Scope of Practice Legislation To Fight Another Day

Amid the deluge of health care bills signed and vetoed by the governor in recent days, absent were several bills that would have expanded the scope of practice of mid-level health clinicians.

So-called scope of practice bills have been gaining traction in statehouses around the country as lawmakers seek to increase access to providers in the face of a nationwide shortage of primary care physicians.

In California, four scope-of-practice bills failed to make it to the governor’s desk:

  • SB 538 for naturopathic doctors;
  • AB 1306 for certified nurse midwives;
  • SB 323 for nurse practitioners; and
  • SB 622 for optometrists.

State Sen. Ed Hernandez (D-West Covina), the author of both SB 323 and SB 622, said he will continue to try to advance the bills in the coming session. Both bills are two-year bills so will be considered again in January.

“The reason why I think this is important is, as a legislator, I have a responsibility to make sure everyone in this state has the opportunity to have access to healthcare,” Hernandez said in a phone interview. “I will continually bring back these bills as long as I am in office.”

The California Medical Association opposed three of the bills. In its legislative wrap-up released Wednesday, the CMA wrote that their defeat sent “an unequivocal rejection of scope of expansions as an answer to care access issues.”

SB 323 would permit a nurse practitioner to practice without physician supervision if the nurse practitioner is certified by a national body, maintains liability insurance and is practicing in a medical group, clinic, health facility or accountable care organization. At least 21 states have enacted scope of practice legislation that allows nurse practitioners to diagnose and treat patients independent of a physician.

The CMA was neutral on AB 1306, by Assembly member Autumn Burke (D-Inglewood), relating to certified nurse midwifes. That bill also died in committee.

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