A package of bills aiming to expand or alter the scope of practice for a collection of allied health professionals successfully cleared the Senate Committee on Business, Profession and Economic Development yesterday.
The scope bills—SB 491, 492 and 493—are being authored by Sen. Ed Hernandez (D-West Covina) and deal with the respective scopes of practice for nurse practitioners, optometrists and pharmacists in California.
While all three bills are now heading to the Senate Committee on Appropriations, SFMS/CMA made important headway on these proposals, garnering some significant concessions that we hope to build upon as the legislation moves forward.
This is the first step in a long journey for these bills, and CMA staff will continue to work diligently to ensure that our concerns are addressed. We also expect the proposals to face an enhanced level of scrutiny should they be approved on the Senate floor and enter the Assembly.
Below is an update on where the bills now stand, including highlights of some of the many amendments and revisions that took place in the past few weeks.
SB 491 - Nurse Practioners
This bill would expand the scope of practice for California’s Nurse Practitioners, allowing them to establish independent practices without the supervision of a partner physician. SFMS and CMA have consistently “opposed” this bill.
Our primary concern with this bill continues to center on the issue of patient safety, but also touches upon the increased costs that may come with under qualified health care professionals ordering unnecessary tests or making superfluous recommendations to specialists. In addition, we called attention to the fact that nurse practitioners did not move to medically underserved areas in Arizona, a stat that granted them independent practice in 1985.
SB 492 - Optometric Corporations
SB 492 initially sought to dramatically expand the scope of practice for California’s optometrists, originally asking that they be allowed to diagnose and treat a host of ailments that manifest in the eye, including diabetes and high blood pressure. In its original form, the bill also allowed optometrists to administer surgical procedures current outside their legal scope of practice.
While SFMS/CMA continues to take an opposed position on this bill, significant amendments have taken place in the past few days. As it stands now, all of the surgical procedures and most of the treatments generally reserved for ophthalmologists have been removed from the bill. This represents significant progress and will provide us a place to build from as the bill moves forward.
SFMS/CMA still has considerable concerns regarding primary care responsibilities that would be extended to optometrists if the bill is allowed to move forward, specifically regarding the ability to diagnose, rather than simply screen for, ailments that may manifest in the eye. It should be noted, however, that optometrists have agreed to not include treatment for primary care in the most recent version of their proposal. We remain committed to working with the author to address these concerns.
SB 493 - Pharmacy Practice
SB 493 seeks to expand the existing scope of practice for pharmacists in California, and is perhaps the bill where SFMS/CMA made its greatest progress leading up to Monday’s hearing. As a result, SFMS/CMA originally took an opposed position to the bill, but has since moved to “oppose unless amended” in advance of Monday’s hearing.
Initially, this bill would have expanded pharmacists’ scope in a way that allowed them to prescribe a wide variety of drugs without physician supervision. Following a round of amendments, much of the prescribing authority has been removed from the bill, but there continue to be some major areas of concern for SFMS/CMA.
The major concern deals with the author’s desire to allow pharmacists to prescribe smoking cessation drugs that both the Medical Board of California and SFMS/CMA consider to be psychotropic in nature. We believe this to present a major risk to patient safety and will continue to oppose the bill until these issues are resolved. Several members of the committee also raised this concern, and as a result, the sponsors acknowledged the issue and committed to working with CMA to resolve it.
As mentioned before, all of these bills still face some considerable hurdles before they can become law and we believe the level of scrutiny will increase as they move forward.