The 3rd meeting of the Interim Joint Committee on Licensing and Occupations was held on Friday, September 8, 2006, at 10:00 AM, in Room 171 of the Capitol Annex. Representative Denver Butler, Chair, called the meeting to order, and the secretary called the roll.
Present were:
Members: Senator Gary Tapp, Co-Chair; Representative Denver Butler, Co-Chair; Senators Tom Buford, Julian M Carroll, Perry B Clark, Julie Denton, Carroll Gibson, Robert J (Bob) Leeper, Daniel Mongiardo, Ernesto Scorsone, Dan Seum, and Damon Thayer; Representatives Tom Burch, James Carr, W Milward Dedman Jr, Jon Draud, Dennis Horlander, Joni L Jenkins, Dennis Keene, Stan Lee, Paul H Marcotte, Reginald K Meeks, Charles Miller, Ruth Ann Palumbo, Jon David Reinhardt, Ron Weston, and Susan Westrom.
Guests: Don Swikert, M.D., Kentucky Board of Medical Licensure; Elizabeth Partin, DNP, ARNP, Kentucky Coalition of Nurse Practitioners and Nurse Midwives; Charlotte Beason, EdD, RN, Executive Director, Kentucky Board of Nursing; Wilma May, Executive Director, Board of Hairdressers and Cosmetologists; Angela Robertson, Board Administrator, Kentucky Boxing and Wrestling Authority; and Chris Lilly, Commissioner, Department of Public Protection.
LRC Staff: Vida Murray, Bryce Amburgey, Tom Hewlett, and Susan Cunningham.
The first item on the agenda was approval of the minutes from the August 11, 2006, meeting. A motion was made and, with a second, the minutes were adopted by voice vote.
Next on the agenda, Don Swikert, M.D., Kentucky Board of Medical Licensure; Elizabeth Partin, DNP, ARNP, Kentucky Coalition of Nurse Practitioners and Nurse Midwives; and Charlotte Beason, EdD, RN, Executive Director, Kentucky Board of Nursing updated members on the implementation of Senate Bill 65. Senate Bill 65 created the Controlled Substance Formulary Development Committee, made up of two advanced registered nurse practitioners (ARNPs), two physicians, and one pharmacist and granted limited authority to ARNPs to prescribe controlled substances. Ms. Partin said the limitations included: a 72-hour supply only on Schedule II prescriptions; and no refills allowed on Schedule III prescriptions. The bill also required that an ARNP be registered in Kentucky for one year before being given prescriptive authority. She said that there also must be a collaborative agreement between the ARNP and a physician, and the physician may limit the prescribing of scheduled drugs. Ms. Partin said that there had been meetings between the Kentucky Board of Medical Licensure and the committee. She said that the Kentucky Board of Nursing has met with agencies such as the Louisville Metro Narcotics Squad and has surveyed other states nursing boards to gather information on how prescribing by nurse practitioners has affected diversion rates. Recommendations were also considered from the Kentucky Office for Drug Control Policy and from the Kentucky All Schedule Prescription Electronic Reporting System (KASPER). Ms. Partin said that there was no evidence found that ARNPs writing prescriptions contributed to an increase in drug abuse or diversion. She said that ARNPs can access the Kentucky Board of Nursing's Web site or the Kentucky Nurse Practitioner Coalition's Web site for information on the changes in prescriptive authority. She said that at the Kentucky Nurses' Association convention in Louisville this coming October, there will be a session detailing Senate Bill 65, with information on how to be responsible prescribers of controlled substances. Dr. Charlotte Beason, Executive Director of the Kentucky Board of Nursing, said that the regulation that the Board of Nursing proposed based on the recommendation of the formulary development committee was that there be aggressive monitoring of an advanced practice nurse prescribing through the KASPER System. Dr. Beason said that the formulary committee felt that the new statute did not stipulate that certain drugs be excluded. LRC's Administrative Regulations Subcommittee has notified the board that the language was not in compliance with the statute. The formulary development committee will be reconvene to rewrite the regulation to be comply with the statute.
Representative Burch asked how many nurse practitioners are available to prescribe medication. Ms. Partin responded about 3,000. Senator Tapp asked how many ARNPs had been given DEA (Drug Enforcement Administration) identification numbers. Ms. Partin said 196 ID numbers have been issued. Senator Carroll asked for an explanation of the proposed regulation and how the members voted. Ms. Partin said the pharmacists and the two ARNPs voted in favor of the regulation and one physician voted against it; however, at the time of the vote for the wording there was one physician absent. Ms. Partin said that the formulary committee's interpretation of the statute was that they could limit drugs by regulation if they felt it was necessary. Representative Draud asked if the medical doctors were opposed to the regulation. Ms. Partin said that the doctors felt that there should be more limitations on the ARNPs prescribing. Dr. Don Swikert, co-chair of the formulary committee, said that the medical doctors do not feel that the formulary committee's proposed regulation complies with the law's provision that there be a limit on those drugs that are identified as having a high chance for abuse or diversion. He said that the LRC's Administrative Regulation Subcommittee has recognized that. Dr. Swikert added that the formulary development committee will meet again and make the regulation compatible with the statute. Senator Carroll said that he felt that the statute required the formulary committee to make a finding on which drugs, have the greatest potential for abuse. Senator Mongiardo commented that physicians presently are the number one source for writing prescriptions that can be diverted and that due to time constraints the KASPER System was inefficient. Dr. Swikert said that KASPER was an invaluable tool; however, the system could be improved. Representative Burch asked if any other state grants prescriptive authority to ARNPs as broad as Kentucky's. Ms. Partin replied that some states have broader authority. Ms. Beason said the board conducted a survey of states where ARNPs have prescriptive authority and found rare exceptions of abuse or diversion. Senator Tapp said the formulary committee should be careful not to interfere with services now available to Hospice patients. Representative Butler suggested that improvements be made to the KASPER System in the next session and added that all doctors and ARNPs should participate in KASPER.
Next on the agenda, Wilma May, Administrator for the Board of Hairdressers and Cosmetologists, said that her agency would like to implement national testing. She said that, by current statute, the exam can only be administered every 30 days with a quorum of board members present. She said that proposed legislative changes would allow the exam to be give by two board members, one board member and the board's administrator, or a professional testing agency. Ms. May said that the board would also like to offer the exam at sites away from the board office and would like to offer the practical examinations more often. Ms. May said that this would allow a student who fails part of the test to re-take an exam within days, so that he or she would be able to go to work in a more timely manner.
Senator Carroll asked why the board wanted to move to national testing, adding that he was not in favor of changing the current testing system. Ms. May said that currently the board administers the exam. If a student fails the exam and files a protest the student is protesting to the same body who failed him or her. Ms. May said that the main reason for the change is that it costs the board in excess of $100,000 per year to rent enough space for the testing. Representative Lee asked what the cost would be for national testing and who would pay the cost. Ms. May said that if the board could eliminate the amount of rent paid by switching to national testing, the board would absorb the cost of the test. Representative Butler said that the committee had told hairdressers and cosmetologists that they were to work out an agreement within their organization before coming back with new proposals. Senator Buford noted that there were two cosmetologist in the audience and asked the chairman if they could speak. Rebecca Taylor, a cosmetologist, said that the students were unhappy about the use of mannequins; however, the board had voted at its last meeting to stop using live models. She said that she works with the Council on Occupational Education and during team visits at various cosmetology and barbering schools she sees that there is chaos in the states where national testing is used. Ms. Taylor said that school operators in Texas, Louisiana, Indiana, and other states say they would like to have a single location testing site, like Kentucky, where the board issues the license on the day of the test with no waiting period. Senator Tapp asked Ms. Taylor if she objected to a temporary license being issued if there were state-wide, mobile testing locations. Ms. Taylor said as long as the board was administering the test she had no objections. Senator Denton indicated that most occupations utilize national testing. She said that national testing was positive since it enabled a professional to practice in multiple states. Pat Stevenson, cosmetologist from Nicholasville, told the committee that she teaches for a manufacture all over the country. Ms. Stevenson said the board could do a better job of communicating with its cosmetologists. She said that apprentices do not know that they need to take a mannequin with them to take their master's test. Representative Butler suggested that the cosmetologist should contact their representatives and senators with their concerns about the board.
Next on the agenda, Chris Lilly, Commissioner, Department of Public Protection, and Angela Robertson, Board Administrator, Kentucky Boxing and Wrestling Authority spoke to the committee. Commissioner Lilly said that mixed martial arts is a new sport created in Brazil by a family named Gracie. It is a combination of karate, judo, boxing, and grappling and is called Brazilian Jujitsu. Commissioner Lilly said in recent years an entrepreneur, Spike TV, developed a large pay-per-view audience. He said that the Armed Forces is adopting this as empty-handed combat training. Mr. Lilly said that there have been amateur events in Kentucky and one professional event, just after the administrative regulations went into effect. Mr. Lilly said that KRS 229.151 authorizes the Kentucky Boxing and Wrestling Authority to regulate mixed martial arts in Kentucky. He said that the events are regulated as boxing events, with three, three-minute rounds adding that most end in the first round. Mr. Lilly said that the most important person at the event is the referee, who can stop the fight when the competitor cannot safely continue.
Representative Meeks said that he would like to name the boxing regulations after Louisville boxer, Greg Page. Mr. Lilly said that Mrs. Page, the boxer's wife, is very supportive of the new regulations, particularly the provision requiring a physician to stay until all athletes have left the venue. Representative Lee asked why this sport is being allowed in Kentucky. Mr. Lilly said that it was a new sport that until 2005 had been unregulated. Mr. Lilly added that he wanted to personally thank Chairman Butler, upon his retirement, for his service.
There being no further business to come before the committee, the meeting was adjourned at 11:40 a.m.