CMA joins 97 specialty and state medical societies in letter to VA about plan to allow advanced practice registered nurses to practice independently The California Medical Association (CMA) joined 97 specialty and medical societies to send a letter to the Department of Veteran Affairs (VA) expressing concerns with a proposed rule that would allow advanced practice registered nurses (APRN) to practice independently in the VA health system. CMA also submitted an additional letter opposing the proposed regulations. The agency announced at the end of May that it wants to expand the scope of practice for APRNs to allow them to order and read diagnostic tests, administer anesthesia, prescribe medications and manage acute and chronic diseases—without physician oversight. The proposal is intended to address long wait times for veterans seeking health care. CMA and the other medical societies are extremely concerned that the VA rule would lower the standards of care and put the health of veterans at risk. “Nurses are an integral part of physician-led health care teams that deliver high-quality care to patients,” the letter said. “In the case of APRNs, they are well equipped to play advanced roles in the health care team. However, APRNs are not substitutes for physicians in diagnosing complex medical conditions, developing treatment plans that take into account patients’ wishes and limited health care resources, and ensuring that the treatment plan is followed by all members of the health care team.” The letter urges the VA to consider policy alternatives that prioritize team-based care rather than independent nursing practice. Under the proposed rule, APRNs working for the VA would be able to practice independently even in states like California where it is outside of their legally defined scope of practice. “The proposal supersedes state law, centralizes health care decision-making, and eliminates local control of licensing and regulation of physicians and health care providers,” the letter said. “This actually results in a lower-standard of care for our veterans than for other patients.” Click here to read the letter. August 8, 2016 General Registered Nurses, Regulatory Advocacy, Scope of Practice, Veterans, Nurses 0 0 Comment Read More »
Bills to expand nurse practitioners', optometrists' scope of practice stall in Assembly committee A bill that would have allowed nurse practitioners (NP) to practice independently and prescribe drugs without physician oversight is finished, at least for the year. Senate Bill 323 was voted down 8-4 on June 30 in the Assembly Business and Professions (B&P) Committee. The committee agreed to take it up again on July 14, but the bill was pulled from the hearing by its author, Senator Ed Hernandez (D-Azusa). The California Medical Association (CMA) and the California Academy of Family Physicians led the fight against SB 323. Senator Hernandez also pulled a separate scope of practice bill, SB 622, that would have allowed optometrists to perform an array of supplementary procedures with little additional training. That measure would have permitted optometrists to perform scalpel surgeries, laser surgeries and intraocular injections. It was pulled on July 14 for the second time this month, ending its run in this year’s legislative session. CMA partnered with the California Academy of Eye Physicians and Surgeons along with a robust coalition, including local county medical societies, to warn lawmakers and the public about the dangers of this bill. “It’s clear that members of the committee saw the potential dangers of SB 622,” said CMA President Luther F. Cobb, M.D. CMA strongly believes that simply expanding the scope of practice of allied health practitioners to give them independent and/or expanded practice will do nothing to improve access to care or quality of care in our state. Allowing practitioners to perform procedures they simply aren’t trained to do can only lead to unpredictable outcomes, higher costs and greater fragmentation of care. Lowering certification standards and oversight puts the safety and health of patients at risk. This was the case a few years ago when eight veterans suffered “significant” vision loss, and another 23 suffered progressive vision loss, after optometrists at the Palo Alto Veterans Affairs Health Care System ignored requirements to refer glaucoma patients so their treatment could be monitored by ophthalmologists. During the June 30 hearing, former CMA President Paul Phinney, M.D., told the committee that in addition to the association's concerns about allied health professionals performing procedures for which they are not adequately trained, there is nothing in SB 323 that would augment the productivity of the state's NPs. About half of nurse practitioners in California do not practice primary care, he said, while the remainder practice in “large, integrated health care delivery systems.” “I worked in one of those health care delivery systems for almost 30 years, and I can tell you that the nurse practitioners in those systems are already very busy,” Dr. Phinney said. “There’s nothing in SB 323 that will augment the productivity of NPs in those systems, which represent a large percent of the remainder of NPs in our state that do primary care.” Assemblymember Jim Wood (D-Healdsburg) called SB 323 a “tough bill” and said he had concerns regarding oversight — particularly whether nurse practitioners would be overseen by an entity other than the Medical Board of California, which oversees physicians. “To have oversight from different entities that are overseeing the practice of medicine is problematic to me,” Assemblymember Wood said. Much debate also revolved around an amendment suggested by the B&P Committee — and refused by Hernandez — that would have applied the corporate bar on the practice of medicine to nurse practitioners — a provision of law that prevents lay corporate entities from interfering with the independent medical judgment of physicians. Organizations voicing their opposition to SB 323 at the hearing included the California Academy of Eye Physicians and Surgeons, the Medical Board of California, California Psychiatric Association, California Orthopaedic Association, California Society of Dermatology and Dermatologic Surgery, and the California Society of Anesthesiologists, in addition to CMA. “Today was a good day for the health of Californians,” Dr. Cobb said in response to the vote. “We commend the Assembly for rejecting SB 323, which would have significantly compromised patient safety.” July 20, 2015 General Scope of Practice, Advocacy, Nurse Practitioners, Optometrists, Quality of Care 0 0 Comment Read More »
California Medical Association responds to vote on Senate Bill 622 After today’s vote in the Senate Business, Professions and Economic Development Committee, California Medical Association President Luther F. Cobb, M.D., responded with the following statement regarding Senate Bill 622: "The amount of training to perform eye surgery stipulated by SB 622, even with the amendments adopted today, is still inadequate to ensure patient safety. Medical doctors perform hundreds more procedures and have tens of thousands more hours of training than what would be required of optometrists under this bill. All Californians deserve to have well-trained physicians to provide high-quality care, and they expect the Legislature to ensure strict safety standards to protect patients." April 29, 2015 General Scope of Practice, State Legislation, State Legislative Advocacy, Optometrists 0 0 Comment Read More »
Medical board approves amendment to regulation allowing PAs to conduct surgery without immediate physician supervision The Medical Board of California approved an amendment to California administrative law that would allow physicians assistants (PA) to perform surgery without the immediate physical presence of a supervising physician. Existing law permits PAs to act as first or second assistant in surgery under the supervision of a physician. In 2011, a concern was raised by a PA licensee to the Physician Assistant Board that the current regulation did not reflect current medical community standards and that the law was unclear on the degree of physician supervision required of a PA as an assistant in surgery. The final regulation, which goes into effect on April 1, 2015, clarifies that a PA may perform surgical procedures, without the physical presence of the supervising physician in the operating room if the physician is "immediately available" to the PA. The medical board defines “immediately available" as “able to return to the patient without delay, upon the request of the PA or to address any situation requiring the supervising physician’s services.” During the course of the regulatory discussions, it was agreed that an update to the regulation to specify the degree of supervision required for the PA was necessary in light of the evolution of current medical practices for both professions. Under the new regulation, physicians could, for example, direct a PA to close the surgical site, allowing the physician to engage in other procedures or tasks on site. Contact: Yvonne Choong, (916) 551-2884 or ychoong@cmanet.org. January 22, 2015 General Physician Assistants, Scope of Practice, Medical Board of California 0 0 Comment Read More »
Dangerous bill putting patients in harm's way barely passes Assembly Committee Sacramento – After an initial vote held SB 491 (Hernandez) in the Assembly Business, Professions & Consumer Protection Committee last week, a reconsideration vote was granted and today the bill moved out of committee. SB 492 (Hernandez), a related bill dealing with expanded scope of practice for optometrists, was held in committee. On behalf of the California Medical Association (CMA) and the Coalition for Patient Access and Quality Care, CMA President Paul R. Phinney, M.D., issued the following statement: “While SB 492 was held in committee, patients should be deeply concerned that SB 491 was able to move forward today. “If SB 491 becomes law, nurse practitioners will be allowed to practice without any supervision by a physician, despite the enormous differences in education and training between the two. "SB 491 allows nurse practitioners to diagnose and treat patients beyond their capabilities and without any additional training, jeopardizing patient safety. "It is also important to note that this bill will not expand access to care, despite claims of the proponents. SB 491 will only further fragment the health care delivery system and increase costs for all patients, at a time when more highly integrated delivery models are vital. “SB 491 would also give nurse practitioners the authority to prescribe opioid drugs, like oxycodone, without supervision. The Board of Registered Nursing in California simply does not have the oversight capabilities to oversee something like that, and with overdose deaths on the rise, we can’t take that risk. “We were able to find a compromise on the pharmacy bill (SB 493) that ensures increased training and physician oversight and we are committed to further discussions on SB 492. We hope that additional conversations about the dangers of SB 491 will bring significant amendments to stop the bill from moving forward." August 14, 2013 General Advocacy, Nurse Practitioners, Scope of Practice 0 0 Comment Read More »
Nurse practitioner scope-of-practice bill fails in committee A bill that would give California's nurse practitioners more autonomy failed on a vote of 6-3 Tuesday in an Assembly Business, Professions and Consumer Protection Committee. The bill (SB 491) would allow nurse practitioners to open practices without any oversight from a trained medical doctor and prescribe dangerous, addictive drugs without supervision. Although the bill failed to pass committee today, it was granted reconsideration and will be voted on again next week. While an important part of the health care delivery system, nurse practitioners simply do not have adequate training or years of education to be qualified to practice medicine without physician oversight. This bill would remove necessary physician supervision, ultimately harming patients and decreasing quality of care. “The 37,000 members of the California Medical Association (CMA) and the dozens of groups aligned in the Coalition for Patient Access and Quality Care applaud the members of the Assembly Committee on Business, Professions and Consumer Protection for their work today,” said CMA President Paul R. Phinney, M.D. “Senate Bill 491 would have allowed nurse practitioners to practice medicine far beyond their training, putting patients in harm’s way. “Despite what some proponents of the bill may have said, SB 491 would not have expanded access to care; it simply would have further fragmented the health care delivery system and increased costs for patients across the state," said Dr. Phinney. SB 491 is one of three bills by Sen. Ed Hernandez (D-West Covina) that would increase the scope of practice of allied health professionals. The coalition opposing the bill includes the California Medical Association; Union of Physicians and Dentists, AFSCME 206; California Academy of Family Physicians; Diabetes Coalition of California; California Society of Anesthesiologists; Blind Children’s Center; California Academy of Eye Physicians and Surgeons; American Society of Ophthalmic Plastic and Reconstructive Surgery; Latino Physicians of California; Chinese Medical Dental Association; Let’s Face It Together; Minority Health Institute, Inc.; Dream Machine Foundation; Canvasback Missions, Inc; Lighthouse Mission; Time for Change Foundation; Here 4 Them; and Osteopathic Physicians and Surgeons of California; among others. Contact: Juan Thomas, (916) 551-2546 or jthomas@cmanet.org. August 7, 2013 General Advocacy, Nurse Practitioners, Scope of Practice 0 0 Comment Read More »
Scope of practice bills to be heard on July 2, urge your legislator to OPPOSE these bills The California Medical Association (CMA) is urging physicians to contact legislators and ask for NO votes on SB 491, SB 492 and SB 493. These three bills will expand scope of practice of nonphysician practitioners and remove necessary physician supervision, ultimate harming patients and decreasing quality of care. These bills may be heard in the Assembly Business, Professions and Consumer Protection Committee as early as July 2. Senate Bill 491 (Hernandez) would allow nurse practitioners to open practices without any oversight from a trained medical doctor and prescribe dangerous, addictive drugs without supervision. While an important part of the health care delivery system, nurse practitioners simply do not have adequate training or years of education that physicians do in order to be qualified to practice medicine without physician involvement. Senate Bill 492 (Hernandez) would allow optometrists to provide primary care service including diagnosing diabetes, high cholesterol and hypertension. Under this bill, optometrists would be able to examine, prevent, diagnose and treat any disease, condition or disorder of the visual system, the human eye and adjacent related structures. Senate Bill 493 (Hernandez) would allow advanced practice pharmacists to evaluate and manage diseases and health conditions without physician consultation. Additionally, any pharmacist would be able to furnish prescription smoking cessation drugs and devices with known harmful side effects including depression and in some cases, suicide. Legislators need to know the true impact these bills would have in their districts. Your calls are imperative to help us stop these bills and protect patients. We ask that you and your colleagues call, fax or email your legislators TODAY and urge them to vote NO on SB 491, SB 492 and SB 493! For more information, including talking points and a sample letter, see CMA's grassroots action center. June 27, 2013 General Advocacy, Scope of Practice 0 0 Comment Read More »
