Assistants Could Do More Under Proposed Bill

Medical assistants yesterday moved a step closer to being able to perform certain clinical tasks under the jurisdiction of a physician assistant or nurse practitioner, rather than the direct authority of a physician.

The Assembly Committee on Business and Professions approved the last step in the committee process for SB 352 by Sen. Fran Pavley (D-Agoura Hills) — a bill which she hopes will reach a floor vote quickly, before the end of the current session.

The measure aims to alleviate the current and growing need for more primary care physicians by expanding the ability of secondary providers to carry out clinical tasks without a physician needing to physically be in the same building.

“Medical assistants can and do carry out a variety of clinical tasks,” Pavley said. “Drawing blood, giving vaccinations. But should a physician not be on the premises at the time, then they cannot do those basic clinical tasks.”

To have medical tasks put on hold and have medical assistants switch over to paperwork whenever physicians need to leave the building is inefficient and doesn’t really protect the patient, Pavley said. 

“All of that reduces access to care in a timely manner,” she said. “We think [those medical assistant tasks] can be done under the authority of a nurse practitioner, a nurse midwife or a physician assistant, without a physician being on-site.”

Opposition came from the California Nurses Association. Stephanie Roberson, legislative advocate for the CNA, said that creating standing orders for medication could lead to troublesome outcomes.

“We think this bill will contribute to the fragmentation of the health care system,” Roberson said.

Rod Moser is a physician assistant from Roseville, and he said yesterday that the bill makes basic sense.

“I have worked side by side with my MA for the past 14 years,” Moser said. “This bill will allow me to legally supervise my MA within her scope of practice. Under current state regulations, a physician has to be in the building somewhere.

Physicians still hold the trump card of authority, he said, because the physician still supervises the PA, who in turn supervises the medical assistant.

“My M.A. gives injections, lots of vaccines, I’d say she gives about 12,000 vaccinations a year, and she’s really good at it,” Moser said. “I think I’m able to do that job [of supervising basic clinical tasks], whether or not there’s a doctor somewhere in the building.”

“We do know there will be a much greater need for these types of services [with Medi-Cal expansion and the exchange starting in 2014],” Pavley said. “This is not an expansion of scope of practice, it’s an expansion of current skills to all kinds of clinic settings.”

The bill passed on an 8-0 vote. Summer legislative recess officially begins July 3, so the measure would need a two-house floor vote by that date.

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