Latest Skirmish in California’s Scope of Practice Wars

SB 491, expanding scope of practice for California's advance practice nurses to limited tasks done without direct supervision, was not passed out of committee yesterday.  You can read about it here: http://blogs.sacbee.com/capitolalertlatest/2013/08/nurse-practitioner-bill-fails-in-california-assembly-committee.html.  Interestingly, SB 491 was not voted down so much as allowed to die — several members on the committee simply did not vote. Silence, of course, speaks volumes.

Public rhetoric runs high, including fears of lower quality and increased medical negligence, as illustrated in the article I have linked above. It is interesting to think that this may also be about power.  The expanded scope of practice bill for California's  pharmacists has survived the same committee after all. So, what's the difference?

Actually, before yesterday, California had three interesting scope of practice bills pending:

  • SB491: Would allow nurse practitioners to establish independent practices and deliver the level of care their training permits without a physician's oversight, including being able to see Medi-Cal patients.

  • SB492: Would permit optometrists to examine, prevent, diagnose and treat conditions and disorders of the visual system and human eye. It would permit an optometrist to diagnose, treat
    and manage additional conditions, and also to give vaccinations and perform primary care procedures requiring no more than topical or local anesthetic.

  • SB493: Would establish "advanced practice pharmacist" recognition status with specific training requirements, allowing such pharmacists to perform physical assessments, order and interpret medication-related tests, and refer patients to other providers.

One difference is the way SB493 has been amended to retain much of the power and authority of the work to be done by specialty pharmacists under the control of physicians.  You can see an analysis of SB 493's different iterations here: >http://www.leginfo.ca.gov/pub/13-14/bill/sen/sb_0451-0500/sb_493_bill_20130528_amended_sen_v96.html>.

Sure, it is about compensation.  But it is also about power and control.

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