A bill that sought to expand access to medically assisted death in Hawaii failed to advance to a final vote after lawmakers stumbled over the role of advance-practice registered nurses and physician assistants.

House Bill 1823 also would have lowered the mandatory waiting period before a doctor can write a prescription for life-ending medicine to 15 days to match most other jurisdictions that have legalized the option.

The measure made it to a conference committee, but lawmakers in the House and Senate could not resolve their differences so it won’t be put to a final vote this week, to the dismay of supporters expecting a legislative victory.

“It’s totally outrageous because the Senate version of the bill and the House version of the bill are identical in substance,” said Sam Trad, who heads the end-of-life options advocacy organization Compassion & Choices Hawaii. “I don’t know why people are passing bills through their committees if they’re not okay with them.”

More than three years after physician-assisted death was legalized in Hawaii, advocates say safeguards built into the 2018 law are preventing terminally ill patients, particularly those on the neighbor islands, from utilizing the option.

Currently, qualified patients must make two oral requests 20-days apart before their doctor can write a prescription for life-ending medicine. HB 1823 would have lowered the mandatory waiting period to 15 days.

Addressing advocates’ concerns that dying patients in underserved communities faced significant obstacles in finding a doctor willing to assist, the measure would have expanded authority to prescribe the life-ending drug to qualified advance-practice registered nurses and physician assistants.

It was the latter proposal that brought the House and Senate into contention, said Rep. Troy Hashimoto, who along with Sen. Sharon Moriwaki leads the Kupuna Caucus, which advocates for issues affecting older adults.

Conference committee participants from the House, led by health chair Rep. Ryan Yamane, were uncomfortable with allowing APRNs to prescribe the lethal drug, Hashimoto said.

Negotiators under Senate health chair Jarrett Keohokalole refused to budge, arguing instead that there was more risk in granting practicing authority to physician assistants.

“In the end, we just had differences that we needed to work out and we weren’t able to do so in that small period of time,” Hashimoto said. “Everybody worked really hard on the bill, and it was kind of unfortunate, but I think we need to continue having dialogue.”

Hashimoto said he will reintroduce the measure next legislative session but was unable to guarantee a better outcome as statewide elections this fall may drastically alter the composition of essential committees.

He will have the support of the advocates, Trad said, promising to monitor the upcoming electoral contests for candidates’ stances on medically assisted death.

“We know this is an important issue to a lot of people,” Trad said. “We’re not going to quit because these unnecessary barriers are forcing people to have just tragic deaths.”

Civil Beat’s health coverage is supported by the Atherton Family Foundation, Swayne Family Fund of Hawaii Community Foundation, Cooke Foundation and Papa Ola Lokahi.