Patrick B. McGuigan
OKLAHOMA CITY – Saying he supports “something good that is actually doable,” the founder of the Oscar Romero Catholic Worker House in Oklahoma City is backing House Bill 1013, a measure he contends would open “a new portal to enter the medical care system. With independently practicing nurse practitioners, people would have better access to healthcare, especially lower income households and rural areas where it's difficult to retain physicians.”
H.B. 1013, sponsored by state Rep. Josh Cockroft, R-Wanette, is gaining increased attention. AJ Griffin, R-Guthrie, is the Senate sponsor. The proposal gained momentum last week with 12-2 passage in a House committee.
According to a House staff release, H.B. 1013 “would give full practice authority to nurse practitioners and advanced practice registered nurses, allowing them to provide health care services in line with their education and training without the requirement of a collaborative agreement with a physician.”
Cockroft says that under current requirements, “In many cases, there is no actual collaboration with the physician. This makes the requirement meaningless and only slows Oklahomans’ – particularly those in rural areas – access to valid health care services. It already is hard for those in rural areas to find adequate services, and frankly this rule hampers economic development in our rural communities.”
Cockroft’s idea has the enthusiastic backing of Bob Waldrop, a well-known church musician and Oscar Romero House founder who is known for his more-often-than-not liberal policy views.
He echoes the views of conservative reformers in a key respect, however, contending “he clinical outcomes for nurse practitioners are equal to those of physicians. Romero has long labored to fight the practical daily issues that face low-income people. He describes the Oscar Romero Worker House, named for Romero – a Catholic archbishop in San Salvador who was murdered in 1980 while celebrating Mass – as “a lay association that works in food security by delivering food” to those “who don't have transportation.”
Waldrop approaches the H.B. 1013 issue with an informed background in Catholic social teaching. In a fact sheet on the bill, Waldrop contends, “A primary driver of abortion in low income households is financial desperation, caused by what Pope John Paul II referred to as ‘structures of sin’ that make life hard for lower income people.
“Better access to quality health care, at lower costs, will lessen the financial desperation of lower income households. Less financial desperation for lower income households will lead to fewer abortions.”
Waldrop’s backgrounder continues, “This proposal will protect unborn children and increase social justice. This protection comes in a way that should not be objected to by those who oppose restrictions on abortion, since it is helping mothers who don't want to abort their children to avoid that choice.”
He observes that because a Republican is sponsoring the idea in the overwhelmingly Republican-controlled Legislature, “there is a realistic chance of getting it passed.”
Waldrop wrote to his own House member, state Rep. Jason Dunnington, D-Oklahoma City, saying that H.B. 1013 “would allow nurse practitioners to practice within their professional standards independently of doctors. The bill would also effectively lift the restriction on the number of nurse practitioners allowed in the state, since there is presently a limit on how many nurse practitioners a doctor can ‘supervise.” The result would be “less expensive for patients, while continuing to ensure high standards of treatment. This is critical for a state like Oklahoma, where our state's policies on Medicaid effectively leave tens, if not hundreds, of thousands of lower income Oklahomans behind with little or no medical treatment.”
Waldrop’s group delivers food to approximately 400 households monthly. He told Dunning in the letter, which he shared with friends and through social media this week, “One of the most common … requests we receive, which we can rarely help with because we are [a] small organization, is medical assistance. There is simply not enough charitable resources available in Oklahoma to help all who are in medical need but don't have insurance and are low income. Thousands upon thousands of Oklahomans suffer in silence from untreated and under-treated medical issues.
“Freeing nurse practitioners from their indenture to doctors isn't a 100 percent solution, but it IS a solution and a solution that IS possible within the political context.”
Waldrop also reflects, “most nurse practitioners are women, and this would be a step towards the further economic empowerment of women, and that is a good thing.”
State Rep. Jon Echols, R-Oklahoma City, garnered 30 coauthors on similar legislation in 2016, but did not get a hearing for the proposal.
Both the American Association of Retired Persons (AARP Oklahoma) and the Association of Oklahoma Nurse Practitioners support H.B. 1013. AONP noted, in points circulated by the state House media staff, “nurse practitioners carry national board certifications in their area of training and are licensed and regulated by the Oklahoma Board of Nursing. They complete graduate-level education that leads to a master’s or doctoral degree. Nurse practitioners can provide physical examinations, diagnose and treat acute and chronic problems, interpret laboratory results and X-rays, prescribe and manage medications and other therapies, provide training and supportive counseling on the prevention of illness, and refer patients to other health professionals as needed.”
President-elect Toni Pratt-Reid of AONP, said, “Physicians don’t see my patients or review their charts — they sign a collaborative agreement form with the Board of Nursing once every two years and can charge thousands of dollars for it.” Only 12 states require physician agreements for nurse practitioners, the House release asserted. New Mexico and Colorado are among the 21 states that allow nurse practitioners to exercise full practice authority.
The Oklahoma Health Workforce DataBook (state Department of Health) reports that 64 of Oklahoma’s 77 counties are primary care Health Professional Shortage Areas (HPSAs), with 58 percent of the state’s population residing in an HPSA. Oklahoma, with 80.2 physicians for every 100,000 people, ranks 49th in physician-patient ratio, the House release said.
In January, AARP Oklahoma announced support for the Cockroft-Griffin measure. Sean Volskul, state director for AARP, said the Sooner State’a aging population and doctor shortage intensifies the need for Cockroft’s bill.
“The shortage means some Oklahomans are driving long distances and waiting days for appointments for primary care, not to mention a lack of consumer choice. Delays in care not only hurt the consumers, but place added stress on family caregivers, who are all too often overwhelmed with bearing the brunt of providing and overseeing the care of a loved one,” said Voskuhl, who served eight years in the state House as a Democrat, representing Logan, Kingfisher and Garfield counties.
Tourting its views on the legislation, AARP Oklahoma pointed to a January 2016 Sooner Poll of 410 likely voters, which found 86.7 percent support for allowing nurse practitioners to gain practice authority.
“H.B. 1013 is a common-sense measure that will help increase access to quality health care for all Oklahomans. Nurse practitioners are highly educated, have years of training and are eager to serve their fellow Oklahomans. Lawmakers should give them that chance,” said AARP Executive Board Member Mary Overall, a retired registered nurse.