Attorney General's Opinion
Attorney General Richard Blumenthal
February 16, 1994
Janice Thibodeau, R.N.
Chairperson
Board of Examiners for Nursing
Department of Public Health and Addiction Services
150 Washington Street
Hartford, CT 06106
Dear Ms. Thibodeau:
This is in response to an October 19, 1993 request for an opinion regarding the prescriptive authority of advanced practice registered nurses ("APRNs"), which request was generated by Marie Hilliard, the Board's Executive Officer. The question is whether APRNs have prescriptive authority in a private practice setting. The answer is that APRNs may exercise prescriptive authority only in the settings specified in Conn.Gen.Stat. 20-87a(1) through (4), unless and until the Department promulgates regulations specifically permitting APRNs to prescribe medication in a private practice setting.
As Dr. Hilliard noted in her letter, the legislature has prescribed four specific practice settings in which APRNs may prescribe medication, as well as "any other settings that may be prescribed by regulations adopted pursuant to" 20-99a of the statutes. Conn.Gen.Stat. 20-87a(b).1 The only pertinent regulation promulgated by the Department is Connecticut Agencies Reg. 20-87a-1, which provides:
The APRNs urge a broad reading of this regulation, so that they would be permitted to prescribe medication in any setting. However, this interpretation of the regulation is untenable. This regulation merely states that, in whatever setting APRNs exercise prescriptive authority, they must do so in a manner that is consistent with the relevant statutes. Conn. Agencies Reg. 20-87a-1. It is not sufficiently specific to expand the settings in which APRNs may prescribe medication. This requirement of specificity is derived from the statute and by application of the rules of statutory construction. In general, statutes should be construed so as to give effect to the intent of the legislature. State v. Parmalee, 197 Conn. 158, 161, 496 A.2d 186 (1985) (citation omitted); Nationwide Mut. Ins. Co. v. Pasion, 219 Conn. 764, 768-69, 594 A.2d 468 (1991) (citing Sanzone v. Board of Police Commissioners, 219 Conn. 179, 186, 592 A.2d 912 (1991)). "When the words of a statute are plain and unambiguous, we need look no further for interpretive guidance because we assume that the words themselves express the intention of the legislature." Rhodes v. Hartford, 201 Conn. 89, 93, 513 A.2d 124 (1986) (citation omitted). Here, the statutes clearly delegate to the Department the authority to define the settings in which APRNs may exercise prescriptive authority. Conn.Gen.Stat. 20-87a(b), 20-99a.2 Section 20-87a(b) itself states that APRNs shall have prescriptive authority in "any other settings that may be prescribed by regulations...." Conn.Gen.Stat. 20-87a(b). The legislature delegated broad discretion to the Department in defining the settings in which APRNs could practice.3 However, the Department cannot be said to have enumerated any settings other than those set forth in Conn.Gen.Stat. 20-87a(1) through (4). "Under the maxim of 'noscitur a socis,' the meaning of a particular word or phrase in a statute is ascertained by reference to those words or phrases with which it is associated." Staples v. Palten, 214 Conn. 195, 199, 571 A.2d 97 (1990) (citing Schreiber v. Burlington Northern, Inc., 472 U.S. 1, 8, 105 S.Ct. 2548, 86 L.Ed.2d 1 (1985) (other citations omitted)). The statute itself sets forth four specific places or environments in which APRNs may prescribe medication, and then provides the Department with the authority to identify other specific "settings" if it chooses to do so. Conn.Gen.Stat. 20-87a(5). The legislature's list of specific places or environments indicates that the word "settings" in Conn.Gen.Stat. 20-87a(5) refers to other specific places or environments which might be designated by the Department in regulations promulgated pursuant to Conn.Gen.Stat. 20-87a(b) and 20-99a. Thus, Conn. Agencies Reg. 20-87a-1 does not expand the settings in which APRNs may exercise prescriptive authority because it lists no other specific places or environments in which APRNs may prescribe medication. Although the legislature delegated to the Department the authority to promulgate regulations identifying settings other than those listed in Conn.Gen.Stat. 20-87a, the Department has not done so. Conn. Agencies Reg. 20-87a-1 sets forth no specific places or environments in which APRNs may prescribe medication. As such, the Department cannot be said to have identified any other settings in which APRNs may practice. Thus, APRNs may prescribe medication only in those settings set forth in Conn.Gen.Stat. 20-87a(1) through (4), unless and until the Department promulgates appropriate regulations in which such settings are specified.
Very truly yours,
Richard Blumenthal
Attorney General
Jennifer C. Jaff
Assistant Attorney General
RB/JCJ
Footnote:
1 Conn.Gen.Stat. 20-87a(b) provides in full:
2 Conn.Gen.Stat. 20-99a provides that "[t]he department of public health and addiction services shall, with the advice and assistance of the board, adopt regulations necessary for the implementation of this chapter."
3 Of course, the Department is limited by the other legislative provisions relating to APRNs, as well as to nurses in general. Conn.Gen.Stat. 20-87a et seq.