Senate passes bill requiring disclosure of health care workers' HIV status, RN first assistant reimbursement issue continues

Legislation Senate passes bill requiring disclosure of health care workers’ HIV status, RN first assistant reimbursement issue continues

Health care workers infected with the human immunodeficiency virus (HIV) who perform invasive procedures on patients without informing the patients of their HIV status would have to serve up to 10 years in prison and/or be fined up to $10,000 under a bill passed by the Senate in July. After two weeks of action i n the aftermath of the death of Kimberly Bergalis, a Florida woman who was infected with the virus by her dentist, Sen Jesse Helms (R-NC) added the measure to the Treasury/Postal Service Appropriations bill. The bill was passed by an overwhelming 8 1-18 vote. The House already passed its version of the appropriations bill. When Congress reconvenes this month, the House and Senate versions will go to a joint conference committee. The final bill will go to the full Congress for a final vote, and then President Bush would have to sign it for it to become law. AORN and the American Nurses Association (ANA) oppose the measure, stating that mandatory testing and mandatory disclosure of HIV status will not prevent the spread of the virus that causes acquired immune deficiency syndrome (AIDS). The ANA has issued a full statement on HIV (see “ANA House of Delegates Meeting” in this issue). On July 16, the Centers for Disease Control (CDC), Atlanta, released its new recommendations on preventing HIV transmission (see “CDC Recommendations for Preventing Transmission of HIV During Exposure-Prone Invasive Procedures” in this issue). They state that health care workers who perform “expo-

sure-prone” procedures should find out their HIV and hepatitis B virus status. If they are infected, they should avoid performing such procedures. The Senate unanimously approved another amendment to the same appropriations bill. The amendment requires states to adopt the CDC guidelines as law or risk losing federal public health funds.

The AIDS Control Act of 1991 also was introduced by Helms. The bill, S 185, would mandate that the CDC keep records of all individuals who are infected with HIV, require that all blood be tested before a donor is accepted, require collectors or distributors of blood to permit autologous blood donations, and require family planning grant recipients to receive only information regarding the effectiveness of contraceptive methods when compared to abstinence and the most effective ways to avoid infection. According to the March 29, 1991, issue of Capital Update, the bill also sets conditions on grants for the prevention, treatment, and control of HIV infection. No state could receive grants under the Public Health Service Act unless it required physicians and others who analyze the tests to report names and addresses of HIVinfected individuals to public health authorities and spouses of the infected. The bill also would deny grants to states with bathhouses that have a pattern of homosexual activity or IV drug use. No funds would be allowed for providing needles, bleach, or condoms, and condoms could not be promoted as a method of prevention.

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The bill also would impose a $10,000 fine and/or imprisonment for individuals who knowingly donate blood or tissue if they have engaged in high risk behavior, are infected with HIV, have received clotting factor concentrate for hemophilia, or have migrated from Haiti or Central Africa. The bill is being considered in several committees and, at press time, had received no action.

As AORN continues to push for reimbursement for RN first assistants, members are helping by writing to legislators. In light of minimal support from the Physician Payment Review Commission, Rep Cardiss Collins (DIll) and Sen Daniel Inouye (D-Hawaii) introduced legislation that would provide for such reimbursement. The House bill (HR 287) has been referred to the Energy and Commerce and Ways and Means committees. The Senate version (S 180) has been referred to the Finance committee. Pat McGill, RN, MSN, ANA assistant director of congressional and agency relations and AORN’s legislative contact through the ANA, is requesting formal meetings with committee members. Specifically, AORN President Jean Reeder, RN, PhD, CNOR, and Jane Rothrock, RN, DNSc, CNOR, will meet with key members of the House Ways and Means Committee and the Senate Finance Committee. McGill expects the meetings to be held shortly after Congress reconvenes on Sept 9. AORN members are encouraged to write to their legislators and chairmen of the committees. McGill requests that nurses send copies of their letters to her. Addresses are as follows: The Honorable Representative John Dingell Chairman House Energy and Commerce Committee 2125 Rayburn House Office Building Washington, DC 205 15 The Honorable Representative Dan Rostenkowski, Chairman House Ways and Means Committee 1102 Longworth House Office Building 608

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Washington, DC 20515 The Honorable Senator Lloyd Bentsen Chairman, Senate Finance Committee 205 Senate Dirksen Building Washington, DC 205 10 Pat McGill, RN, MSN Assistant Director Congressional and Agency Relations American Nurses Association 1101 14th Street N W, Suite 200 Washington, DC 20005.

Proposed funding levels for nursing education in fiscal year 1992 are disappointing to nurses. After the House appropriated $59.9 million, which represents no increase over fiscal year 1991 figures, Dr Reeder wrote to the full House appropriations committee urging an increase in the level of funding. She said the proposed funding “does not take into account the urgent need for increasing the supply of nurses to meet the health care needs of Americans.” Shortly after the July 4th recess, the Senate appropriated $6 1.4 million, including increases in funding for special projects, traineeships, and certified registered nurse anesthetists (CRNAs). The Senate appropriated $1 1 million for special projects (ie, up from $10.5 million in fiscal year 1991), $14.1 million for traineeships (ie, up from $13.6 million), and $1.9 million for CRNAs (ie, up from $ l .4 million). The Senate also appropriated $45.8 million for the National Center for Nursing Research (NCNR), which is $2.7 million over the House’s proposal of $43.1 million. At press time, the Senate hoped to move the appropriations bills before its August recess. When Congress reconvenes, the two versions will go to conference. According to McGill, the final appropriation is likely to split the difference between the House and Senate proposals, providing a minimal increase in funding over fiscal year 1991 levels. A bill that would redesignate the NCNR as

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Medical device user facilities will be required to report medical device problems to the FDA and/or product manufacturers. the National Institute of Nursing Research was introduced by Rep Carl Purse11 (R-Mich). The bill (HR 2447) would elevate NCNR within the National Institute of Health (NIH) and place it in a more favorable position to obtain funding. The bill is budget neutral and currently has 70 cosponsors. It has been referred to the House Energy and Commerce Committee and will be attached as an amendment to HR 2281, the NIH reauthorization bill. AORN supports this measure. User facility reporting requirements of the new Safe Medical Devices Act of 1990 were discussed at a Food and Drug Administration (FDA) Center for Devices and Radiological Health conference in April. Beginning Nov 28, 1991, medical device user facilities, including hospitals, ambulatory surgical facilities, nursing homes, and outpatient treatment facilities, will be required to report serious medical device problems to the FDA and/or product manufacturers. According to a June 5 , 1991, report from the Department of Health and Human Services (HHS), an incident that must be reported is one that reasonably suggests that a medical device caused o r contributed to a death or a serious illness or injury that I ) is life threatening, 2 ) results in permanent impairment to a patient’s body structure or function, or 3) needs any immediate medical or surgical intervention to prevent a patient from being permanently damaged by a medical device. Deaths must be reported directly to the FDA and to the manufacturer if known; illnesses and injuries must be reported to the manufacturer. If the manufacturer is unknown, reports must go to the FDA. Reports must be submitted within 10 working days after the medical per-

sonnel in facilities become aware of information about a device problem. In addition, facilities must send semiannual summaries of all reports for that period. Facilities that do not comply will be fined up to $15,000 per violation to a maximum of $1,000,000 per proceeding.

A bill that would provide incentives for students to enter the nursing profession was introduced by Rep Patsy Mink (D-Hawaii) and referred to the Committee on Education and Labor. The impetus for the bill was the shortage of nurses in the United States and the fact that decreasing numbers of nurses have forced hospitals to reschedule surgery, close emergency rooms, limit patient admissions, and reduce the number of beds. The bill states that a decline in nursing school enrollment suggests that the shortage will not be overcome without further action to help nursing students. The bill (HR 2300) would add full-time nurses and medical technicians to the loan, loan forgiveness, and loan deferment provisions of the Higher Education Act of 1965.

Health care for women and minorities got a boost with House action on June 26. According to the July 1, 1991, issue of Medicine & Health, the House approved $167.2 billion in HHS funding for fiscal year 1992. Thanks to successful lobbying by the Congressional Caucus for Women’s Issues, the bill includes $50 million to pay for breast and cervical cancer screening by states, which is nearly double the fiscal year 1991 amount. The bill also increases cancer research by about $20 million. Other funding in the bill includes $25 million to launch a 10-year NIH study of women’s health problems and $12.5 million for NIH’s Office of Research on Women’s Health. Other specifics in the bill include $298 mil-

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lion for childhood immunizations, $100 million for cities with large populations infected with HIV, $138 million to combat infant mortality, and $1.7 billion for Medicare contractors. The House also directs the NIH to study the incidence of prostate cancer in black men and to give more grants to black student researchers. A bill that would allow nursing schools to establish clinics supervised and staffed by nurse practitioners and nurse practitioner students was introduced by Sens Tom Daschle (DSD) and Inouye. The clinics would provide primary care targeted to medically underserved rural and Native American populations. They would provide forums in which public and private schools of nursing would design and implement clinical training programs for their students, thereby combining nursing education and health care provision. The bill includes an amendment to the Indian Health Improvement Act to provide $5 million in grants to public and private nursing schools to create the clinics where Indians would have easy access to them. It also authorizes $5 million in grants under the Public Health Service nursing education program for schools that develop clinics in medically underserved areas and provides Medicare and Medicaid reimbursement for the services provided. The bill is being considered in the Senate Finance Committee, according to the May 24, 1991, issue of Capital Update.

The Occupational Safety and Health Administration (OSHA) has hired a second occupational health nurse. Elise Yiasemides, RN, MS, COHN, is a health scientist specialist in OSHA’s Directorate of Technical Support. She will serve as the principle source of agency expertise on scientific, engineering, and medical issues involved in the overall occupational safety and health field. According to the June 21, 1991, issue of Capital Update, Y iasemides will review the development of health standards and educational programs to protect employees from occupational hazards. D. CRUZ LAURIE SENIOR ASSOCIATE EDITOR 612

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Alzheimer Drug Studies to be Expanded The US Food and Drug Administration (FDA) has proposed expanded access for the drug tacrine (THA), a cholinesterase inhibitor used to treat Alzheimer’s disease. The FDA has not recommended the drug for approval but has asked the manufacturer to consider “a program that would allow expanded access and rapid collection of useful data,” according to an article in the April 1991 issue of Medical World News. This would move more patients into simplified clinical studies and provide the FDA with additional data on which to base approval. The drug yields a small cognitive improvement in Alzheimer’s patients. The manufacturer already has submitted additional scientific data to the FDA and is trying to establish a large trial, according to the article.

Hormone Found to Predict Heart Attacks Researchers have found that levels of renin, a kidney hormone that regulates blood pressure, can predict heart attacks. Patients with high renin levels and no other risk factors (other than mild hypertension controlled by medication) had more than seven times the risk for heart attack than patients with low renin levels. In the presence of other risk factors (eg, smoking, diabetes, high cholesterol) patients with high renin levels had more than three times the risk than those with low renin. Among 241 patients with low renin levels and no other risk factors, no patient suffered a heart attack. This study may explain why more than half the people who suffer heart attacks have normal cholesterol levels; high renin levels may be the reason. Measuring renin levels on a routine basis and controlling high levels with medication may prove useful in preventing heart attacks, according to an article published in the May 1991 issue of Science Briefsfrom New York-Comell.