Rep. Darby Makes Closing Remarks on HB 3794, "What I Don't See is White Coats in Rural Texas"

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Last week, the House Public Health Committee held a public hearing on HB 3794 by Representative Drew Darby, legislation on Advanced Practice Registered Nurses (APRNs) that addresses one of the most pressing challenges in our state today: the shortage of accessible, affordable healthcare, especially in rural and underserved communities. Watch hearing clip here.

Dozens of white coats stormed the capitol to testify against the bill, trotting out the usual arguments on patient safety and the inferiority of APRN education. Not a single physician testifier had data proving that patient outcomes worsened in states and jurisdictions that removed physician delegation requirements and granted APRNs full practice authority, including 27 states, the VA, and all three branches of the military. And not a single physician testifier could speak to a change in the quality of care during COVID when almost the entire country—including Texas—waived these requirements.

“These folks in white coats. I don’t know what they think—there is going to be blood in the committee room here?” Rep. Darby said as he addressed the committee members in his closing remarks.

“What I didn’t hear is anybody with a white coat say they were going to practice in rural Texas,” Darby added. “They’re practicing in large urban areas, big hospital groups, some of them bought and paid for by private equity groups. What I’m here to ask is for your consideration about how we meet access to care in rural Texas. That’s what I care about. That’s what I hope you care about, too.”

Rep. Darby addressed the lack of progress with the status quo policy solutions.

“What we’re doing now isn’t working folks—you can talk about GME, loan repayment, shortages.” “But what we don’t have are doctors willing to move to rural Texas. We do have nurse practitioners that are highly trained, highly qualified, actually providing those services, willing to live and work in rural Texas, but yet—they have to pay for that piece of paper.”

Rep. Darby called out the current system as one of “phantom doctor” agreements that consists of nothing more than a monthly phone call and chart review for care that’s already been delivered.

“Healthcare team in rural Texas is a nurse practitioner by herself in a little community—that’s all there is.” “Within one hour driving distance from San Angelo there is a nurse practitioner manning a clinic by herself, paying a doctor over $100,000.”

Rep. Darby went on to say that if Texans want to live in big cities, they need the resources that rural Texas provides. But rural Texans need quality healthcare.

“If we don’t have quality healthcare in our rural communities, nobody is going to live there.” “There are 27 counties where you cannot deliver a baby. What are you going to do about that? What are we going to do about it? Are we going to listen to people in white coats looking down their noses at us? We’re having to live in these areas—underserved areas—without access to quality healthcare.”

HB 3794 was left pending in committee where it awaits further action by the House Public Health Committee Chaired by Rep. VanDeaver.