latimes.com/local/political/la-me-pc-nurse-practitioner-bill-advances-20130813,0,569056.story

Bills on nurse practitioners, pharmacists advance in Assembly

By Melanie Mason

4:57 PM PDT, August 13, 2013 - Los Angeles Times

SACRAMENTO — Measures that would expand the roles of nurse practitioners and pharmacists advanced in the Assembly on Tuesday, setting the stage for a fierce lobbying battle in the session's final weeks.

Both measures wade into the so-called scope of practice debate over what type of medical care can be administered  by non-physicians, setting off a turf war between doctors and other medical providers.

The more contentious of the two bills is SB 491, which would allow nurse practitioners to practice without physicians' supervision. The measure, written by state Sen. Ed Hernandez (D-West Covina) failed to muster enough support in the Assembly's Business, Professions and Consumer Protection Committee last week by a 6-3 vote, with five committee members abstaining. 

Hernandez offered a narrower version of the bill Tuesday, which would allow nurse practitioners to operate independently only if they practice at a hospital, clinic or some other medical facilities. That was enough to bring on two additional Assembly Democrats — Richard Gordon of Menlo Park and Chris Holden of Pasadena — and pass with an 8-3 vote.

Hernandez is also the author of SB 493, which would allow pharmacists to independently administer some vaccines, and provide certain nicotine replacement drugs and hormonal contraceptives. It passed the Assembly Health Committee on an 18-0 vote.

Both bills now move to the Assembly Appropriations Committee.

Supporters of the Hernandez bills say that nurse practitioners, pharmacists and other medical providers can help secure healthcare access in places where there are not enough doctors to meet patients' demand. That strain could be exacerbated with the implementation of President Obama's healthcare law, which will increase the number of newly insured patients seeking treatment.

"If we are going to be mandating that every single person buy health insurance, then we better make sure that there’s enough people to see these people safely," said Hernandez, who is head of the Senate Health Committee.

Doctors counter that allowing non-physicians to practice independently could put patients in harm's way.

“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," said Dr. Paul Phinney, president of the California Medical Assn.

"SB 491 allows nurse practitioners to diagnose and treat patients beyond their capabilities and without any additional training, jeopardizing patient safety."

The California Medical Assn., the influential lobbying arm for the state's physicians, opposes the nurse practitioner bill and is neutral on the pharmacists measure. It has spent nearly $1.2 million on lobbying in the first half of the year.

Hernandez says such scope of practice bills are "very, very difficult politically." He had a third proposal to expand the roles of optometrists, but decided to hold that bill over into next year.

"Rather than having three contentious bills, I decided to hold [the optometry bill], work over the interim with the opposition and see if we could come to a resolution so that we don’t have to have a contentious hearing as we did last time," said Hernandez, who is an optometrist.

But, he added, he wanted to see action on his nurse practitioners bill before the Legislature adjourns for the year Sept. 13.

"I really believe that nurse practitioners need to be independent so that they can see MediCal patients, become providers and go into areas in need," Hernandez said. "This one I needed to fight right now."