Rural Republicans for Nurses

Rep. Christian: "The number one cost is that people do not have primary care."

Rep. Garnet Coleman, D-Houston, spent a chunk of yesterday shepherding Senate Bill 532 by Sen. Dan Patrick, R-Houston, through the House. It's an interesting measure for retail clinics, cutting the amount of time the physician has to be there overseeing a physician assistant or nurse practitioner from 20% to 10%, and increasing the maximum distance from their home practice from 60 miles to 75 miles.

When it came to amendments, Rep. Wayne Christian, R-Center, went on what can only be called a blue streak from the front mike. As a loyal conservative, he compared the debate to watching Pres. Barack Obama speaking at Notre Dame. "The thing that got me upset, the longer I heard him talk, the more I found myself agreeing with what the man had to say," he said, to a round of applause. The debate had to get beyond caricature and name-calling, and address the core issue of rural health care provision.

He gave some pretty stark statistics about his own medically under-served district. "We've have one doctor at 95 years of age in Jasper county, one over 90 in Sabine County, another 80 plus and 70 plus in Center, Texas […] Folks, we don't have the doctors to provide primary care."

He proposed an amendment that he said would increase medical provision by letting advanced practice nurses in rural counties write prescriptions (as some classes of nurses are already allowed to do in hospital.) "We don't have enough CVS pharmacies throughout my district and rural Texas, we don't have the clinics that would be provided by this bill" he said. He twice refused to yield to Rep. Betty Brown, R-Terrell, instead hammering on what he saw as a failure to back nurses.

That wasn't without controversy. There were rumblings about turning nurses into functional independent practices, including from Rep. Bill Zerwas (himself a doctor) and bill sponsor Coleman but Rep. Rob Orr, R-Burleson, noted that the state already does that through depending on nurses in school clinics.

While amendments by both Orr and Christian both failed, the lengthy debate undoubtedly raised some major questions about rural health care provision. All of which might get tackled next session (that would be 2011.)