A deeply divided House on Tuesday rejected a bill that would have given physicians’ assistance more authority to practice without supervision.
House Bill 1095 was up for a final vote in the House last week, but lacking the votes to pass it, the sponsors won permission to send it back to second reading debate in order to come up with amendments they hoped would push it over the finish line.
It didn’t work.
The amendment proposed by Reps. Susan Lontine, D-Denver and Perry Will, R-New Castle, would have clarified the “scope of practice” for the PAs. That amendment, which the House did adopt, listed just what a PA could do without supervision.
Under HB 1095, the supervisory relationship between a physician and a PA would change, giving the latter more independence depending on the length of time the physician assistant has been in practice. Once the PA has completed 3,000 practice hours, that PA is no longer required to be in a “collaborative plan” with a supervising physician. An amendment raised that minimum to 5,000 hours; another said a physician would not be obligated to enter into a collaborative plan with a PA as a condition of employment.
At that point, PAs are required only to consult with and refer to appropriate members of their health-care team based on a patient’s condition, their education, experience and competencies, and standards of care.
Backers said the bill would allow PAs to practice in rural parts of the state where health care is not always available. However, the bill did not direct PAs to practice in those rural areas.
Those who opposed the bill said it would create a second-class level of health care for rural Coloradans.
“We don’t believe [the amendment] addresses any of the concerns we had,” said Rep. Lindsey Daugherty, D-Arvada. The amendment doesn’t state what PAs cannot do or when they would have to consult with a physician, she said, and removes the “team-based safety net” that PAs would need.
Lontine argued that the bill does not create independent practice, even with the amendment. She said the amendment responded to a request on scope of practice, so that there would be no concern about PAs working beyond their scope.
Rep. Leslie Herod, D-Denver, who opposed the bill, said the bill did not have enough safeguards to prevent the kinds of problems envisioned.
On the other side, Rep. Brianna Titone, D-Arvada, said doctors have talked down about PAs, referring to them during a bill last year as flight attendants who don’t know what they’re doing “since they can’t fly a plane.” Her brother is a PA, Titone said, one who teaches doctors, nurses and PAs how to do his work. These are people who are passionate and knowledgeable about their work. “It will be good for the profession,” she added.
Both caucuses were split on the bill.
Rep. Colin Larson, R-Littleton, spoke against the bill, although he said he appreciated the amendment. The problem this bill addresses around rural access is a real one, he said, but the bill will not cause a flood of PAs to move to rural Colorado to provide care. People who don’t come from rural towns don’t tend to move there for work, he said, adding there ought to be incentives to promote that.
Rep. Rod Pelton, R-Cheyenne Wells, said Cheyenne County had just one hospital when he was a commissioner, and it was constantly looking for doctors. The PAs in his county give top-notch care, with the same standards as doctors.
“It’s hard to attract doctors to communities of 800 or 500,” he said.
Rep. Richard Holtorf, R-Akron, added that the level of professionalism, from nurses to PAs to family nurse practitioners and doctors, is incredibly high. It wouldn’t change under HB 1095, he said.
In their final comments, Will said the bill sponsors heard from small communities all over the state.
“We need this. If you haven’t lived in those communities and experienced it, you won’t understand,” he said, adding that if a horse rolls over on him in one of those small towns — something that’s happened to him before — he doesn’t care if it’s a doctor or PA who provides his care.
The bill failed on a division, or standing, vote, a procedure where votes are not recorded. A later recorded vote, requested by Lontine, showed the bill failed on a 35-28 vote.
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