Legislative Update Janice Lanier JD RN Liaison Public Policy Committee
Election results—What’s next?
Almost everyone has heard the results of the 2024 General Election. Some are elated others dismayed, but regardless of those emotions, the work of current elected state officials will go on until time runs out on the 135th General Assembly in December. The infamous “lame duck” session is set to start in mid-November, which means the deal making has begun in earnest. Some long-standing bills will move, and others will become the “vehicle” or “Christmas tree” upon which to attach a myriad of special interest hot button issues.
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Read the latest 135th General Assembly Bill Tracking as of November 1, 2024
Members of the Ohio General Assembly have not been at the statehouse since late June, so while little official business has been conducted, legislators have not been idle. All seats in the Ohio House of Representatives are on the ballot for the November General Election, and half of the Ohio Senate seats (even-numbered districts) are also before voters.
Be an informed voter on November 5th. The material developed by ANA sets out where the presidential candidates stand on health care related issues. Please note this resource is not intended as an endorsement of either candidate.
Introduction
The general assembly began its summer recess June 26th and is not likely to resume holding official sessions until after the November general election. As is the case when a prolonged hiatus is looming, committee meetings were frequent, agendas were long, and sessions ran into the night. Multiple bills received cursory attention, and political wheeling and dealing was the order of the day. When the gavel fell in the house (hours after the senate had already started its recess), over 50 bills had been addressed with many becoming so-called Christmas tree proposals (full of many different surprises) on their way to becoming law in Ohio.
Submitted by Jan Lanier
ANA-Ohio submitted opposition testimony to the Senate Health Committee on June 12th. Although interim executive director Terry Pope was on hand to testify, the committee had to limit the number of witnesses it would hear that day due to the outpouring of opposition to the bill. The unique concerns identified by ANA-Ohio centered on the bill’s failure to address how the proposal would negatively impact nurses expected to administer the of- label drugs addressed in the legislation. ANA-Ohio’s testimony, which is officially part of the senate committee’s proceedings, is reproduced below.
Testimony in Opposition to HB 73 before the Ohio Senate Health Committee June 12, 2024
Chairman Huffman, Vice Chairman Johnson, Ranking Minority Member, Antonio and members of the Senate Health Committee.
My name is Terry Pope. I am a registered nurse with years of experience working in numerous health care systems and hospitals in Ohio and elsewhere. I am here today on behalf of ANA-Ohio a relatively new professional organization for all RNs in the State of Ohio. After careful consideration, ANA-Ohio agreed to oppose HB 73.
ANA-Ohio appreciates the work that has been done and the changes made in the substitute bill that is now before this committee. However, the organization continues to have concerns about how the bill, when implemented, will affect nurses who routinely provide essential care such as administering medications (including off-label drugs) in hospitals and other facilities that are affected by this bill.
Because of the potential for harm when a patient is receiving health care, many safeguards are built into the procedures all providers are expected to follow. For example, generally, medication administration involves multiple providers—a physician who prescribes, a pharmacist who dispenses and a nurse who administers the drug. Ideally, having several individuals involved helps ensure any errors will be caught before the medication is administered to the patient. In this scenario, nurses are often the final safety valve against medication errors.
For nurses, regulations adopted by the Board of Nursing set forth acceptable standards of safe practice. These rules found in Chapter 4723-4 of the Ohio Administrative Code help
ensure a patient’s safety is not compromised. In part, the rules set forth the steps a nurse must take when deciding whether an order is safe to carry out. “When a nurse believes or has reason to believe that an order is inaccurate, not properly authorized, not current or valid, harmful or potentially harmful to a patient, or contradicted by other documented information the nurse must consult with the appropriately licensed practitioner and notify the ordering physician when the order is not followed.” (Rule 4723-4-03 Oh. Adm. Code). A rule in this same chapter, 4723-4-06 (H) OAC, requires the nurse to maintain a safe environment for the patient. The language of these rules can be particularly troublesome for nurses when the circumstances surrounding whether to administer an off-label drug are especially contentious. When dealing with such a controversial situation and especially when the order in question is from a practitioner with temporary privileges, the nurse is placed in an untenable position—whether to adhere to professional standards of practice or respond to the real-life immediate pressure to do what many conflicting voices are insisting upon.
Adding to the ambiguity, with respect to immunity provisions, the bill expressly states in Section 3792.06 (D) (line 229) that a health-related licensure board, Ohio Department of Health, State Board of Pharmacy, or other state board or agency responsible for the licensure or regulation of a health care profession shall not pursue an administrative or disciplinary action against a provider, pharmacist, or other health care professional, or hospital for publicly or privately expressing a medical opinion that does not align with the board, agency, etc. This section presumably would include nurses, but the breadth of the protection is limited. The wider immunity from administrative and civil liability provided elsewhere in the bill cannot be presumed to apply to any person or entity that is not specifically mentioned in those sections-- pharmacists, physicians, and hospitals. This lack of clarity poses problems for nurses, other non-identified providers, and perhaps even the patients this bill purports to help.
ANA-Ohio appreciates the efforts of the bill’s co-sponsors and other lawmakers to try to find ways to address the very difficult situation that led to the introduction of this bill in 2023. However, it is also important not to create an entirely new set of problems when trying to respond to a specific set of circumstances that may, by their facts, defy a realistically implementable appropriately crafted legislative solution.
Thank you for your consideration of the points ANA-Ohio has raised. I will be happy to try to answer any questions you may have.
Latest news from the Ohio Statehouse Janice Lanier JD RN Liaison Public Policy Committee
Legislative activity
While there has been lots of activity around the statehouse, the focus has been on moving bills that could be politically useful in the coming general election. Adding to the mix are the ongoing conflicts within the House republican caucus involving Senate President Matt Huffman (R-Lima) and House Speaker Jason Stephens (R-Kitts Hill) over who will lead the House in the next (136th) General Assembly. Read More
Political activity
The General Assembly has been on its primary election break, which means there has been little official business taking place for the past month. All of that is expected to change when lawmakers return to Columbus in April. What they will actually accomplish remains to be seen. The battles within the Republican Party, that are likely to be a harbinger of what to expect in the months ahead, continue as the primary election results are being interpreted in a variety of ways, depending on one’s perspective. Further, the expected battle for the Speaker of the House position between current Senate President, Matt Huffman (who will win a seat in the Ohio House in November), and current House Speaker Jason Stephens will heat up and affect what the chambers decide to focus on and how business will be conducted for the next few months.
Legislative activity Money, how to make it and how to spend it, has been uppermost in the minds of Ohio's lawmakers in the early months of 2024
Making money Two bills were introduced in late January, one in the house and the other in the senate, to eliminate the state income tax. Although both bills have the same goal to eliminate Ohio's state income tax by 2030, SB 216 (senators George Lang (R-West Chester) and Steve Huffman (R-Tipp City) & HB 386 sponsored by representatives Adam Mathews (RLebanon) and Brian Lampton (R-Beavercreek) vary in the approach taken to achieve their mutual goal. Both bills were referred to the ways and means committees of the respective sponsors’ legislative chambers; however, no hearings have been held yet.
The ANA-Ohio Board of Directors approved the following statement at its December 11, 2023, board meeting.
Members of the ANA-Ohio Public Policy Committee are reviewing HB 285 very carefully. (The bill would in part establish nurse patient ratios in Ohio law). Neither the committee nor the association has taken an official position on the proposal yet, largely because the issue is very complex, and the bill bears scrutiny. We encourage nurses to read the bill very carefully and to contact ANA-Ohio with specific questions or concerns. It is not an easy read so please feel free to reach out.
As for a general update the bill was introduced October 2, 2023, and referred to the House Health Provider Services Committee on October 3, 2023. It has not been scheduled for a hearing yet. The bill has bipartisan co-sponsors, including Rep. Beth Liston (D-Dublin) a physician who is also on the health committee that will be hearing the bill. Neither of the nurses in the General Assembly (Rep. Rachel Baker (D-Cincinnati) nor Jennifer Gross (R-West Chester) has signed on to co-sponsor; nor did physician Rep. Anita Somani (D-Dublin) ranking member on the committee. Both nurses are also members of the committee. Bill sponsor, Rep. Haraz Ghanbari (R-Perrysburg) described the bill as a work in progress, and said he was working with hospitals to make it "workable" for them. The bill is also sponsored by Rep. Elgin Rogers (D-Toledo).
As of January 15th, the bill had not been scheduled for a committee hearing. Given the very limited time the House is likely to be meeting prior to the March 19th primary, we continue to believe the bill will not receive serious scrutiny for some time. There remains time to do a thorough review and develop an equally thorough response.
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