Applying the Lessons Learned From Katrina
While the UEVHPA does not specifically address PAs’ supervision requirements, it has provided opportunities for PAs in individual states to resolve those issues separately. When Indiana was considering passage of the UEVHPA, Davis says, “we flagged the issue and said, ‘You know, this might be a good time—while the legislators are thinking about disaster response—to talk to somebody about putting the PA language someplace.’”
That place didn’t have to be within the UEVHPA: “If you’re looking for a uniform law, you don’t necessarily stick your own provisions on it—that seems a little invasive,” Davis observes. Instead, the PA disaster response language was introduced through an omnibus bill that was in the works.
Jan Towers, PhD, NP-C, CRNP, FAANP, Director of Health Policy for the American Academy of Nurse Practitioners, is a bit less sanguine about the UEVHPA. “They still haven’t fixed the issue,” she notes, which for NPs is “shedding the shackles of law that requires physician collaboration or delegation within some of the states that have obsolete laws.”
Section 8 of the UEVHPA, “Provision of Volunteer Health or Veterinary Services,” contains the following statements:
• “… a volunteer health practitioner shall adhere to the scope of practice for a similarly licensed practitioner established by the licensing provisions, practice acts, or other laws of this state” and
• “Except as otherwise provided in subsection (c) [which allows states the right to modify or restrict services provided by a volunteer], this [act] does not authorize the volunteer health practitioner to provide services that are outside the practitioner’s scope of practice, even if a similarly licensed practitioner in this state would be permitted to provide the services.”
What concerns Towers is that “we’re still going to the lowest common denominator. Bottom line is, NPs are prepared [educationally] the same way across the board, and being tied to a physician in some states, while in other states they are not, is really limiting.”
Towers says it would have been “very helpful” if the UEVHPA had included language that expressly gave states the right to lift supervision or collaboration requirements. “There are some states that have actually passed regulations and statutes that speak to this by saying, ‘If there is a disaster, then the need to be tied to a physician is lifted, for the period of time of the disaster,’” she points out.
But, as with the PAs’ supervision requirements, “that’s happening state by state, and it’s something we’re going to have to work on,” according to Towers.
Wanted: Team Players
One thing that everyone seems to agree on is that preregistration, precredentialing, and involvement in emergency or disaster response teams should be encouraged. To this end, the UEVHPA requires that volunteer health care providers be registered with a system that can confirm their licenses and credentials before they are deployed in response to a disaster.
“The use of registration systems is intended to (1) discourage the uncoordinated use of ‘spontaneous volunteers’ who may independently travel to the scene of a disaster without the support of public or private emergency response agencies,” the preface to the draft legislation reads, “and (2) promote the recruitment and training of volunteers in advance of emergency declarations, while also allowing and facilitating additional registrations at the time of an emergency.”
The increased emphasis on teams, from the community level on up, has been one of the biggest lessons acted on since Katrina. “The amount of planning that’s gone on post-Katrina is incredible,” MTI’s Bollinger says. “A lot of states are looking at creating medical volunteer corps, looking at PAs, NPs, physicians, and paramedical personnel, and gathering them into a database that they can tap into. You know, ‘OK, we need four PAs to go to this clinic, or this displaced persons site, and provide care.’ Boom, that’s in the database; we can launch those folks.”
So-called spontaneous volunteers, though well intentioned, “can put burdens on a fragile infrastructure,” observes Bollinger. “In some ways, you’re relocating the disaster.”
That’s why PAs and NPs are encouraged to join a medical response team—whether a Red Cross unit, a Disaster Medical Assistance Team, or a private agency like MTI. “The best help is not the person who grabs their medical bag and goes down alone,” Davis says. “It’s folks who are part of an organized system that are the most helpful. They show up with their own water and tools and people that they know how to work with.”
Organized units will often handle credentialing and registration, but clinicians can also register on their own so that their licensing information can be verified in advance, allowing them to be mobilized quickly in the event of an emergency. “Having to do any kind of registration once a disaster happens, of course, slows down the process,” Towers observes.
