The battle to establish a statewide trauma network gathered more attention, but the most recent Assembly session also saw what may be the end of the prolonged dispute over who can give a patient a shot.

 

The Arkansas Medical Society described the legislation, which allows physicians to delegate the administration of medication to an unlicensed person, as "perhaps the biggest win of the session."

 

"What this bill does is, it simply says that delegation is part of the practice of medicine, and the (state) Medical Board shall establish rules as to what can be delegated and what cannot be delegated, and any other parameters, training, and whatnot," said H. Scott Smith, director of governmental affairs for the Arkansas Medical Society.

 

If a physician is ultimately responsible for whatever happens to the patient, and the physician trains an individual, licensed or not, then the physician and the medical board should be the ones making the decision as to who does what, Smith said.

 

The dispute stretches back for around a decade. In order to discourage the practice of unlicensed workers giving shots, the state Board of Nursing began sending out letters informing those workers that they were violating the Nurse Practice Act. A few years ago, the nursing board began warning licensed nurses that if they knew of unlicensed workers giving shots and did nothing to stop it, the nurses themselves might be subject to disciplinary action.

 

Jean K. Zehler, president of the Arkansas Nurses Association, said the group opposed the legislation for one main reason: the bill could compromise the safety of the patient.

 

"There's more to administering medication than the physical act of doing it," Zehler said.

 

A big part of the education process for Licensed Practical Nurses and Registered Nurses addresses medication and administration, Zehler said. Knowing what the medication does and its potential adverse effects are critical for the patient's well-being.

 

In addition, Zehler said, the new law doesn't change the fact that the Nurse Practice Act says that giving shots needs to be done by a licensed person.

 

So if a physician's office has a nurse on staff, it would violate the Nurse Practice Act to delegate giving a medication by an unlicensed person, Zehler said.

 

Smith said nurses see giving shots as their exclusive domain.

 

The nurses want a rule that allows nurses to delegate the giving of injections, but they didn't want physicians to be able to do the same thing, Smith said. The Medical Association thought that was a little inconsistent.

 

"From our perspective, there are a lot of folks out there that give themselves, and have given themselves and their kids, allergy shots or insulin shots for a long time," Smith said. "This is not new."

 

A number of other states specifically allow physicians to delegate the administration of shots to unlicensed workers because of the nationwide nursing shortage, Smith said.

 

Zehler said there's no other instance where the Legislature has allowed an unlicensed person to do the job of a licensed worker.

 

It's no different than saying it's OK for a secretary to take X-rays – something that now requires a license – because now a secretary can administer injections in the doctor's office, Zehler said.

 

The Medical Board is currently putting together rules and regulations but had yet to release them at the Medical News of Arkansas' deadline.

 

Zehler said she hopes the rules will require a standardized curriculum or training process, something to assure quality control.

 

"I mean, would you want somebody to give you an injection who saw one, did one, and that was it?" she said.

 

Zehler said the legislation also lacks public protections. An unlicensed person who gets fired because a patient was harmed or killed can just go to work for another doctor because unlike licensed healthcare workers, there is no discipline registry, she said.

 

Smith said the delegation issue was one of many wins for physicians.

 

Physicians also worked with the insurance industry to pass a bill that cut the amount of time it takes for health plans to credential a doctor from 180 days to 90 days, he said.

 

"We need as many physicians in Arkansas as we can get," Smith said, "Any hurdles or impediments to bringing more folks into the state to practice medicine, we consider that a problem."

 

It's discouraging for a physician to find out he or she must wait half a year to be put on a provider panel, Smith said.

 

The Arkansas Hospital Association also hailed the credentialing bill as a success, as an action that will help its members.

 

The hospital association counted the establishment of a Medicaid hospital provider assessment as one of its major goals and victories. The assessment will generate the state match needed to attract $100 million more in federal funds for inpatient and outpatient payments to hospitals. The state will distribute the money among hospitals based on the number of Medicaid patients the facilities treat.

 

Arkansas joined 20 other states in passing an assessment, according to the Hospital Association.

 

The association argued that Arkansas hospitals lost $99.9 million in treating Medicaid members in 2006, and that the hospitals were actually already paying a hidden tax to help subsidize Medicaid.