Honorable Robert Bunda

President of the Senate

Twenty-Second State Legislature

Regular Session of 2004

State of Hawaii

Sir:

Your Committee on Commerce, Consumer Protection and Housing, to which was referred S.B. No. 3085, S.D. 1, entitled:

begs leave to report as follows:

The purpose of this measure is to statutorily require the Department of Commerce and Consumer Affairs to establish an advisory committee to advise the Board of Medical Examiners on issues relating to the formulary.

This measure specifically requires:

Testimony in support of this measure was submitted by the Board of Nursing (BON), the Board of Medical Examiners (BME), the Hawaii Nurses' Association, and nine private citizens. Testimony in opposition to this measure was submitted by the Hawaii Medical Association.

Your Committee finds that APRNs play an important role in the provision of health care in our State, and that their prescriptive authority is essential to effective patient care. In an effort to streamline the regulatory process, the Legislature, pursuant to Act 192, Session Laws of Hawaii 2002, authorized the BON to grant prescriptive authority to qualified APRNs and required the Department of Commerce and Consumer Affairs (DCCA) to establish a joint formulary committee to recommend applicable formularies for the BME's consideration. Your Committee further finds that, as established by the BME, APRNs currently practice under an overly restrictive formulary.

Your Committee recognizes that there are concerns regarding the manner in which the BME has developed the formulary, including its consideration of the recommendations of the joint advisory committee. Absent input from APRNs, a formulary cannot be developed without the knowledge of their function and any other issues they may face in their daily practice. Therefore, your Committee determines that in order to allow APRNs to maximize their skills and abilities while continuing to provide patients with the best care possible, input must be received from APRNs as well as physicians and pharmacists. Your Committee also determines that an advisory committee must be statutorily established with safeguards for ensuring that the BME consider the advisory committee's recommendations and be otherwise accountable for its dismissal of such recommendations. Furthermore, the granting of prescriptive authority should ultimately remain within the authority of the BON, which is knowledgeable as to the practice of APRNs, rather than revert back to the DCCA.

Accordingly, your Committee has amended this measure by delaying its effective date to July 1, 2030, to facilitate further review and discussion of the issues, and by making technical, nonsubstantive amendments for purposes of clarity and style.

As affirmed by the record of votes of the members of your Committee on Commerce, Consumer Protection and Housing that is attached to this report, your Committee is in accord with the intent and purpose of S.B. No. 3085, S.D. 1, as amended herein, and recommends that it pass Third Reading in the form attached hereto as S.B. No. 3085, S.D. 2.