Balancing Access and Quality: What South Carolina’s Debate on Team-Based Healthcare Means for Patients
At the recent Senate Medical Affairs Committee hearing, lawmakers, lobbyists, and healthcare professionals came together to weigh in on a series of bills shaping the future of healthcare in South Carolina — most notably S.669: Team-Based Health Care.
Senator Hutto’s Call for Balance
Senator Brad Hutto reminded the committee of the days when “every little town had a doctor,” underscoring how access has eroded as South Carolina’s population has grown from 2 million to 5.5 million. He emphasized that today’s challenge is striking the right balance:
“It’s about the public. It’s about access to health care. It’s about making sure that we work together. And for me, it’s about making sure that we get qualified medical practitioners in the rural areas. It is really not fair to ask somebody to get in the car and drive an hour to go see a doctor. And that’s happening in South Carolina now, whether we like it or not.”
-Senator Brad Hutto
His remarks framed the broader debate:
How can the state expand access to care while ensuring patient safety and high-quality outcomes?
Lobbyist Concerns: Wanda Crotwell’s Testimony
Representing the Nurses Association and Department of Public Health, Wanda Crotwell addressed S.45 and raised concerns about S.669. She praised senators for recognizing the reality of provider shortages while reminding them that “health insurance does not ensure access to care.”
Crotwell highlighted that South Carolina remains one of only 12 states that still limit full practice authority for APRNs, a policy she argued has direct consequences on health outcomes:
All of the top 20 states in United Health’s 2024 rankings allow full practice authority for APRNs.
In contrast, states restricting APRN practice consistently rank lower in health outcomes.
Her testimony placed South Carolina’s legislative decisions in a national context —suggesting that restrictions may come at the cost of healthier communities.
Janet DiNino: A Voice from the Front Lines
Among the most compelling testimony came from Janet DiNino, MSN, RN, AGPCNP-BC, representing Your Health. With over 30 years in nursing and advanced practice, she brought both data and lived experience:
The Stakes: South Carolina has the 6th highest diabetes prevalence in the nation, with 533,000 adults living with the disease. The state also ranks 6th in end-stage renal disease with nearly 14,000 patients on dialysis. In Richland County, one zip code has the highest rate of amputations in the Deep South.
The Reality in Rural Counties:
Calhoun County: 1 physician and 2 NPs for 14,000 residents.
Union County: 8 physicians and 14 NPs for 27,000 residents.
Williamsburg County: 13 physicians and 9 NPs for 30,000 residents.
The Cost of Restriction: DiNino argued that limiting NP practice will not create more doctors — it will only delay care, deepen shortages, and increase costs.
She also humanized the debate with powerful stories from her practice: patients rationing insulin, living without air conditioning or running water, and even soaking their feet in bleach to treat wounds. These aren’t policy abstractions — they are daily realities for South Carolinians.
The Bigger Picture
The testimony of Senator Hutto, Wanda Crotwell, and Janet DiNino painted a vivid picture: South Carolina’s healthcare system stands at a crossroads. Legislators must decide whether to maintain restrictive practice laws or adopt reforms that give healthcare professionals — physicians and non-physicians alike — the flexibility to meet patient needs.
What unites all voices in this debate is a common goal: quality care, close to home, for every South Carolinian.
Janet DiNino, MSN, RN, AGPCNP-BC
Janet DiNino has been a registered nurse since 1992, beginning her career through a diploma program at Presbyterian Hospital School of Nursing during a period of critical nursing shortages. Over more than three decades, she has served patients across oncology, hospice, palliative care, emergency medicine, and skilled nursing facilities.
Committed to advancing her education, Janet later earned her bachelor’s and master’s degrees in nursing administration and leadership, followed by a post-master’s certificate in Adult-Gerontology Primary Care as a Nurse Practitioner. Today, she continues her career with a focus on improving patient care and strengthening access to healthcare in South Carolina.