Authorization of partner STD treatment amended, advanced

After three days of debate, lawmakers amended and advanced a bill March 27 that would expressly allow expedited partner therapy (EPT) for the treatment of certain sexually transmitted diseases.

Under LB528, sponsored by Omaha Sen. Sara Howard, certain health providers who diagnose gonorrhea or Chlamydia in a patient would be allowed to prescribe, provide or dispense oral antibiotics to the patient’s sexual partner or partners without an examination.

Current law does not address whether EPT is allowed in Nebraska, Howard said, and the bill is intended to make the practice expressly permissible here, as it is in 33 other states.

Gonorrhea and Chlamydia often are asymptomatic and can lead to a variety of complications including infertility and premature childbirth, she said, adding that both infections can pass from mother to child.

“Both can cause eye infections, which can lead to blindness in newborns,” Howard said.

A Health and Human Services Committee amendment, adopted 33–0, replaced the bill.

Lincoln Sen. Kathy Campbell, chairperson of the Health and Human Services Committee, said the amendment provided clarifications requested by health care providers.

As amended, LB528 would specify that a physician, physician assistant, nurse practitioner or certified nurse midwife would be allowed to prescribe or dispense oral antibiotics within their scope of practice.

The bill also would require that prescriptions for a patient’s sexual partner or partners must include the partner’s name.

“This will allow pharmacists to screen for interactions and follow normal protocols for dispensing antibiotics,” Campbell said.

Bancroft Sen. Lydia Brasch opposed the bill and expressed concern about EPT’s lack of follow-up care for partners.

“Taking prescription drugs is not as simple as taking over-the-counter medication,” she said. “Who is responsible for the care and follow-up for an unknown or stealth patient?”

Grand Island Sen. Mike Gloor said even over-the-counter medications pose health risks and that the peer organization in the state responsible for weighing the medical evidence has spoken on the issue.

“The Nebraska Medical Association finds this appropriate,” he said.

During debate March 25, Papillion Sen. Bill Kintner offered an amendment to the committee amendment that would have required a medical practitioner to ask the age of a patient and any sexual partners of the patient. If either the patient or a sexual partner were under 18, parental notification would have been required.

“It seems we do everything we can to cut parents out,” Kintner said. “If it was your child, you would want to know.”

Brasch supported the amendment, saying parents should be involved in their children’s medical decisions.

“It’s not good public policy to start prescribing medicine to minors without parents being informed,” she said.

Howard opposed the amendment, saying current Nebraska law does not require parental notification for minors to be tested and treated for sexually transmitted diseases.

“The concern is that if minors are required to notify parents they will be less likely to seek testing and treatment,” she said.

The amendment failed on a 4-21 vote.

Omaha Sen. Beau McCoy offered an amendment to the committee amendment during debate March 26 that would require practitioners to provide written information about Chlamydia and gonorrhea for the patient and any partners.

“There are about a dozen states that require medical professionals to give this information to patients to pass along,” McCoy said.

Sen. Ernie Chambers of Omaha supported the amendment, calling inclusion of educational materials a pragmatic addition to the bill.

“When we know that the problem is there, it will not be eradicated by turning our eye away from it,” he said.

Omaha Sen. Rick Kolowski also supported the amendment, saying sexually transmitted diseases are mobile and affect many young people in Douglas and Sarpy counties.

“This issue is not just a north Omaha or south Omaha issue,” he said. “We have one-third of the students in the state of Nebraska in those [two] counties.”

The amendment was adopted 37-0.

McCoy offered, and later withdrew, another amendment that would have removed gonorrhea from the bill’s provisions.

A third McCoy amendment, offered March 27, would have provided immunity from civil liability for a practitioner who prescribes, provides or dispenses oral antibiotics pursuant to the bill or who chooses not to prescribe, provide or dispense such oral antibiotics.

McCoy said medical providers should not have to be concerned about being sued when making treatment decisions.

“[The amendment] provides immunity from civil liability for medical practitioners who choose to perform EPT or who choose not to,” he said.

Sen. John Nelson of Omaha supported the amendment, saying liability concerns could pose a barrier to care if medical providers fear future lawsuits.

Howard opposed the amendment, saying there are no documented cases of an adverse outcome from EPT and that the medical community has not expressed concern about liability issues.

“At this moment in time, the doctors aren’t asking for this amendment,” she said. “They aren’t asking to be immune from liability.”

The amendment failed on a vote of 15-27 and senators voted 32-3 to advance the bill to select file.