Senate OKs bills addressing medical provider gap

Associated Press - The Sacramento Bee

Published Tuesday, May. 28, 2013

SACRAMENTO, Calif. -- Over the objection of doctors, the state Senate on Tuesday passed two of three health reform-related bills intended to address California's medical provider gap.

Lawmakers passed SB491 by Democratic Sen. Ed Hernandez of West Covina, which will expand the role of nurse practitioners. The 21-12 vote was the bare majority needed for the bill to move to the Assembly.

The Senate also passed SB492, which is intended to expand medical services provided by optometrists. The bill, which passed 25-5, would allow optometrists to check for high blood pressure, cholesterol and even administer specific immunizations.

The third bill, SB493, would expand services provided by pharmacists, such as ordering laboratory tests to detect diabetes. It is expected to be voted on later this week.

All three face heavy opposition from the California Medical Association. The doctors group has argued that the state should focus on building more medical schools, adding residency slots and expanding programs that help doctors pay off student loans in exchange for working in underserved communities.

SB491 would give greater independence to nurse practitioners to treat Medicaid and Medicare patients even if the doctors they work for do not. Supporters said the change is necessary to serve rural and minority communities as California prepares to insure million of new patients under federal health care reforms.

Hernandez said nurse practitioners already are allowed to work independently in 17 states. One of those, Arizona, saw an increase in nurse practitioners moving there after the change was made.

"We need to do something to address the provider shortage," said Hernandez, an optometrist by training. "We have to look at making sure we get more individuals access to primary care."

But some lawmakers of both parties worried that the change would create two classes of medical care and argued that not all Californians will have access to quality care provided by doctors.

Sen. Hannah-Beth Jackson, D-Santa Barbara, said she would rather get more primary care doctors into the field.

"This is a situation where we really need to make sure that even if people live in underserved communities that they get the best health care we can provide," Jackson said. "And I don't believe allowing nurse practitioners to practice without any oversight gives those people the protections that they need."

Hernandez said he was still working with opponents to craft the specific types of medical services that optometrists would be able to provide. Republican Sen. Bill Emmerson of Redlands, a dentist, said he opposed SB492 because it was "bad policy" to pass an incomplete bill.