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Scope-of-Practice Bills Proceed, Pause

The Assembly Committee on Business, Professions and Consumer Protection yesterday passed SB 493 by Sen. Ed Hernandez (D-West Covina), which would expand scope-of-practice rights for pharmacists.

The committee failed to pass a companion bill (also authored by Hernandez) that would have expanded scope of practice for nurse practitioners.

The failed bill, SB 491, can be reconsidered, setting up a final vote next week. The bill fell two votes short of approval with five committee members abstaining.

The pharmacy bill adopted significant amendments before the vote and shed all of its organized opposition as a result. Since SB 491 only fell two votes short of approval, author Hernandez has some selling to do — and possibly more amendments to make — before next week’s meeting.

“This is one of those bills that’s more controversial, more politicized and more difficult,” Hernandez said. “As legislators, we sometimes have to make tough decisions. We have to decide, at the end of the day, what is in the best interests of patients.”

At issue is the dearth in primary care physicians in California, particularly in rural and urban underserved areas. With expansion of Medi-Cal and implementation of the Affordable Care Act in 2014, it is likely the problem will get more acute as more patients increase the demand for those providers.

“We have to make sure there is access for those individuals,” Hernandez said, by expanding the scope of practice for other providers, such as optometrists, pharmacists and nurse practitioners.

Ruth Haskins, an OB/GYN practicing in Sacramento, spoke for the California Medical Association.

“Access is a critical issue in the state. However, SB 491 is bad medicine. It will put patients in harm’s way,” Haskins said. “The best kind of care is given in collaborative teams, led by a physician. The important distinction, however, is the protocols and procedures in place [to guide that care]. Physician involvement is what’s critically important in this process.”

Many of the committee members expressed mixed feelings about the nurse practitioner bill, including Assembly member Kevin Mullin (D-San Mateo), who voted in favor of it.

“If we don’t pass this, I feel we’d be supporting the status quo,” Mullin said, “and we are not in a status quo situation right now.”

One committee member, Assembly member Susan Talamantes Eggman (D-Stockton), who also voted for the bill, said she thought aspects of the policy in the bill were right, but that the politics were wrong.

“She hit the nail on the head,” Hernandez said, “because these are extremely difficult decisions we have to make in the Legislature, these scope-of-practice rules.” Approval of scope-of-practice bills would make a big impact in California, he said.

“I would ask you to allow this bill to move through committee, allow this bill to work through the process,” Hernandez said, adding that he would likely entertain further amendments in the next committee, if the bill made it to Appropriations.

The AB 491 vote was 6-3 with five committee members declining to vote.

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