i understand the decoy ms. lazar felt sorry for the store owner, and i do, too, and yet the department could go up to 90 days and instead imposed 25 days. so i'm actually inclined to support the department. >> commissioners, we've had many tobacco cases come in front of us and, you know, the early ones we all tried to establish a nexus between the penalty and what is done in other areas such as the sale of liquor to minors and i don't think we've come to any significant agreements among ourselves and with the department on that. i would just say at this point given the way the economy is, i think this appellant deserves a break. >> what do you mean by "break?" >> she did sell cigarettes to a minor, and so i would look at a reduction of the penalty. >> well, i think you heard my question and what i'm struggling with, and if we do want the department to take these things seriously, we should help them adhere to the law. this is not something we do lightly. i can be convinced of a few days' reduction but no greater than

ms. etienne. >> hi, miss nellie, how are you doing today? >> good! it's good to see you! >> reporter: lazars more than a dozen patients. she sometimes works day and night. >> i i'm able to take calls in e middle of the night and help them talk through what's going on with them and help keep little babies out of the emergency room who just have a fever or ear infection. >> reporter: but lazar is not a doctor. instead, the rising sun health clinic is run by lazar and one other nurse practitioner. >> we diagnose, we treat, we manage chronic health conditions but also there is a strong emphasis on health promotion as well as disease prevention. >> reporter: lazar is part of a nationwide trend. in the last four decades, the number of nurse practitioners has risen to more than 140,000. and more and more are working on their own, especially in poor inner city neighborhoods and rural areas, where there are few doctors in private practice. the scope of what nurses can do medically has also been growing for the past decade, at a time when the pool of primary care or family doctors has been shrinking