Now is the most dangerous time in the legislative session.

Much mischief happens this last weekend.


One joint resolution has a strong chance of passing setting the payment for emergency room charges in the hands of the Nevada Legislature.  It was introduced May 21, 2013 and is under the radar.  Can you say, DANGER WILL ROBINSON!  Today it is the hospitals; tomorrow it will be other businesses.  Do we want the state government setting payments for whatever they define as a right?  Emergency plumbing services, emergency air conditioning repair, emergency housing, emergency legal defense, you name it and they will put it into the mix.  AJR9 does not need the governor’s signature but anyone who knows the following legislators or live in their districts must contact them immediately.

For AJR9 contact everyone but definitely the ones listed below:

Name (Party) District email contact link

Majority Leader Senator Mo Denis-D (2) [email protected]

Senator Justin Jones-D (9) [email protected]

Senator Joyce Woodhouse-D (5) [email protected]us

Senator Michael Roberson-R (20) [email protected]us

Senator Aaron D. Ford-D (11) [email protected]

Senator David Parks-D (7) [email protected]

Senator Mark Manendo-D (21) [email protected]

Speaker of Assembly Marilyn Kirkpatrick-D (1) [email protected]

Assemblyman Jason Frierson-D (8) [email protected]

Assemblywoman Marylyn Dondaro-Loop-D (5) [email protected]

Assemblywoman Ellen Spiegel-D (20) [email protected]

Assemblyman Andrew Eisen-D (21) [email protected]

Assemblyman Andrew Martin-D (9) [email protected]

Assemblywoman Teresa BenitezThompson-D(27) [email protected]


If unsure of your Districts go to:

Roster for Assembly is:

Roster for Senate is:

Here is the link for the text of the joint resolution: AJR9



We will have to work hard to get some of these passed proposed laws vetoed by our governor.  He needs our votes to win re-election so let’s share our displeasure and hold everyone accountable at the ballot box!

There is an extremely dangerous law that has passed both chambers (pushed by Speaker Marilyn Kirkpatrick-D & Assemblywoman Maggie Carlton-D) and heads to the governor next.  We need him to veto AB170 and it is not clear if he will.  And although Nurse Practitioners are a valuable asset to a healthcare team this law will change this for the worse.  It is a first in the nation, a complete independent practice Advanced Practice Nurse (APN) license.  Although several states have special circumstances where Nurse Practitioners can prescribe certain lower risk medications and assist in rural areas with some autonomy, no state gives the Nursing Board carte blanche in defining any area of practice, and anywhere that they want, no restrictions.  There were a couple of amendments but none of these amendments truly require collaboration with a physician (no supervision at all).  Yes, the APN can simply open an office after a year of nurse practice and begin seeing patients.

Please note that collaboration agreements with physicians are not moneymakers for the physician.  It is my understanding that a physician cannot bill for collaboration to an insurance company.  In fact for the time spent in collaborative duties, the physician would make more money seeing patients of his own and not performing collaborative monitoring of the APN charts.  Truly not attractive from a medical liability or remunerative vehicle.

Furthermore, this will greatly decrease physicians wanting to practice in Nevada’s shortage specialties such as Primary Care because we will be a beacon to every APN in the country who wants to hang up a sign and begin practicing medicine.  The authors of this proposed law never allowed or attempted to create any oversight, limitation, or safety net to insure public safety.  Here is a fact, the majority of APN’s practice in major metropolitan areas in Nevada.  They removed the prohibition to practice outside of the APN practicing where they are not qualified but an amendment requires these APN’s to be insured but who wants the need to sue in the first place?  Shouldn’t we avoid the potential of danger before the life-threatening event if possible?

Why go to college for four years and fulfill all the premed required courses, four years of medical school and three years minimum of residence (minimum of 11 years) when you can get a four year nursing degree, APN for three years, no residency (7 years) and begin an independent office practice just 2,000 hours (a full time job is 2,080 hours a year) later in Nevada.

Which is more cost effective? Which one would you like at your bedside?  The new healthcare law (aka Obamacare) encourages this type of patient “access” to care.  In fact, unlike most legislation this proposed law takes effect July 1, 2013!  Most routine stuff will be okay but cross your fingers that it is routine stuff because if it is not chances are it could be missed because the APN’s simply don’t have the training for the rare complex problems.

The link for the text of the bill is: AB170 as passed by our Nevada Legislators, pay particular attention to what is being removed in red from Nevada law, like page 4 (Section 6) and 22 (Section 37) below.

Sec. 6. NRS 632.237 is hereby amended to read as follows:

(b) If authorized pursuant to NRS 639.2351 [,] and subject to the limitations set forth in subsection 3, prescribe controlled substances, poisons, dangerous drugs and devices . [,
pursuant to a protocol approved by a collaborating physician. A protocol must not include and an advanced practitioner of nursing shall not engage in any diagnosis, treatment or other conduct which the advanced practitioner of nursing is not qualified to perform.]

Sec. 37. NRS 454.695 is hereby amended to read as follows:

454.695 [1.] An advanced [practitioner of nursing] practice registered nurse may prescribe poisons, dangerous drugs and devices for legitimate medical purposes in accordance with [:

(a) The certificates] the certificate he or she holds from the Board and the license issued by the State Board of Nursing . [; and

(b) The protocol which is approved by the State Board of Nursing.

2. For the purposes of this section, “protocol” means the written agreement between a physician and an advanced practitioner of nursing which sets forth matters including the:

(a) Patients which the advanced practitioner of nursing may serve;

(b) Specific poisons, dangerous drugs and devices which the advanced practitioner of nursing may prescribe; and

(c) Conditions under which the advanced practitioner of nursing must directly refer the patient to the physician.]

Please share your thoughts because I am very concerned for Nevadans.  Contact the governor and share your concerns. He can send a strong message to the legislature to work out a safer alternative by a veto for this potentially life threatening change for the most vulnerable.

His office telephone number is: (775) 684-5670

Link to Nevada Governor website is:

Link to his campaign website is:

Link to his Facebook is:

Link to his Pinterest is:


Dr. Annette Teijeiro


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