know
losing
the
kappa
cs
means
losing
the
practice.
It
means
patients
will
not
get
the
care
that
they
need.
G
It
means
economic
loss
to
the
community,
because
the
staff
that
the
nurse
practitioner
has
employed
lose
their
jobs,
and
I
can
also
tell
you
that
if
I
were
to
lose
my
kappa
cs,
no
local
physician
would
sign
an
agreement
with
me
and
it's
not
because
they
don't
like
me.
We
get
along
really
well.
In
fact,
I
can
call
any
of
them
anytime
that
I
need,
but
I'm
competition
and
that's
pure
and
simple.
G
The
reason
house
bill
354
is
not
just
about
prescribing
scheduled
drugs
and
you
might
ask
if
a
nurse
practitioner
has
authority
to
prescribe
non-scheduled
drugs
independently.
Why
would
they
lose
their
practice?
The
answer
is
because
to
purchase
flu
vaccine
injectable
antibiotics
syringes
and
other
necessary
supplies
for
medical
supply
companies,
or
to
have
your
prescriptions
for
non-scheduled
drugs
accepted
by
some
out-of-state
mail-order
pharmacies.
You
must
have
a
dea
number
under
current
law
kentucky
nurse.
Practitioners
must
have
a
kappa
cs
in
order
to
get
a
dea
number.
G
During
the
two
years
of
the
covid
pandemic,
nurse
practitioners
were
not
required
to
have
a
kappa
cs
to
prescribe.
We
demonstrated
that
we
were
prudent,
prescribers
of
controlled
substances.
We
are
not
afraid
to
have
our
prescribing
record
examined
by
a
review
panel,
as
described
in
the
committee
substitute
passage
of
house
bill.
354
will
allow
nurse
practitioners
to
improve
access
to
quality
care
studies
from
states
that
grant
nurse
practitioners
authority
to
prescribe
to
prac.
G
C
I
C
I
E
She
answered
my
questions.
My
statement
very
very
brief.
Yes,
sir,
is-
and
I've
said
in
this
committee
before
aprns-
are
the
general
practitioners
of
the.
When
I
was
young
like
in
the
50s
and
60s,
we
had
general
practitioners.
A
lot
of
them
made
house
calls
if
you
want
access,
quick
access
to
health
care.
Today,
it's
aprns
you
look
to
thank
you.
C
Thank
you.
We're
representing
miller
were
those
offices
all
in
black
and
white
okay.
J
Thank
you,
mr
chair,
thank
you
for
your
testimony
today.
I
just
I
have
a
couple
of
questions.
I
I
know
that
you
ran
through
the
bill
and
I
think
I
think
I
just
want
the
committee
and
all
who
are
watching
to
understand
specifically
what
this
does
so.
Can
you
explain
exactly
what
lifting
the
kappa
cs
does
you
know
we
we
heard
about
the
expansion
of
practice.
H
It's
not
an
expansion
of
practice,
because
this
is
already
within
our
practice,
scope.
The
thing
that
this
does
is
eliminates
the
agreement.
It
doesn't
change
anything
else.
The
nurse
practitioners
who
are
new
will
still
have
four
years,
collaborating
with
the
physician
before
they
will
be
able
to
apply
for
the
good
standing
review
by
the
board
and
then,
if
they
are
deemed
in
good
standing,
then
that
agreement
with
the
physician
would
go
away,
but
they
would
continue
prescribing
under
the
same
rules
and
the
same
statutory
limits
that
are
already
in
place.
J
If
I
may,
mr
chair,
is
this
an
option,
or
is
this
an
automatic
roll-off
of
the
kappa
cs
after
four
years?
No.
H
It
is
not
automatic,
it
is
a
process,
they
will
have
to
apply
to
the
board
and
the
board
will
have
to
grant
that
permission
after
the
review.
Okay,
so.
G
You
can
but,
but
you
have
to
find
somebody
to
sign
that
agreement
and
that's
not
always
easy
plus
if,
if
something
happens
to
the
physician
or
the
physician
withdraws
you're,
suddenly
there
with
a
practice
and
not
able
to
do
some
of
the
things
that
you
need
to
do.
That's.
H
Another
good
point
actually,
because
if
something
happened
to
the
physician
or
the
physician's
license,
and
the
nurse
practitioner
is
put
in
jeopardy,
even
if
she's,
not
in
the
same
town
in
the
same
city
or
just
by
being
attached
to
a
collaborator,
if
the
collaborator
loses
their
license
or
has
an
accident
or
is
suddenly
unavailable
or
dies
that
nurse
practitioner
practice
is
then
put
in
at
risk.
Well,.
G
J
This
help
recruit,
do
you
think,
physicians
to
rural
areas
and
and
some
of
the
underserved
areas
I
mean
I.
It
looks
to
me
that
eliminating
the
kappa
cs
will
increase
competition,
as
as
you
alluded
to
so
I'm
concerned
about
the
the
lack
of
physicians
in
underserved
areas
as
well,
and
I
I
just
don't
see
that
this
will
be
very
encouraging
to
individuals
who
are
in
medical
school
and
are
looking
to
provide
primary
care.
That's
that's
one
of
my
concerns,
but
you
know
I,
I
guess
I'll
just
go
ahead
and
answer
my
first
question.
J
C
K
K
K
The
one
question
that
comes
to
our
mind
about
putting
in
place
this
panel
that
has
been
suggested
despite
well
intended
is
this
question
shouldn't
the
board
already
be
doing
those
things,
and
I
think
that's
a
question
for
legislators
to
consider
when
they
look
at
the
regulatory
boards
and
they
look
at
how
they
manage
the
prescribing
patterns
and
behaviors
of
their
licensees
about
how
are
they?
How
are
they
regulating
that?
How
are
they
overseeing
that
and
why
is
it
necessary
to
put
in
place
another
panel
to
do
what
their
board
should
already
be
doing?
K
I'm
not
suggesting
that
there
is
a
problem,
but
that
is
a
question
to
be
asked
before
we
put
in
place
another
set
of
bureaucracy
to
take
a
look
at
that.
The
other
thing
I
want
to
point
out
is
that
I
think
there
were
some
references
to
casper
numbers
showing
consistently
that
their
numbers
are
going
down.
K
This
is
clear:
we
have
a
real
disagreement
about
what
casper
numbers
actually
say,
because
we
have
casper
numbers
that
show
that
they
are
consistently
up
way
up
over
the
course
of
a
lot
of
years,
and
so
maybe
a
starting
point
for
both
groups
is
to
get
together
and
compare
their
numbers
and
see
how
we're
analyzing
those
numbers,
because
we've
been
very
consistent
in
using
raw
casper
numbers
since
2011,
which
is
a
year
prior
to
house,
bill
1.
house
bill
1.
K
There's
been
one
group
that
has
been
up
while
dentists
and
physicians
have
come
down,
and
so
we
need
to
have
a
very
serious
look
at
what
numbers
we're
looking
at,
how
we're?
How
we're
using
those
numbers,
how
we're
analyzing
those
numbers.
But
I
will
say
this-
is
that
we
cannot
support
anything
that
looks
to
eliminate
the
kappa
cs.
You
heard
a
lot
about
access.
I
challenge
committee
members
to
take
a
hard
look
at
the
legislation
and
look
in
there
to
see
where
are
their
provisions
to
address
high
blood
pressure?
K
Where
are
their
provisions
to
deal
with
obesity?
Where
are
their?
Where
are
their
provisions
to
deal
with
a
lot
of
the
chronic
conditions
that
we
face
as
a
population
here
in
kentucky
I'll?
Give
you
a
preview?
You
won't
find
it
because
this
bill
is
exclusively
about
one
thing
and
that
is
controlled
substances
and
that
concerns
us
from
a
public
safety
point.
I
know
there's
a
lot.
Historically,
it's
a
turf
war
right
competition.
K
Doctors
are
worried.
One
of
the
reasons
you
can't
see
your
primary
care
physician
as
quickly
as
what
you
like
is
because
there
is
a
lot
of
business
to
go
around
right
now.
I
haven't
heard
one
of
my
members
approach
me
and
say:
I'm
opposed
to
this
bill
because
it's
putting
me
out
of
business,
I
just
haven't
heard
that
so
there's
enough
business
to
go,
go
around
it's
not
a
it's,
not
a
turf
war.
It
is
a
public
health
issue
and
the
cdc
numbers
bear
that
out.
K
Kentucky
is
now
ranked
third
in
the
nation
for
overdose
deaths.
It's
up
55
percent
in
our
state,
and
I
want
to
make
something
very
clear
here
because
it
was
referenced
and
I
think
attention
was
given
to
in
the
previous
testimony
we're
not
blaming
nurse
practitioners
for
that
increase
in
those
overdose
deaths.
It's
a
nice
talking
point,
but
that's
not
what
we're
doing
what
we're
doing-
and
mr
dr
fletcher
is
correct-
is
that
a
lot
of
this
is
synthetic
opioids
coming
from
out
of
the
country.
We
we
acknowledge
that.
K
But
what
message
do
we
send
at
the
height
of
our
opioid
epidemic,
to
where
we're
looking
at
a
bill
and
removing
what
can
be
a
legitimate
check
and
balance
to
control
the
flow
of
these
very
serious
medications
when
we
still
are
looking
at
numbers?
At
that
degree,
we
think
it
runs
counter
to
what
the
general
assembly
has
done
for
the
last
10
10
years
in
passing,
legislation
trying
to
deal
with
the
opioid
use
disorder
that
we
face.
K
Numerous
pieces
of
legislation
have
been
passed
to
fix
that
problem,
to
rectify
what
we're
seeing,
and
so
we
think
that
sends
the
wrong
message
and
we
do
want
to
take
up
the
executive
order.
K
First
of
all,
it
wasn't
extended
the
last
time
it
was
extended
before
it
was
put
in
place,
and
we
see
that
more
as
not
a
permission
to
do
these
things.
It
was
a
two-year
opportunity,
a
two-year
opportunity
that
we
believe
that
they
missed,
because
two
things
were
apparent.
Our
numbers
say
that
their
prescriptions
went
up
during
that
time
during
a
time
when
they
actually
probably
saw
less
patients
and
offices
were
closed
because
of
covet,
so
the
numbers
naturally
should
have
been
down,
but
they
went
up.
K
The
other
thing
that
was
recently
testified
to
in
another
committee
by
the
executive
director
of
the
board
of
nursing
or
excuse
me,
the
kentucky
nurses
association-
is
that
if
you
eliminate
the
kappa
cs,
we
will
be
welcoming
2
000
nurse
practitioners
home
to
kentucky
well
for
two
years
that
opportunity
also
was
there.
Did
we
see
a
mass
influx
or
relocation
of
nurse
practitioners
to
kentucky?
K
The
kappa
cs
is
not
a
barrier
it
just
isn't,
because
while
we
didn't
see,
2000
nurses
come
home
to
kentucky.
We
have
seen
a
very
steady
increase
of
nurse
practitioners
practicing
in
kentucky
and
I'll
be
the
first
to
say.
That's
a
good
thing,
that's
a
very
good
thing
and
they've
done
it
with
the
kappa
cs:
they're,
not
decreasing
in
numbers.
This
is
not
a
barrier.
K
They
can
currently
locate
anywhere.
They
want
to,
within
the
state
of
kentucky,
to
set
up
a
practice,
they're
right,
they're,
independent,
except
with
respect
to
the
kappa
ces.
So
they
can
locate
there.
They
can
open
up
a
practice
they
can
treat,
they
can
diagnose,
they
can
prescribe,
but,
as
we've
shown
you
through
some
geo
mapping
that
hopefully
you
received
yesterday
that
nurse
practitioners
will
locate
largely
like
a
lot
of
other
provider
groups
in
the
metropolitan
areas,
and
so
what
does
this
mean?
K
It
means
this,
whether
it's
aprns
pas
dentists,
pharmacists,
ots,
ats,
pts
every
other
group.
What
it
means
is
that
this
effort
over
the
last
20
to
25
years
to
expand
scope
to
fix
the
access
problem
has
not
worked.
It's
a
failed
policy.
That's
been
tried
and
has
failed.
Quite
simply
I'll.
Leave
you
with
this.
We
cannot.
We
cannot
scope
of
practice
our
way
out
of
the
access
issues,
but
there
are
constructive
solutions
and
I'll
point
to
house
bill.
573.
K
representative
moser
has
filed
that
it's
about
a
loan
forgiveness
program
that
we've
been
working
with
her
on
before
the
session
even
started,
and
here's
who
it
benefits.
You
may
be
thinking
well.
This
is
going
to
help
physicians,
forgive
their
loans.
Physicians
are
a
part
of
it,
but
so
are
nurse
practitioners,
so
our
pas,
so
our
dentist
and
a
whole
host
of
other
health
care
providers
that
we
wanted
to
keep
in
there
to
truly
try
to
solve
the
axis
problem.
This
is
not
the
solution.
C
Absolutely
representative
bradshaw:
do
you
have
a
question
for.
B
Yes,
I
do
first
say
hello
to
whitney
she's
one
of
my
favorite
people
to
ever
deal
with
so.
B
K
So
what
it's
really
intended
to
do?
It's
really
intended
to
be
a
two-way
street.
It's
not
supposed
to
be
punitive
to
the
nurse
practitioner.
We
have
always
said,
because
we've
heard
from
our
members
that
the
kappa
cs
can
be
as
beneficial
to
the
physician
as
it
is
the
nurse
practitioner
notice.
We
don't
say
supervision
agreement,
we
say
collabor
collaborative
agreement,
it's
a
true
collaboration.
K
So
what
it's
meant
to
do
is
it's
meant
to
talk
discuss
if
there
are
questions
establish,
maybe
some
parameters
around
that
it.
B
K
B
I
mean:
is
it
a
requirement
that
there's
there's
there's
they
work
together.
K
K
Absolutely
anytime
a
physician
either
supervises
or
collaborates,
there's
going
to
be
massive
liability,
and
that's
one
thing
that
we've
noticed
when
there
have
been
issues,
whether
testosterone
or
other,
controlled
substances
and
there's
lawsuits
filed
oftentimes.
The
nurse
practitioners
brought
in,
but
they
also
target
directly
at
the
physician,
because
you
know
that's,
that's
they're
brought
into
it
because
they're
a
part
of
that
collaborative
agreement.
Now
one
thing
you
may
be
referencing
is
that
you
hear
a
lot
about
well,
they
charge
a
lot
for
these
collaborative
agreements,
and
it's
extortion.
K
I'll
say
this
about
some
of
the
comments
that
were
made
about.
Oh,
if
someone
dies
and
we
lose
our
collaborative
agreement
or
what
we're
being
charged.
We
have
consistently
asked
for
that
data
and
we
have
consistently
not
seen
it
so
we've
kind
of
taken
at
face
value
that
these
problems
exist
and
we've
tried
in
the
past
to
work
around
those.
But,
to
be
honest
with
you,
we've
never
seen
the
data
showing
where
massive
amounts
of
nurse
practitioners
have
lost
their
their
collaborator
and
their
practices
to
shut
down.
K
K
Again,
I
haven't
seen
numbers
showing
that
these
wild
amounts
that
are
being
charged.
I
would
suspect
that
if
there
is-
and
I
say
if-
because
I
can't
verify
that
that
it's
it's
rare,
it's
isolated
and
we
would
say
again
that
that
needs
to
be
dealt
with
by
the
respective
boards,
but
that's
why
we
think
a
stronger
collaborative
agreement
is
necessary,
not
one
that
gets
phased
out
and
the
other
thing
I'll
point
out
about
the
bill
is
that
they
talk
about
well.
A
new
nurse
practitioner
would
have
four
years
well
notice
in
the
bill.
K
They
also
eliminate
the
one-year
moratorium
for
new
nurse
practitioners
notice
that
language
is
struck
out
of
the
bill.
Currently
they
have
to
wait
a
year
before
they
can
do
that.
That
language
has
been
struck.
So
a
new
nurse
practitioner
could
come
out
and
immediately
start
prescribing
control
substances
with
a
kappa
cs.
Physicians,
don't
even
have
that
ability.
E
You,
mr
chair,
thank
you
corey
for
being
here
and
just
a
very
simple
question:
do
you
feel
aprns
are
medically
qualified
to
prescribe
controlled
substances.
K
We
know
that
they
receive
some
education
in
training
in
that
area,
but
we
do
feel
like
that.
It
is
value
added
when
it
is
in
collaboration
with
a
physician
who
also
has
an
extensive
amount
of
education
and
training
as
well.
We
think
that
is
a
partnership
that
works,
especially
in
an
area
as
serious
as
controlled
substances
again.
This
is
the
bill
is
exclusively
on
that
subject,
and
so
we
feel
like
that.
Partnership
is
what
is
required
to
make
sure
it's
in
check.
No
did
they
create
the
problem?
E
And
I
appreciate
that
answer
and
I'll
tell
you
I'm
certainly
not
a
medical
professional,
but
I
will
share
with
you
my
experiences
with
opioids,
I'm
an
amputee
and
I
have
some
chronic
pain
issues,
nerve,
pain
issues.
Luckily,
for
me,
they're
minor,
but
I
used
to
play,
played
competitive
disabled
golf
traveled
around
the
country.
You
know
my
experiences
in
the
1990s,
all
the
amputees,
brachioplexus
type
injuries.
E
Pill,
bottles
that
were
given
to
us
for
chronic
pain
and
I've
seen
a
lot
of
people's
lives
destroyed
and
your
profession
profession
doesn't
have
a
good
track.
History
on
that,
and
I
just
want
to
point
that
out.
E
C
You
last
is
representative
banta,
then
we're
going
to
vote.
I
I've
I've
been
on
this
bill
now
as
a
co-sponsor
for
a
few
years,
and
I
only
have
an
aprn.
I
don't
have
a.
I
don't
have
a
doctor
and-
and
I'm
very
happy,
but
you
know
I
don't
even
ask
for
an
aspirin.
I
So,
but
my
question
is
when
I,
when
I
speak
to
people
that
are
involved
in
this,
I'm
like
why
can't
you
guys
meet
and
come
together
and
talk
about
this
so
every
year
we
aren't
battling
this
out,
and
the
answer
I
got
is
that
doctors
aren't
really
willing
to
meet
with
them.
So
is
there
ever
a
way
you
guys
can
all
get
together
and
duke
it
out.
K
If,
if
there
is
one
thing,
I'm
generally
pretty
diplomatic
in
my
responses
by
design,
but
this
is
one
that
I
will
certainly
push
not
at
your
question.
It's
a
valid
question.
I
will
push
back
as
hard
as
I
possibly
can
on
anyone
who
says
that
kma
has
ever
turned
down
a
meeting
been
willing
to
discuss
or
offer
solutions.
K
In
fact,
when
this
was
a
senate
bill
last
year
we
proposed
two
different
options:
number
one
get
rid
of
the
collaborative
agreement
and
go
under
the
kbml
and
be
regulated
like,
like
the
physicians,
are,
let's
get
this
all
under
one
board
rejected
option
two:
let's
strengthen
the
collaborative
agreement
and
have
a
list
of
safeguards
that
we
can
put
in
place
and
if
we
do
that,
we'll
phase
it
out
after
a
certain
number
of
years,
we
didn't
like
four
we
suggested
eight.
Is
that
negotiable?
K
Yes,
along
with,
as
long
as
it's
comprehensive
safeguards
that
makes
sure
that,
while
that
kappa
cs
is
in
place,
it
is
meaningful
and
not
a
a
worthless
piece
of
paper.
Like
the
nurse
practitioners
have
consistently
said
it
is
so
put
some
teeth
to
it
and
then,
after
a
number
of
years
it
can
phase
out
so
we're
willing
to
meet.
We've
always
been
willing
to
meet,
and
I
want
to
tell
you
all
any
suggestion.
Otherwise
is
just
disingenuous.
I
B
I
E
F
E
J
Explain
my
vote,
please.
Yes,
I
am
a
no.
I
am
concerned
that
this
will
further
erode
the
partnership
and
the
collaboration
that
we
see
now
in
patient
care
and-
and
I
am
greatly
concerned
that
this
will
further
diminish
the
number
of
physicians
that
we
have
in
the
state.
J
I
am
a
nurse.
I
completely
understand
the
value
of
our
great
nurses
and
I
appreciate
all
of
the
service,
but
I
really
am
concerned.
I
mean
about
a
lot
of
things.
We've
been
a
lot
of
I've
been
part
of
this
conversation
for
a
long
time,
and
I
do
understand
that
there
have
been
some
offers
to
to
really
make
the
collaborative
agreement
better,
stronger
and
protect
nurses.
J
I'm
just
concerned
that
there
really
hasn't
been
a
whole
lot
of
compromise
and
and
on
the
issue
of
nurses,
coming
back
to
kentucky
if
the
kappa
cs
is
lifted.
It's
I
mean
it's
a
bit
of
a
red
flag
to
think
that
nurses
are
coming
back
specifically
to
prescribe
controlled
substances,
but
anyway
I
I
can't
be
a
yesterday.
I
I
will
reserve
the
right
to
change
my
mind
on
the
floor.
If
some
changes
are
made
and
thank
you.
B
I
C
C
C
You
having
come
to
the
end
of
the
agenda
next
week,
we
will
meet
and
start
meeting
in
room
169,
so
don't
get
lost
and
okay
we'll
probably
meet
next
week
and
keep
your
ears
open
for
a
possible
special
meeting.