Senate Panel Approves CPRIT Reform, "Scope-of-Practice" Bills

The Senate Health and Human Services Committee on Tuesday expressed its support for a bill to reform the Cancer Prevention and Research Institute of Texas and the “scope-of-practice” bill that would increase the prescriptive power of advanced practice nurses.

Both bills now will now go before the full Senate.

The CPRIT reform bill, Senate Bill 149, restructures CPRIT’s leadership staff and establishes measures to prevent conflicts of interest between CPRIT officials, CPRIT grantees and the CPRIT Foundation, a nonprofit association that supplements the salaries of CPRIT officials. Senators on the committee also adopted an amendment to remove the Attorney General and state Comptroller from the CPRIT Oversight Committee.

"Our laws and rules have been twisted in ways that are disappointing and unacceptable," Sen. Jane Nelson, R-Flower Mound, said in a statement. "SB 149 reinforces our clear legislative intent that CPRIT be operated in a fair, transparent manner that is befitting of its lifesaving mission. We will not allow the actions of a few individuals to stand in the way of our effort to find treatments and cures for this terrible disease."

Many advocates of cancer research and prevention testified Tuesday in favor of reforming the institute.

“CPRIT was the catalyst for us being able to reach out in to our rural communities,” said Dorothy Gibbons, chief executive officer of The Rose in Houston, which offers breast cancer screenings and diagnostic services. “When we go to these rural areas, we never have any no-shows, our vans are packed. The people are so thankful that we’re there.”

The Rose was able to conduct cancer screenings for more than 4,300 women with a CPRIT prevention grant, said Gibbons, and 124 women were diagnosed with cancer, 43 of whom were receiving their first mammogram screening.

The "scope of practice" compromise comes after years of disagreement between physicians and advanced practice nurses on how nurses’ prescriptive authority should be tied to physicians. Although advanced practice nurses receive extensive training, physicians argued at the time that the training was only a fraction of the medical training physicians receive, and might leave the nurses less prepared. Advanced practice nurses argued that the power of physicians to dictate their prescriptive authority and collect fees left them with a lack of control over their livelihood.

Nelson, who authored Senate Bill 406, which would eliminate on-site physician supervision requirements to allow doctors to delegate prescription authority to advanced practitioner nurses, joked that the negotiation process “was like going through labor,” and commended physician and nursing groups for reaching an agreement addressed in the bill.

SB 406 would also increase the number of advanced practice nurses a physician can supervise from four to seven, and it would also address coordination between the Texas Medical Board and the Board of Nursing and Physician Assistants. It would also allow physicians to delegate authority to advanced practice nurses to prescribe Schedule II controlled substances, which are classified as having a higher potential for abuse, in hospitals and hospice settings.

“Although we didn’t obtain everything we wanted to with this bill, it [does] a great deal in improving the current complicated site-based restriction law that we followed for many years,” said Jean Gisler, a nurse practitioner representing the Texas Nurses Association and other nursing groups.

Dr. Gary Floyd, representing the Texas Medical Association and other physician groups, told senators that the bill "represents a significant step forward in supporting a lot better access for all parts of Texas," and would help foster a team environment for health care providers.

Although the Senate committee unanimously approved the bill, Sen. Charles Schwertner, R-Georgetown, expressed concerns about oversight. Schwertner, an orthopedic surgeon, pointed out that ambiguous language in the bill may allow nurses to prescribe Control II  substances in outpatient hospital clinics.

“The intent is this does not apply to clinics, it applies to the hospital,” Nelson responded. “We may need to clarify that.”

Editor's Note: This story originally misspelled Jean Gisler's name. It has been corrected.