Almost three years after Hurricane Katrina, as natural disasters occur around the world with seemingly greater frequency, is the United States better prepared to respond to a disaster in our own backyard? And what improvements are still needed if health care providers, including NPs and PAs, are going to be utilized to the full extent of their capabilities?
Paul Bollinger, MPH, Emergency Medical Services Senior Advisor for the Portland, Oregon–based Medical Teams International (MTI), quotes MTI’s director of disaster response as saying, “It’s easier to send a doctor to Liberia than it was to Louisiana.” Bollinger adds, “That’s a huge issue, portability, in times of disaster—and yes, governors can change those laws, but I think by the time the bureaucracy wheels turn, it’s too late.”
Uniform Emergency Volunteer Health Practitioners Act
Greasing those bureaucratic wheels is the aim of the Uniform Emergency Volunteer Health Practitioners Act (UEVHPA), a piece of model legislation drafted by the Uniform Law Commission (ULC). According to Eric Fish, Legislative Counsel for the ULC, the goal of the UEVHPA is “to facilitate a better response to large-scale disasters by getting rid of some of the red tape and paperwork and things that could slow down responders.”
The ULC decided to address this issue as a direct result of what happened during and after Hurricanes Katrina and Rita struck the US Gulf Coast, laying bare the many levels on which bureaucracy and disorganization stymied relief efforts. “A few of the commissioners had family members involved with the medical response [to Katrina],” Fish says, “and it was brought up that way. And then, working with groups such as the Red Cross, it became apparent that some quick action in this field of law would be beneficial.”
Usually, it takes three to four years for the ULC to produce model legislation, from the time an area of interest (such as emergency response) is proposed to the point at which the commissioners approve the final version. In the case of the UEVHPA, most of the act was approved the year after the Katrina disaster, with additional sections addressing liability and workers’ compensation approved last year.
Colorado, Kentucky, and Tennessee were the first states to enact the UEVHPA in 2006 and 2007. In 2008, the act has been introduced in 12 states; so far, Indiana and New Mexico have enacted it. (See map.)
So how does the UEVHPA address some of the problems experienced in the aftermath of Katrina? Two key points are outlined in the prefatory note to the act (available as a PDF at www.uevhpa.org):
• “To protect the public health and safety, the act requires that, prior to deployment, volunteers must be registered with public or private systems capable of determining that they have been properly licensed and are in good standing with their principal jurisdiction of practice” and
• “To alleviate confusion and uncertainty regarding the types of services that may be provided by volunteer health practitioners, the act requires volunteers to limit their practice to activities for which they are licensed, properly trained, and qualified to perform. Further, volunteer health practitioners must conform to scope-of-practice authorizations and restrictions imposed by the laws of host states, disaster response agencies and organizations, and host entities.”
“It doesn’t supersede any existing state law,” Fish explains. “What this does is just set up a registry that a state can call upon in times of disaster.” He employs a baseball analogy for clarification: “It’s like having people in your bullpen. You know who’s in the bullpen, you know what they can do, you’ll bring them up for whatever situation.”
But is it enough?
Beyond the UEVHPA
No single piece of model legislation will iron out every wrinkle the nation faces in disaster response. PAs and NPs have particular issues when it comes to practicing outside the state in which they are licensed—supervision by and collaboration with physicians, respectively.
Long before Katrina, the American Academy of Physician Assistants (AAPA) drafted model language saying that “any PA who is licensed in the state or licensed in another state or authorized to practice by a federal employer as a physician assistant should be able to provide whatever care they are able to in a disaster or emergency situation, with whatever supervision is available,” summarizes Ann Davis, PA-C, AAPA Director of State Government Affairs. Five states (soon to be six) have adopted AAPA’s model language; overall, 38 states have some sort of provision for recognizing PAs in disasters or emergencies.
AAPA doesn’t have an official position on the UEVHPA, but Davis says, “In my opinion, the bill is fine as drafted, because it defines ‘health care practitioner’ as anybody who is licensed to provide health care services in a state. It’s broad enough that I don’t think anybody would question if PAs were meant to be included.”