Committee hears testimony on bill to require child-abuse training for licensed medical providers

The Executive Departments and Administration Committee opened a public hearing on House Bill 493 to consider a requirement that physicians, physician assistants, nurse practitioners and nurses complete one hour of accredited continuing education focused on recognizing and reporting child abuse and neglect.

Proponents, including retired child-abuse pediatrician Dr. Gwendolyn Gladstone and Cassandra Sanchez, the state Child Advocate, said targeted, recurring education would help providers spot early signs of maltreatment and refer cases for further review. Dr. Gladstone said she treated “thousands of children” and described instances when children later presented with severe injuries after prior medical encounters where warning signs were missed. Sanchez told the committee her office reviewed cases in 2023 where infants with multiple fractures had previously been seen by emergency or primary providers and said conflicting medical opinions sometimes hindered court action.

Supporters emphasized an existing, free online course hosted by Dartmouth that offers one hour of continuing-education credit and said uptake has been low: Sanchez told the committee that as of February, “only 59 professionals had completed that hourlong course.” Resmiye Oral, director of the Child Advocacy and Protection program at Dartmouth, said CAP and others have developed longer and shorter trainings, that the one-hour course is intended as a minimum, and that boards had been unable to establish licensing rules requiring the training.

Opponents included Ben Bradley of the New Hampshire Hospital Association, who said health-care professionals already have a statutory duty to report suspected child abuse under RSA 169-C and argued the legislature should not legislate a specific continuing-education mandate. Bradley noted prior statutory education requirements (for opioid prescribing) were later returned to the Board of Medicine and urged that the professional boards be allowed to set continuing-education parameters.

Nicholas Fry, general counsel for the Office of Professional Licensure and Certification (OPLC), told the committee several implementation issues merited clarification. Fry said the bill’s current language could be read as creating a condition for initial licensure rather than solely a continuing-education requirement, that nurse practitioners are not covered by the Board of Medicine and therefore need separate treatment, and that the phrase “Category 1 medical hours” aligns with Board of Medicine rules but not nursing rules. He also said the statutory wording appears to require recurrence of the training every two years when licenses are renewed.

Committee members asked how the requirement would be enforced and whether it should be left to the licensing boards. Proponents described a typical enforcement approach: providers would submit a certificate of completion as part of their continuing-education reporting at renewal. Members also discussed whether the one-hour minimum is sufficient and whether specialty groups (for example, psychologists, psychiatrists or naturopathic physicians) should be included; witnesses said psychiatrists would be covered as physicians but psychologists are regulated under a separate chapter and naturopathic doctors requested inclusion.

The committee did not take a vote. Members expressed differing views about whether the statutory route was appropriate or whether the Board of Medicine and Board of Nursing should adopt rules. The chair scheduled an executive session on both this bill and a second bill for the following Wednesday afternoon and postponed final action.

The hearing record includes testimony from health-care providers, program directors and state officials outlining both the potential benefits of mandatory training and practical questions about statutory language and enforcement.

Looking ahead, committee members said they want input from the licensing boards before final action; the matter was set for further committee consideration at the next scheduled executive session.