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WHA Testimony Supports Bill Enabling APCs to Activate Advance Directives Alongside Physicians

November 21, 2019

Building upon bipartisan support in the Wisconsin State Assembly, WHA members and staff testified in favor of legislation updating state law to allow qualified advanced practice clinicians (APCs) to play a needed role to help ensure patient health care wishes are followed through the patient’s advance directive. Senate Bill 254 had a public hearing before the Senate Committee on Health and Human Services Nov. 20; the Assembly approved companion legislation on a bipartisan voice vote Nov. 12.

The bill helps to address a problem of delays in following a patient’s documented health care treatment wishes by allowing qualified APCs to serve as one of two health care providers required to make a determination of incapacity or make a diagnosis of terminal condition or persistent vegetative state – such diagnoses are necessary to carry out wishes detailed in an advance directive such as a medical power of attorney or living will. The bill requires that a physician independently examine and concur with the APC’s independent diagnosis in order to activate an advance directive.

WHA and APCs working in WHA member organizations helped provide legislators with real-world examples of how current law’s requirement that two physicians must concur on an advance directive-related diagnoses is needlessly interfering with patient care, especially in rural communities.

“I see these situations play out every day,” said Fort HealthCare’s Director of Emergency Services and former state nursing board chair Sheryl Krause, MS, RN, CEN, ACNS-BC, pointing out how current law bars otherwise-qualified APRNs and physician assistants (PAs) from assisting the patient in this specific area. “In this situation, hospitals are forced to find a second physician,” Krause said, “perhaps even pulling that physician away from an emergency department that could become inundated with patients at any moment, resulting in further delay to activating the advance directive, or delay to patients waiting for care in a busy emergency room.”

In addition, Paula Cynkar, MPAS, PA-C, in partnership with WHA and the Wisconsin Academy of Physician Assistants, testified alongside Krause in support of the legislation, covering the didactic and clinical training PAs currently receive. Cynkar, a hospitalist PA at UW Hospital, also discussed her interactions with patients and their families who need to have decisions made regarding the patient’s care, consistent with the patient’s wishes.

State Assembly Reps. Patrick Snyder (R-Schofield) and Steve Doyle (D-Onalaska) and State Senators Howard Marklein (R-Spring Green) and Janis Ringhand (D-Evansville) are the lead bipartisan authors. Contact WHA General Counsel Matthew Stanford or Vice President of Workforce & Clinical Practice Ann Zenk for more information.

This story originally appeared in the November 21, 2019 edition of WHA Newsletter