Legislature Fails To Advance Nurse Practitioner Scope-of-Practice Bill

Last week, the California Legislature chose not to advance a bill (SB 491) that would have allowed nurse practitioners to operate without physician supervision at certain medical facilities to help curb the state's physician shortage, the Los Angeles Times reports (Mason, Los Angeles Times, 9/1).

Background on Physician Shortage

Only 16 of the state's 58 counties have the supply of physicians recommended by the federal government.

In addition, the Association of American Medical Colleges says that nearly 30% of California's doctors are nearing retirement age.

Meanwhile, the state is preparing to expand Medi-Cal and require most residents to have health insurance under the Affordable Care Act, which could exacerbate the shortage. Medi-Cal is California's Medicaid program.

In February, Sen. Ed Hernandez (D-West Covina) introduced a set of bills (SB 491, SB 492 and SB 493) that, respectively, would expand the scope of practice for nurse practitioners, optometrists and pharmacists to address the physician shortage.

In May, the Senate passed SB 491 and SB 492 and sent the measures to the Assembly for consideration.

Last month, Hernandez pulled SB 492 from consideration, saying the bill's supporters need more time to compromise with those who oppose it.

Changes to SB 491

To garner additional support for SB 491, Hernandez last month removed language that would have granted nurse practitioners the authority to operate completely independent of doctor oversight after finishing 6,240 hours of supervised work.

A separate amendment to the bill clarified that nurse practitioners cannot replace a physician or surgeon, requiring them instead to work in a "collaborative setting" (California Healthline, 8/14).

However, the changes resulted in AARP and the American Association of Nurse Practitioners dropping their support of the measure.

SB 491 Fails To Advance

On Friday, the nurse practitioner bill failed to advance in committee after strong opposition from the California Medical Association, according to the Times.

The group spent almost $1.2 million lobbing against the bill and other measures in the first half of this year.

Paul Phinney -- president of CMA -- said, "California's nurse practitioners should be working more closely with physicians, not independently."

Hernandez said that "the sticking point for the nurse practitioner bill [was] the word 'independent,'" adding, "For organized medicine, that's the ... line in the sand."

He said that CMA used fear-mongering techniques when opposing the measure, adding that "there's absolutely no evidence to show" that patient safety is at risk when nurse practitioners practice independently.

Hernandez said that he will continue to push scope-of-practice bills next year and that "[t]he fight is not over" (Los Angeles Times, 9/1).