Oppose to Louisiana HB 495

AAEM and AAEMLa are opposed to Louisiana HB 495, the independent practice of nurse practitioners to diagnose and treat disease. Please lobby your LA state congress person. They are voting today. We've provided a sample letter below.

Find your Louisiana Representative.

Sample Letter


Rep. [Name]:

I am writing to express my serious opposition to both of these bills on the basis of patient safety. Nurse practitioners and PAs are not appropriately trained to diagnose and treat disease independent of physician supervision and collaboration. While a physician goes through 4 years of college, 4 years of medical school and 3-7 years of supervised residency training, a nurse with a 2 year Associate's degree can, in 18 months of ONLINE education, complete the requirements of nurse practitioner. 

I am a physician who is active in educating future physicians. I can tell you without doubt that supervised training is essential to ensure that a future physician is competent to perform a physical examination and perform invasive procedures. There is also a significant understanding of pathophysiology that goes into determining an accurate diagnosis and determining the risk to benefit ratio of a given invasive procedure. 

This level of training in pathophysiology is absent from the education of the NP and the PA. Extensive understanding of biochemistry, immunology, and pharmacology are necessary to determine which of the myriad drugs in any drug class is the right drug for the right patient. This is not something that can be simply memorized. This level of education is not provided to the NP and the PA. The NPs and PAs with whom I have worked often come to physicians for help with cases that are too complicated for them to diagnose and manage. This is appropriate. 

NPs and PAs are valuable members of the health care team when supervised by a board certified physician. It is dangerous to patients to allow them to practice independently, and can result in moral injury to the NP or PA when they are permitted to practice in a way that exceeds their abilities and they go on to kill a patient or miss a diagnosis that results in severe morbidity to the patient. For example, I was recently on a medical review panel in a case where an unsupervised NP practicing psychiatry deemed a patient not at risk for suicide and sent him home. An hour later, he shot himself in the head and died. 

[Rep. Name], you know as well as I do that the corporate practice of medicine will result in hospital corporations hiring more unsupervised NPs and PAs because this will save them money. The financially advantaged constituents will be able to afford to see a physician and the Black, Latinx, poor white, and rural populations will get the lesser skilled care of NPs and PAs. Passage of these bills will reinforce the race and ethnicity-based health disparities already outrageously prevalent in the state of Louisiana.

Please vote to support your constituents. They deserve to receive the same quality of health care that you yourself receive. I teach my residents and medical students to treat each patient as if the patient were a member of their family. I am asking you to do the same. Do not provide your constituents with a lesser quality of care. Every patient deserves care supervised by a qualified physician. 

Thank you for doing the right thing. 

[Your Name]



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