The regulatory process: impacting the NP's role

The importance of the involvement of nurse practitioners not only in the passage of laws regulating their practices, but also in the interpretation of the law is illustrated by 2 cases. The first case in February, 1991, involved the Drug Enforcement Administration's (DEA) proposal to prevent NPs from directly obtaining a DEA number for drug prescriptions. Affiliated practitioners could only provide services through a physician. 428 persons replied to the proposed regulation in the Federal Register, of which 419 were opposed. The objections were to the impact on access to health care, the problems with physician liability, the confusion created in sites with multiple collaborating physicians, and the difficulty of tracing abuses. Without the full weight of the law in a final ruling, the DEA proceeded to deny DEA numbers to NPs. Congress passed legislation which prevented the DEA from issuing regulations that interfered with access to health care. Questions were raised about whether the DEA was trying to set policy, when the law clearly stipulated who was authorized to prescribe controlled substances. The DEA withdrew the proposed regulation on April 24, 1992. Regulations which give qualified mid-level practitioners their own DEA numbers will be forthcoming soon for comment. The second case involved the Department of Health and Human Services, which published regulations known as the "Gag Rule" in 1987. This gag rule prohibited all providers in family planning clinics funded by Title X of the Public Health Service Act from counseling pregnant women about abortion. The final ruling was made in January, 1988, with a memo of guidance that suggested that a woman would not be prevented from obtaining complete medical information. Court cases (Rust vs. Sullivan, for example) supported the regulations. Medical and nursing groups were outraged at the interference, since 85% of services were performed by nurse clinicians. Further damage was done when the Deputy Assistant Secretary for Population Affairs indicated that nurses were not fully trained to provide pregnancy counseling. Court cases (NFPRHA/NANPRH vs. Sullivan and PPFA vs. Sullivan) argued that the regulations changed the law on who could counsel clients without providing an opportunity for publication of opinions in the Federal Register. The answer to the request for the injunction is pending along with legislation to overturn the gag rule.