CARSON CITY — Advanced practice registered nurses would be authorized to sign myriad health-related forms under a bill heard Friday by a Senate committee, but concerns were raised over allowing them to sign off on a defendant’s competency to stand trial.
Senate Bill 277, sponsored by state Senate Co-Majority Whip Joyce Woodhouse, D-Henderson, said the goal is to expand the authorization of advanced nurses trained in specialties to sign documents that currently require a doctor’s signature.
A similar bill is pending in the Assembly.
“Nevadans are challenged to access basic health care,” Woodhouse said, explaining that the bill would make the system more efficient and timely, particularly in rural areas.
Legislation passed in 2013 gives APRNs authority to practice outside the confines of a doctor’s office as a way to expand access to health care. But many forms require the signature of a physician.
Though Woodhouse’s bill was well received, John Piro of the Clark County public defender’s office and his Washoe County counterpart, Sean Sullivan, raised concerns about letting advanced psychiatric nurses determine mental competency for criminal defendants.
“Our concern as public defenders is that there may be challenges” in court cases if the bill is passed as drafted, Sullivan said.
He and Piro said the biggest concern is there would be no peer-to-peer review of findings, as there is now between two psychiatrists or psychologists who perform such examinations for the courts.
Sullivan said defense lawyers would likely challenge the findings of an APRN and hire forensic psychiatrists or psychologists to refute their assessment.
“Credentials and training are different,” he said, adding that judges would likely give more credibility to the determinations of a doctor.
The public defenders offered an amendment that would allow APRNs to assess competency for defendants accused of misdemeanors but keep the requirement that defendants accused of gross misdemeanors and felonies be examined by psychiatrists and specially trained psychologists.
Psychiatric social workers are currently allowed to examine misdemeanor defendants.
Piro said the amendment would allow the criminal justice system to test the “sea of change” before allowing it for defendants charged with more serious crimes.
No action was taken by the committee.
Contact Sandra Chereb at email@example.com or 775-461-3821. Follow @SandraChereb on Twitter.
What to sign
Examples of medical forms APRNs would be authorized to sign within their areas of expertise under Senate Bill 227:
- Death certificates and declarations of death
- End-of-life directives
- Disability determinations for obtaining a special license plate or handicapped parking placard
- Disability claims for worker’s compensation
- Statement of medical clearance for students who have suffered concussions to return to competitive sports
- Health certificates to prospective taxi-cab drivers
- Certifications of temporary or permanent disability to excuse someone from jury duty
- Authorizations for pupils to self-administer medication for asthma, anaphylaxis or diabetes while in school
- Exemptions from immunizations because of medical conditions