A bill that would have allowed nurse practitioners (NP) to practice independently and prescribe drugs without physician oversight is finished, at least for the year.

Senate Bill 323 was voted down 8-4 on June 30 in the Assembly Business and Professions (B&P) Committee. The committee agreed to take it up again on July 14, but the bill was pulled from the hearing by its author, Senator Ed Hernandez (D-Azusa). The California Medical Association (CMA) and the California Academy of Family Physicians led the fight against SB 323.

Senator Hernandez also pulled a separate scope of practice bill, SB 622, that would have allowed optometrists to perform an array of supplementary procedures with little additional training. That measure would have permitted optometrists to perform scalpel surgeries, laser surgeries and intraocular injections. It was pulled on July 14 for the second time this month, ending its run in this year’s legislative session. CMA partnered with the California Academy of Eye Physicians and Surgeons along with a robust coalition, including local county medical societies, to warn lawmakers and the public about the dangers of this bill.

“It’s clear that members of the committee saw the potential dangers of SB 622,” said CMA President Luther F. Cobb, M.D.

CMA strongly believes that simply expanding the scope of practice of allied health practitioners to give them independent and/or expanded practice will do nothing to improve access to care or quality of care in our state. Allowing practitioners to perform procedures they simply aren’t trained to do can only lead to unpredictable outcomes, higher costs and greater fragmentation of care.

Lowering certification standards and oversight puts the safety and health of patients at risk. This was the case a few years ago when eight veterans suffered “significant” vision loss, and another 23 suffered progressive vision loss, after optometrists at the Palo Alto Veterans Affairs Health Care System ignored requirements to refer glaucoma patients so their treatment could be monitored by ophthalmologists.

During the June 30 hearing, former CMA President Paul Phinney, M.D., told the committee that in addition to the association's concerns about allied health professionals performing procedures for which they are not adequately trained, there is nothing in SB 323 that would augment the productivity of the state's NPs. About half of nurse practitioners in California do not practice primary care, he said, while the remainder practice in “large, integrated health care delivery systems.”

“I worked in one of those health care delivery systems for almost 30 years, and I can tell you that the nurse practitioners in those systems are already very busy,” Dr. Phinney said. “There’s nothing in SB 323 that will augment the productivity of NPs in those systems, which represent a large percent of the remainder of NPs in our state that do primary care.”

Assemblymember Jim Wood (D-Healdsburg) called SB 323 a “tough bill” and said he had concerns regarding oversight — particularly whether nurse practitioners would be overseen by an entity other than the Medical Board of California, which oversees physicians.

“To have oversight from different entities that are overseeing the practice of medicine is problematic to me,” Assemblymember Wood said.

Much debate also revolved around an amendment suggested by the B&P Committee — and refused by Hernandez — that would have applied the corporate bar on the practice of medicine to nurse practitioners — a provision of law that prevents lay corporate entities from interfering with the independent medical judgment of physicians.

Organizations voicing their opposition to SB 323 at the hearing included the California Academy of Eye Physicians and Surgeons, the Medical Board of California, California Psychiatric Association, California Orthopaedic Association, California Society of Dermatology and Dermatologic Surgery, and the California Society of Anesthesiologists, in addition to CMA.

“Today was a good day for the health of Californians,” Dr. Cobb said in response to the vote. “We commend the Assembly for rejecting SB 323, which would have significantly compromised patient safety.”