Political maneuvering stalls bill to let nurses treat more patients without doctors' sign-off

As the legislative session ticked toward its end this week, one of North Carolina’s most powerful lawmakers used parliamentary maneuver to make sure a widely supported piece of healthcare legislation didn’t advance.

The bill would give advanced-practice registered nurses more responsibility to treat patients without supervision from a doctor. Called the SAVE Act, the measure has been bandied about for years at the General Assembly, with APRNs pushing for it and doctors working against it.

Nurses say the required supervision is cursory, more paperwork than anything else, which doctors charge for. Doctors say it’s an important part of team care.

This session’s version in the House, House Bill 277, has 75 sponsors — more than enough votes to pass in a 120-member House if it came to the floor. It has been in committee without a hearing since March 2021, a clear sign that leadership doesn’t back the bill.

State Rep. Gale Adcock, one the measure’s lead sponsors, said Tuesday that she’d use a parliamentary maneuver of her own to free the bill. She filed a “discharge petition,” which amounts to an end-around on the House’s Republican leadership.

If 61 members of the House signed on, the bill would skip committee and come to the floor.

But discharge petitions can’t be filed until a bill has been sitting in committee for 10 days. On Wednesday, Speaker of the House Tim Moore moved the bill from one House committee to another, resetting the clock and blocking Adcock’s discharge petition.

Adcock, D-Wake, said she had 18 signatures — which can only be given inside the House clerk’s office — when the speaker pulled the plug. She said 12 other members had agreed to sign and that she was “on track to have 61 signatures” in time to free the bill this legislative session, which is slated to end Friday or Saturday.

“It’s shocking that one individual in the House can override the desire of a supermajority of members who clearly want to vote on the SAVE Act, a nonpartisan policy bill that will increase access to care, add 4000 jobs and boost our economy,” Adcock said.

Asked about the move, Moore, R-Cleveland, said he doesn’t “think there’s as much support out there perhaps as some of the bill sponsors think there is.”

House Majority Leader John Bell said much the same thing.

“There are people that co-sponsored it that have concerns about the bill,” said Bell, R-Wayne. “A lot. I’m not going to name names.”

Adcock said that’s their story.

“My story is that 61 signatures were a certainty,” she said in a text message. “Why else would he move the bill? Why not let me fall on my face by coming up short?”

This measure has also been part of this year’s Medicaid expansion debate, with the state Senate attaching it to its version of Medicaid expansion. Its inclusion is one of the reasons the House wouldn’t go along with the Senate proposal and filed its own.

There’s also a standalone version of the SAVE Act in the Senate, which has not come to the floor there despite having half the Senate membership as sponsors, including two of three Health Committee chairs and the Senate’s deputy president pro tempore, one of the chamber’s top Republican leaders.