It's puzzling that a state Senate that two years ago fell over itself to allow non-doctors to perform eye surgery would balk at freeing nurse practitioners from a feudalistic mandate that has an unclear, if any, impact on patient care.

In 2011, we opposed allowing optometrists to perform laser surgery because the proposal had not been studied, had been tried in only one other state and would inevitably mislead many patients. It flew through the legislature, nonetheless, greased by campaign contributions from optometrists.

This year, we support allowing nurse practitioners, who have advanced medical training, to prescribe non-narcotic medicines without the collaborative agreement with a physician that state law now requires.

This proposal is already working in 17 states and the District of Columbia. It has been extensively studied and gained broad support, from the Institute of Medicine to the Federal Trade Commission. It also could improve access to basic care in places without doctors, which includes much of Kentucky.

The Kentucky Medical Association, representing doctors, opposes the proposal, citing concerns about patient safety and quality of care if NPs have no doctor to consult.

The KMA prefers a compromise that stops short of independence for nurse practitioners while addressing some of their concerns, especially about having to pay sometimes large fees to obtain the doctor's signature required for nurses to prescribe medicines.

Kentucky's nurse practitioners already routinely prescribe medicines; each side cites the historic lack of problems with NPs prescribing as evidence that it is right.

The KMA also stresses that federal health care reform encourages doctor-led teams as the best way to deliver care and control costs.

But independent NPs would not conflict with doctor-led teams. Instead, nurse practitioners would be a vital part of such teams, and the collaboration would be genuine.

Kentucky doesn't have enough primary-care doctors or nurse practitioners and should be encouraging both.

Senate Bill 43, which was amended in the House to free nurse practitioners from having to pay doctors what amounts to tribute, cleared the House 70 to 16.

It merits final Senate approval in the session's last two days.