ANNAPOLIS – Maryland senators reversed themselves Thursday, approving by one vote a bill to allow nurse practitioners to serve as primary-care providers after nearly killing the bill by two votes the previous day.
The Senate approved the legislation, sponsored by Sen. Arthur Dorman, D- Prince George’s, 24-23. On Wednesday, however, the bill seemed headed for the morgue with a 22-24 vote opposed.
The measure was resuscitated with a motion to reconsider, but it’s not out of intensive care yet, as it still needs to pass the House, where similar legislation died last year.
The bill allows health maintenance organizations to include nurse practitioners on lists of primary care providers, and requires HMOs to make either a practitioner or physician available to a patient for medical treatment.
Nurse practitioners already serve as primary care providers in federal health programs like Medicare and Medicaid and in school clinics. Expanding their ability to treat HMO patients would increase access to health care, proponents said.
Opponents said they believed the bill would compromise the quality of care because access to doctors might be limited, especially during nights and weekends.
After the Senate defeated the bill Wednesday, Sen. Ulysses Currie, D- Prince George’s, asked the body to reconsider and a new vote was scheduled for Thursday.
Currie, who at first voted against the bill, said his “nay” vote was not a parliamentary maneuver designed to get a new vote. Under the rules of the Senate, only a legislator voting with the majority can call for a second vote.
Currie, after casting a positive vote for the measure Thursday, said his mind was changed by the thought of his 95-year-old aunt, who is being treated for a torn knee.
Nurses, not her doctor, have encouraged his aunt to complete her physical therapy, Currie said.
Sen. Paula Hollinger, D-Baltimore County, a nurse by training, urged fellow lawmakers to change their vote, saying a vote against the bill would send the message to nurses that legislators do not respect them. That could drive more and more nurses to leave the profession at a time when Maryland is suffering a severe nurse shortage, she said.
The proposal was saved by four senators who changed their vote to favorable: Currie and Sens. John J. Hafer, R-Allegany; Larry E. Haines, R- Carroll; and J. Lowell Stoltzfus, R-Somerset.
Two other senators, Clarence W. Blount, D-Baltimore, and Thomas McLain Middleton, D-Charles, reversed themselves and voted against the bill the second time. Sen. Leonard Teitelbaum, D-Montgomery, who was the only senator not voting the first time, opposed the measure.
Blount’s reversal seemed unusual. He supported the proposal Wednesday saying that during a hospital stay, it was the nurse practitioner who gave him the most health care, particularly during off-hours.
“Weekends are terrible times,” Blount said. “The people who are the experts are not there.”
Blount declined to explain his turnaround, saying only that his votes reflect his unhappiness with both sides of the issue.
By requiring HMOs to make available either a physician or nurse practitioner, opponents said, these health plans could staff practices without physicians.
In addition, the health care patients receive during off-hours would be compromised, said Sen. Andrew P. Harris, R-Baltimore County, a physician.
During nights and weekends, most practices put one physician “on-call” to handle emergencies. That could mean a patient wouldn’t be treated by a doctor during these times if the nurse practitioner is on-call, Harris said. Nurse practitioners also could end up providing medical treatment beyond their level of expertise.
Sen. Thomas L. Bromwell, D-Baltimore County, said physicians oppose the bill because they are in a “turf battle” to protect their role as primary care providers.
“I know local docs called you,” Bromwell said to the legislators, “and told you how terrible this bill is.”
Maryland nurse practitioners are required to pass a certification exam, which usually entails the completion of a master’s degree. About 95 percent of the state’s nurse practitioners have master’s degrees and some of those have also earned Ph.D.s, according to the Board of Nursing.