Massachusetts Medical Society: Testimony in Opposition to An Act to Improve Access to Care by Removing Barriers to Practice for Psychiatric Clinical Nurse Specialists

Testimony in Opposition to An Act to Improve Access to Care by Removing Barriers to Practice for Psychiatric Clinical Nurse Specialists

The Massachusetts Medical Society wishes to be recorded in opposition to H.1730/S.1157. These identical bills would remove the existing statutory framework underlying the relationship between physicians and psychiatric nurse practitioners and would allow psychiatric nurse mental health clinical specialists to issue written prescriptions and order and interpret tests. 

This legislation provides no public protections or standards to replace the legal basis for the functioning team approach to collaborative and supervisory relationships among psychiatric nurses and physicians which has served the Commonwealth so well over the years.

The Massachusetts Medical Society urges the legislature not to expose the public, particularly our most vulnerable patients, to the independent practice of individuals with minimal training and no oversight whatsoever. A team-based approach to health care, under the supervision of a physician is the gold standard of care and there is no need to change that requirement for psychiatric nurse mental health clinical specialists.

Any consideration of independent practice for psychiatric nurse mental health clinical specialists must address the lack of public protections required of nursing. Nurse practitioners are not subject to the public protections the legislature has created for the practice of medicine by physicians. Nurse practitioners do not have profiles listing their education, residency, specialties and history of discipline, criminal convictions or malpractice payments. They are not required to have professional liability coverage. They are not subject to mandatory continuing education requirements in specific areas as are physicians. They do not have requirements regarding electronic medical records and a host of other legislative mandates which apply to physicians.

For the reasons noted above, the MMS also wishes to be recorded in opposition to H.1731, An Act Providing Signature Authority for Psychiatric Nurse Mental Health Clinical Nurse Specialists.  This bill would allow psychiatric nurse mental health clinical specialists to sign documents which currently require the signature of a physician or nurse practitioner; and would further strike the following language which the MMS believes to be important patient protection provisions:  “Nothing in this section shall be construed to expand the scope of practice of nurse practitioners. This section shall not be construed to preclude the development of mutually agreed upon guidelines between the nurse practitioner and supervising physician under section 80E.”

The MMS urges the Committee on Mental Health, Substance Use and Recovery to reject H.1730/S.1157 and H.1731 and to report these bills out of committee ought not to pass.

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