Law Coursework: Reading Comprehension and Legal Analysis Section

Law Coursework
Name
Institution
PART I: Reading Comprehension and Legal Analysis Section
Question A
Advanced practice registered nurses (APRNs) play an important part in the health care system of the U.S. with more than 267, 000 APRNs in the country, the body presents a powerful force in the country’s mission of providing adequate primary health care to its population (NCSBN, 2015). In recent times, different states in the country agreed on adopting similar regulatory frameworks in regard to the issues of APRNs. In coordination with professional associations and boards of nursing, the states think it wise to implement the Consensus Model, which provides guidance for different states to embrace uniformity in the regulation of the roles of APRNs in the country. Currently, several states have adopted some elements of the Model, although there exist some variations among different states. The Consensus Model outlines the guidelines pertaining to the education, licensure, certification, and accreditation of APRNs (Phillips, 2012).
For APRNs to be prepared for practice factors pertaining to education, accreditation, and certification are of paramount importance. In education, APRNs must undergo through a formal education, pursuing a graduate degree or attaining a post-graduate certification awarded by an institution that is accredited by nursing-related accrediting body recognized by the U.S government. One must possess core competencies aligning to the roles of an APRN.
APRNs roles inclines towards enhancing the health of the public and do not focus of providing direct care to individuals. The four main roles for APRNs include informatics, education, public health and administration duties (NCSBN, 2008). Informatics aim at identifying ways of improving information management and communication in nursing in order to enhance efficiency and reduce costs of operations in providing health care to the public. Education role requires nurses to continuously, improve on their skills and knowledge pertaining to public health delivery. Their role of public health calls for nurses to be committed to delivering safe and high quality patient care, while administration roles emphasizes on nurses participation in facilitating administration duties geared towards fostering public health.
The foundational requirements for licensure requires nursing boards to be solely responsible for licensing APRNs in their different specialties categories, and only those who have attained graduate level of education from accredited education institutions and have passed national certification examination. Nursing boards are restricted from issuing temporary licenses, but encouraged to license APRNs as independent practitioners free of regulatory requirements.
LACE is the formal communication mechanism that guides through the implementation of the Consensus Model for APRN Regulation. It guides on the creation and roles of licensure, accreditation, certification, and education bodies to ensure proper APRNs are in place in delivering public health care services. The purpose of LACE is to provide a formal communication and mechanism that ensures transparency among the entities responsible of implementing the Consensus Model (NCSBN, 2008).
Question B
1. Colorado Medical Society v. Colorado Board of Chiropractic Examiners (Denver, Colo. Dist. Ct.)
Issues: Should Colorado chiropractors be allowed to administer various botanical homeopathic compounds by injection, since their education and training skills allow them?
Holdings: The court held that Colorado’s legislation has no clause permitting chiropractors to administer various botanical and homeopathic compounds by injection and so the Colorado Board of Chiropractic Examiners (CBCE) had no jurisdiction to implement the rule 7(C) that seeks to allow the same.
My Opinion: Although Chiropractors have the professional qualifications to administer various botanical homeopathic compounds by injection, their scope of duty in Colorado is limited owing to unavailability of the law allowing the same. Chiropractors are non-physicians health care practitioners and therefore should provide the service if the state’s law permits them to do so. Health care practitioners have the duty to respect the state’s laws governing their practices.
2. Missouri State Medical Association v. State of Missouri, 256 S.W.3d 85 (Mo. 2008)
Issues: Was the Missouri statute allowing for the practice of midwifery constitutional considering its enactment into law being done improperly? The statute entailed a one-sentence insertion hidden within another bill without its contents being properly noticed or reviewed.
Holdings: The trial court considered the purported law unconstitutional for the reason that its passage would violate other existing laws in terms of their meaning, thus causing confusion between the statutes touching on the same subject. However, the Missouri Supreme Court reversed the trial court claiming that the plaintiff lacked standing in the case.
My Opinion: Midwifery is a non-physician health care practitioner who can provide health care services that are inclined to their education, training, and experience. However, introducing a clause in the constitution allowing midwifery, without stating other regulatory requirements could conflict with the existing laws governing the practice, for instance, among nurse practitioners. I disagree with the final court ruling on the ground that the passage of the statute would render the constitution on the subject, redundant or confusing. I believe health care practitioners should have some relevant regulations to safeguard the safety and interest of public health (AMA, 2015).
3. Selective Insurance Co. v. Rothman, 414 N.J. Super. 331 (N.J. App. Div. 2010)
Issues: Does physician assistance have a duty to perform needle electromyography (EMG) while under the supervision of a physician according to New Jersey law, in a situation where selective insurance law exist restricting such a role to the licensed physician?
Holdings: The trial court based its decisions on the reasoning that the New Jersey Medicine and Surgery Act allow physician assistance to perform needle EMG testing under the supervision of a physician, calling for physician assistance to be given licenses in order for insurance billing to be charged directly to the practitioners. However, under the Selective Insurance law of the state, such medical practices are restricted to licensed practitioners in order for medical bills to be charged. Even though the trial court ruled, against the statutory interpretation of the Selective Insurance law, the Appellate Division reversed the ruling in adherence to proper statutory interpretation.
My Opinion: The ruling was favorable on the reason that it prevented contradicting the licensure of health care practitioners in the state, something that could bring confusion in the health care system of the country (AMA, 2015).
4. Texas Orthopaedic Association v. Texas State Board of Podiatric Medicine 254 S.W.3d 714 (Tex.App. 2008)
Issues: Can the Texas State Board of Podiatric Medicine (TSBPM) define the “foot” as including the ankle and various soft tissue?
Holdings: The court ruling by the Appellate court ruled against the defendant, TSBPM, on the reason that the body exceeded its authority in its definition of “foot,” which was inconsistent with the Texas podiatric statute.
My Opinion: I agree with the court ruling on the ground that health care practitioners should only be allowed to practice in areas where they are trained, educated on and have experience in order to safeguard the essence of quality public health (AMA, 2015).
Question C
It is the State’s responsibility to ensure, through certification and licensure, that health care professionals provide services that match their training. Notably, different states in the U.S have different scope of practice laws governing NPs, with some being flexible while others restrictive (NGA, 2012). Some of the states with the most flexible practice laws include Colorado, District of Columbia, Alaska, Arizona, Hawaii, Idaho, Lowa, Maine, Montana, New Hampshire, New Mexico, North Dakota, Oregon, Rhode Island, Vermont, Washington, and Wyoming. The states with restrictive practice laws include Alabama, California, Connecticut, Delaware, Georgia, Florida, Illinois, Indiana, Kansas, Louisiana, Maryland, Mississippi, Missouri, Nevada, New York, North Carolina, South Carolina, South Dakota, and Texas. Others are Massachusetts, Michigan, Minnesota, Nebraska, Ohio, Pennsylvania, and Virginia.
With the expected increase in the demand for primary care in the U.S, in the coming years, there is clear evidence that the country needs more primary care providers to cater for the projected increase in the number of people seeking medical attention. With the estimation that the country will need approximately 4,000 and 7000 additional physicians every year, to cater for the looming numbers of patients seeking medical attention, it would be necessary for state governments to lessen the strictness of their practice laws for NPs. This will increase the role of NPs in providing the highly demanded primary care services, which most of them are restricted in many states (NGA, 2012). Such laws should be adjusted to allow, for instance, NPs to practice independently to allow them provide services such as diagnosing treatment and prescribe medication among others. This would have the potential of helping mitigating the shortages of workforce required for the job. Researches have shown that NPs provide equal quality of care to patients as compared to physicians and therefore, restricting them to practice independently would just doing the country harm. It has been found that NPs have equal or higher patient satisfaction rates as compared to physicians, which proves that NPs can work equally competently as physicians in providing the highly demanded primary health care in the country. Furthermore, the academic and professional qualifications attained by registered NPs in the country qualify them to provide such primary care to patients (NGA, 2012). Expansive approach to regulating the scope of practice for nurses is more favorable for the country.

PART II: Comparison of Scope of Practice Acts and Regulations Section
Memorandum
To: Senator Swanson
From: The senior legislative aide to state Senator Swanson from the state of Setonia
Re: The Scope of Practice Acts and Regulations for APRNs in New York and California
Date: 1 March 2015.
An Overview of Setonia’s Nursing Practice
In the U.S, there is concern over the looming health care needs of the population, owing to the rapidly aging and growing population in the country. However, through APRN Consensus Model, different states are working towards lessening their regulations on the scope of the Advanced Practice Registered Nurses (APRNs) in order to increase the scope of their roles, which will solve the future shortages of nurse practitioners to offer the much needed health care needs. Currently, there are 17 state laws enacted in response to the shortage of primary care providers across the nation (Phillips, 2012). Restrictive nurse practice laws reduce the scope of APRNs’ roles and this tends to reduce the number of nurses able to provide more variety of health care services. As more states such as New York and California are adopting new legislation implementations to enhance the scope of practice and hence the productivity of their APRNs, other states seek to utilize such reforms as the benchmark to redesign their healthcare landscape in responding to the expected future shortages of primary health care. Setonia is one such state that seeks to identify the various favorable laws in the New York and California’s Nurse Practice Statutes to use them as the model in updating its legislations to help transform its APRNs profession to benefit its population. This is possible by pinpointing the various key distinctions between the statutes and regulations in New York and California, and noting their impact to nursing practice in the states, to identify the ones, which could be beneficial for the state to adopt.
Just as California and New York, Setonia is a highly populated state with a APRNs population of 14,000 serving more than 25 million people, designated as one of the Health Professional Shortage Areas “HPSA” & Medically Underserved Areas/Populations in the nation (HRSA, 2015). While the APRNs definition includes certified registered nurse anesthetists, nurse-midwives, nurse practitioners and clinical nurse specialists, the APRNs in Setonia are licensed as nurse practitioners (NPs), legally required to practice under physicians’ supervision. They are legally refrained from admitting patients and required to possess a national board certification and a master degree in order to be certified to practice. In the state, APRNs are only allowed the authority to prescribe drugs in collaboration with physicians. Such restrictive legislations have made the state have a low nurse-patient ratio of about 1:2, presenting the need to adopt more flexible legislation in respond to the situation (Skillman et al., 2012).
The Scope of Practice for APRNs under New York and California ...