Assessing the 2011 Legislative Session

Now that the regular legislative session has wrapped up for the year, the NCMS Government Affairs team is pouring through the 200+ bills related to health care and the practice of medicine to bring you a comprehensive update of the bills that moved in the General Assembly this year and how they will impact you and your patients.

As the 2011 Legislative Summary is assembled we will share sections in the weekly Bulletin.  This week we begin with a summary the 13 scope of practice bills that were filed this year all of which have the potential to impact patient safety in North Carolina.

SB 246 – Expand Pharmacists’ Immunizing Authority, Hartsell (R-Cabarrus)

Companion: HB 444

The role of pharmacists in administering immunizations was first discussed at the Joint Legislative Health Care Oversight Committee in October of 2010.  Early into the 2011 Session of the General Assembly, Senator Fletcher Hartsell (R-Cabarrus) filed SB 246 with the goal of expanding the authority of pharmacists in administering vaccinations and immunizations.  As filed, the bill would have allowed immunizing pharmacists to administer any CDC approved vaccination or immunization in the following manner:

  • At the request of any patient age 18 and over.
  • With parental consent of any patient age 14-17.
  • With a prescription order for any patient age 7-13.

With well-known opposition of the NCMS, the Academy of Family Physicians and the Pediatric Society the bill underwent a total of five re-writes before the end of Session in June.  The final draft of this legislation required a written protocol to be developed by the Division of Public Health and included the following expansion for any CDC approved vaccine or immunization:

  • With a prescription OR standing order for any patient age 18 and over.
  • Flu vaccines for any patient age 14 and older (those under 18 would require parental consent).
  • With a prescription order for any patient age 14-17.
  • No vaccinations or immunizations for patients 13 and younger.

The latest draft of this legislation received a favorable report by the Senate Health Committee following an amendment that involved the NC Medical Board in the protocol drafting process.  Following passage on the Senate floor, the House Health Committee heard SB 246 during the final week of Session but did not vote on the measure.  Due to continued objections by the Academy of Family Physicians, the House Health Committee under the leadership of Representative Mark Hollo (R-Alexander) appointed a sub-committee to evaluate the legislation. The subcommittee did not meet before adjournment. 

In the final days of session, one piece of this legislation was rolled into SB 609 – Facilitate Locum Tenens Physicians, which allows immunizing pharmacists to administer flu vaccinations to any individual age 14 and over.  This amendment was supported by the Academy of Family Physicians, the Pediatric Society and the NCMS.  However, the remaining provisions of SB 246 are eligible to be discussed in 2012.

HB 522 – Midwifery Licensing Act, Wilkins (D-Person)

Companion: SB 662

Following last year’s vote by the Midwifery Joint Committee against the licensure of Certified Professional Midwives (CPMs) the North Carolina Friends of Midwives pushed throughout the 2011 Session for the passage of either of their licensure bills.  Despite several NCFOM advocacy days, neither bill was heard in a health committee. However, both bills received approval by the Joint Legislative Committee on New Licensing Boards, making them eligible for consideration by the House or Senate Health Committee in the short session.

This legislation would propose to create a second licensing board to regulate midwifery in North Carolina, legalizing the independent practice of direct entry midwifery by CPMs. This bill would place no educational requirements on CPMS who become licensed prior to 2013, requiring only the credential of CPM as awarded by the North American Registry of Midwives (NARM), an advocacy organization for the group.  The legislation also fails to establish any licensure fee for CPMs, leaving many enforcement questions unanswered and places no limitations on the pregnancies which CPMs can attend.

SB 467 – Naturopathic Licensing Act, Hartsell (R-Cabarrus)

Companion: HB 847

The Naturopathic Licensure Act was introduced this year by a new sponsor, Senator Fletcher Hartsell (R-Cabarrus).  The bill sat quietly for many months before being discussed at the first meeting of the Joint Legislative Committee on New Licensing Boards in May.

This legislation proposes to create a new licensing board for Naturopathic Doctors in the state, of which there are approximately thirty practitioners who would be eligible.  The original bill provided no enforcement ability over those currently practicing natural medicine without a license, included many expansions of the scope of practice previously introduced in legislation and did not require adequate fees for the operation of the board.

SB 467 was heard in the Senate Health Committee during the final week of session and few questions were permitted, including those of physician committee members.  The NCMS held a lengthy discussion with those advocating for this legislation prior to it being heard in the Senate Finance Committee, and many NCMS proposed changes were made to the bill.  However outlying concerns of the NCMS and opposition expressed by other members of the medical community including Oncologists, Family Physicians, Chiropractors and Physical Therapists led the bill to be displaced during the final committee meeting and the legislation was placed into HB 773 – Studies Act of 2011. However due to the fees involved in this legislation, it is eligible to be considered in 2012 and is very likely to be debated a second time.

HB 878 – Study/Radiologist Assistant Licensure, Wainwright (D-Craven)

Companion: SB 672

This bill proposed to create an eleven member commission which would study the licensure and regulation of Radiologist Assistants within the state. Two of the eleven seats on the commission would be reserved for representatives from the physician community and the radiologist community.  Both HB 876 and its companion bill, SB 672, were incorporated into HB 773 – Studies Act of 2011, which is currently in conference committee negotiations.

HB 639 – Clinical Exercise Physiologist Licensure, M. Alexander (D – Mecklenburg)

House Bill 639 proposed to create a five member North Carolina Clinical Exercise Physiologist Licensure Board which would license and regulate Clinical Exercise Physiologists (CEP) within the state. One seat on the proposed licensure board is reserved for a physician.  Educational requirements include a master’s degree and passage of the CEP exam administered by the American College of Sports Medicine.  This bill was referred to the House Health Committee.  However, before the Health Committee can hear the bill, it must be reviewed by the Legislative Joint Committee on New Licensing. This did not happen during Session. Due to the licensure fees required, HB 639 was not subject to the crossover deadline and is eligible for consideration in the short session next year.

HB 429 – Establish Music Therapy Practice Act, Insko (D-Orange)

House Bill 429 proposed to create a three member North Carolina Music Therapy Licensure Board which would license and regulate Music Therapists (LMT) within the state. Educational requirements include a bachelor’s degree and the passage of board certification exams.  This bill was approved by the Legislative Joint Committee on New Licensing and subsequently referred to the House Health Committee during the final week of session. The Health Committee never heard the bill.  Due to the licensure fees required, HB 429 was not subject to the crossover deadline and is eligible for consideration in the short session next year.

HB 753 – Establish Radiologic Technicians Licensure, Insko (D-Orange)

House Bill 753 is also referred to as the “NC Consistency, Accuracy, Responsibility and Excellence (CARE) in Medical Imaging and Radiation Therapy Act.” The bill proposed to create an eleven member North Carolina Medical Imaging and Radiation Therapy Board which would license and regulate Radiologic Technicians within the state. Two of the eleven seats on the board would be reserved for physicians (Radiologist and Radiation Oncologist).  Educational requirements include four years of education or the passage of an equivalent examination. This bill was approved by the Legislative Joint Committee on New Licensing and referred to the House Committee on Rules during the final week of session, likely where it would be incorporated into the 2011 Studies Act. However, as of the last night of session, HB 753 had yet to be incorporated into the Studies Act.  Due to the licensure fees required, HB 753 was not subject to the crossover deadline and is eligible for consideration in the short session next year.

SB 230 – Pedorthist Licensure, Hartsell (R-Cabarrus)

Senate Bill 230 proposed to create a seven member North Carolina Pedorthist Licensure Board which would license and regulate Licensed Pedorthists (LP) within the state. Educational requirements include a high school diploma and certification by the Board for Certification in Pedorthics (BCP).  This bill was introduced by Senator Fletcher Hartsell (R-Cabarrus) and immediately referred to the Senate Finance Committee, chaired by Senator Hartsell. However, before the Finance Committee can hear the bill, it must be reviewed by the Legislative Joint Committee on New Licensing. This did not happen during Session. Due to the licensure fees required, SB 230 was not subject to the crossover deadline and is eligible for consideration in the short session next year.

HB 412 – Study Use of Alternative Medicine, Farmer-Butterfield (D-Wilson)

Representative Jean Farmer-Butterfield (D-Wilson) filed HB 412 with the goal of studying the use of alternative medicine in North Carolina. The bill calls on the Division of Public Health to work with the NC Medical Board to study if health care providers licensed in North Carolina should be allowed to practice alternative medicine when treating patients.  The bill was immediately referred to the House Rules Committee and was never discussed in that committee. The bill was incorporated into HB 773 – Studies Act of 2011, which is currently in conference committee negotiations.

 
 

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2 Comments

  • Kim Mosny, CPM

    CPMs have been licensed and regulated in the Commonwealth of Virginia for 6 years. We anxiously await the time when CPMs in our adjoining state of North Carolina are rightfully acknowledged as licensed professionals. As the only credential that REQUIRES the student to receive training specifically to provide midwifery care in the home setting, CPMs are uniquely trained and comprehensively prepared to attend birthing women who choose out of hospital birth care.

    Home birthing families deserve and want their midwives (CPMs) to be regulated with the assurance that such regulation will protect public health and safety and improve the integration of home birth midwifery into our maternity health care system.

    Thank you for the opportunity to comment.

    Kim Mosny, CPM [VA licenced]
    President of CMA
    Commonwealth Midwives Alliance

  • This note is to address inaccuracies in the above summary of H522, the Midwifery Licensure Act, to assure NCMS membership truly understands the situation.

    While it is true that the Midwifery Joint Committee, which is the licensing board for Certified Nurse Midwives in North Carolina, declined to propose a licensing methodology to regulate CPMs who are the primary care-provider to women who choose the home setting for birth in our state as requested by the House Select Committee on Licensing Midwives, this was primarily due to physician opposition to a woman’s inherent right of self-determination in selecting the setting for birth and her attendant. It is important to know that the CNMs that serve on the MJC voted to proceed, along with one representative from the Board of Nursing.

    Next, the North American Registry of Midwives (NARM) is not an advocacy organization, it is the credentialing organization for CPMs. NARM establishes the knowledge, skills and experience requirements to achieve the CPM credential that is accredited by the Institute for Credentialing Excellence (formerly the National Commission for Certifying Agencies) which also accredits the CNM credential and many others in the healthcare field.

    It is incorrect to state there are no educational requirements for CPMs prior to 2013. There are two education/training pathways to attain the CPM credential: 1) the Portfolio Evaluation Process which is a very formal apprenticeship, and 2) graduation from a Midwifery Education and Accreditation Council (MEAC) accredited school. Both pathways must meet the same knowledge, skills and experience requirements and there are over 800 curricula topics that the student midwife must master in the didactic component. Irrespective of training pathway, CPMs must pass rigorous knowledge and skills examinations. MEAC schools are accredited by the US Department of Education. Approximately half of newly credentialed CPMs graduate from MEAC schools and half through the PEP pathway. While we do not evaluate either pathway as producing better midwives, we see a potential benefit to transition to MEAC for long term integration.

    Also, it is inaccurate to state that licensing fees are not specified. It is clearly stated in the bill language that the cost of regulation shall be offset by licensing fees. The cost of regulation is expected to vary over time and therefore numerical values should not be specified.

    Finally, the NCMS membership should know that our state stands out in the region as the least safe state in the Southeast for women who choose midwifery care and the home setting for birth. We have women crossing state lines seeking care from licensed CPMs in our neighbor states of VA, TN and SC, we are not managing intrapartum transfers, women fear hostility and antagonism should they transfer, the primary care provider is unregulated and rates of planned home birth are accelerating in our state and all across the United States. This environment is unacceptable and the only way for any state to manage home birth is to license and regulate CPMs. We will continue working until this is addressed.

    I look forward to the debate in the Health Committees of the House and Senate.

    Russ Fawcett
    Vice President, North Carolina Friends of Midwives