Oh No! Not Texas!!

Welp, it’s happening folks. The Full Practice Authority(FPA) crowd have slithered their way over to Texas legislators and introduced a bill, HB 2029, seeking to practice medicine without a medical license. Again. The no bulls**t, 10-gallon hat-wearing Lone Star State is considering allowing lone wolf nurse practitioners(NPs) free reign to practice on the unsuspecting public. Without oversight. Texas, a state that is known for its leadership and hard stances may fold. Cave. Become a quivering mass of jello in this travesty and potentially do what 23 states and D.C. have done–pass FPA because…well darnit, it’s what everyone else is doing. Since when has Texas ever been a follower?

I remain baffled as to why legislators refuse to do their due diligence to ensure that their constituents are protected from maverick NPs. Can’t keep using the pandemic as an excuse to pass laws that should not be passed because the nagging by the NP lobby has become unbearable. Recently, I read an article in Medpage Today, questioning whether state nursing boards(BRNs) are becoming more aggressive in disciplining nurses. The Texas BRN is held out as the epitome exemplifying that aggression. The irony. From my perspective, knowing colleagues who have reported NPs for mismanagement and substandard care, the Texas BRN appears apathetic. From the article:

  • “National and state data show increases in several disciplinary categories at nursing boards over the last two decades, particularly from 2005 to 2016.
  • Nationally, adverse actions reported against registered nurses (RNs) more than doubled from 2001 to 2011, according to the National Practitioner Data Bank (NPDB), and increased steadily from 14,092 in 2012 to 16,190 in 2016. These actions fell slightly from 2016 to 2019, the last year for which complete data were available.
  • Similarly, actions against advanced practice nurses (APNs) surged more than five-fold from 2001 to 2014, according to NPDB data.
  • NPDB data for Texas show that adverse actions against RNs and other nurses more than doubled from 2008 until 2012. The number of actions against Texas APNs in 2016 was nine times the 2013 number.” NINE TIMES!!!

For reasons that remain inexplicable, legislators in states with FPA have failed to follow up to determine if the quality of care provided to the public is actually as high as NP organizations claim. This was discussed more in detail in an article I wrote for Authentic Medicine(https://authenticmedicine.com/2020/06/a-legal-precedent-perhaps/). I suggested one way to assess the quality of care is to review or audit malpractice claim data before AND after FPA was instituted. Documented information such as this can be indicative of the caliber of clinical practice. If adverse actions and/or payouts against NPs are increasing, it would behoove legislators to determine why. Is it congruent with the expansion of FPA…or not? I’ve long maintained that legislators, auditing or other regulatory bodies would be surprised by what they find. However, they should not be, because it is predictable. One cannot expect individuals without formal training in medicine to practice competently, unsupervised. The negative manifestations of that substandard care on some patients will inevitably result in litigation. When AB 890, the California bill enabling NPs to practice unsupervised, was making its way through the various committees, I personally sent compiled malpractice data from the California Nurses Association(CNA)/Nurses Service Organization(NSO) claims report to legislators, all to no avail. I doubt one legislator read it. Although the data set was limited to California claims, the report was clear:

  • ”The three locations with the highest frequency of closed claims are physician office practice, NP office practice and aging services facility/skilled nursing.” 
  • ”Diagnosis, medication and treatment/care management allegations account for 84.5 percent of all the closed claims in the dataset.”


Legislators in any state can obtain malpractice information, not only from the various nursing liability companies, but the National Practitioner Data Bank(NPDB). The question is, why don’t they? I believe it is feigned ignorance. Laziness. Lack of motivation. Indifference. They would rather listen to the hogwash presented to them by the NP lobby and continue to spew the rhetoric that FPA will increase access to care. Expecting legislators to do their own homework for the sake of their constituents is apparently too much to ask. They do not wish to spend the time it would take to do things right. 

Texas, Texas, where art thou Texas? Do not forsake the public for charlatans. Be the leaders you have always been. 


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425330cookie-checkOh No! Not Texas!!