Wednesday, January 16, 2019

Legislation Jeopardizes Patient Safety


As health care delivery becomes more complex, expanding the team of health care professionals that serves patients makes sense. However, it is not in the best interest of patients to abandon the current physician-led team approach to health care. California’s SB 491, SB 492, and SB 493 would allow nurses, optometrists, and pharmacists to take on the duties of a medical doctor without a doctor’s training. RCMA/CMA and the Coalition for Patient Access and Quality Care are working together to make sure lawmakers realize that providing allied health practitioners with independent and/or expanded practice will not provide newly insured patients, who are more likely to have complex medical conditions, with access to the health care they deserve

Find out how you can help by visiting www.qualitycareaccess.org



Legislative Alert: Urge your Legislator to OPPOSE Bills to Expand Scope of Nonphysician Practitioners

Urge your assembly members to OPPOSE SB 491, SB 492 and SB 493 today!

These bills would provide nurse practitioners with independent practice, allow optometrists to perform surgical and nonsurgical primary care beyond their scope of practice, and create a new advanced practice pharmacist who can prescribe medication and administer immunizations. Ultimately, these bills will put patients at risk and lower the quality of care provided in our state.

Additional information, including talking points, are provided below.

(Click here to) Take Action!

(Click here if you called) I Made the Call!

Call (877) 362-8455 to be connected with your legislator.

CMA is urging you to call your legislators and ask for NO votes on SB 491, SB 492 and SB 493. These three bills will expand scope of practice and remove necessary supervision by a physician and surgeon, ultimate harming patients while decreasing quality of care.

 SB 491 (Hernandez) – This bill would allow nurse practitioners to open practices without any oversight from a trained medical doctor and prescribe dangerous, addictive drugs without supervision. While an important part of the health care delivery system, nurse practitioners simply do not have adequate training or years of education that physicians do in order to be qualified to practice medicine without physician involvement.

SB 492 (Hernandez) – This bill would allow optometrists to provide primary care service including diagnosing diabetes, high cholesterol and hypertension. Under this bill, optometrists would be able to examine, prevent, diagnose and treat any disease, condition or disorder of the visual system, the human eye and adjacent related structures.

SB 493 (Hernandez) – This bill would allow advanced practice pharmacists to evaluate and manage diseases and health conditions without physician consultation. Additionally, any pharmacist would be able to furnish prescription smoking cessation drugs and devices with known harmful side effects including depression and in some cases, suicide.

All three of these bills will be heard in the Assembly Business, Professions and Consumer Protection Committee soon.

Legislators need to know the true impact these bills would have in their districts.

Your calls are imperative to help us stop these bills and protect patients. We ask that you and your colleagues call, fax or email your legislators TODAY and urge them to vote NO on SB 491, SB 492 and SB 493!

Phone calls and office visits are most effective, but faxes and emails are important too. If you choose to fax or email your legislators, we strongly encourage that you personalize the letter (provided below), which will greatly increase its impact.

If you are logged into the CMA website, your legislators should automatically be displayed. If not, you can click here to locate your legislators by zip code.

Talking Points

  • SB 491, SB 492, and SB 493 harm patient safety plain and simple.
  •  Other health professionals, while hugely important to the health care delivery system and an integral part of medicine, are not trained to diagnose and treat diseases like physicians are.
  •  Rather than further fragment the health care delivery system, we need to be looking at integrated care models that utilize everyone to the best of their abilities.
  •  SB 491, SB 492 and SB 493 will allow NPs, optometrists and pharmacists to practice medicine without being subject to the controls and oversight of the Medical Practice Act. The end result would be that these specific health practitioners would be held to a lower standard of care than physicians providing the same service.
  • If passed, these bills will allow individuals the ability to prescribe dangerous medications such as opioids. The Registered Board of Nursing is simply not equipped to oversee such prescribing and does not have an investigatory arm, as the Medical Board of California does.  
  • In my own experience, under-trained professionals order more tests and imaging studies as well as send patients for more referrals than do physicians.
  • To ensure patient safety, medical care must be administered in coordinated teams led by experienced, fully trained, qualified physicians.  
  • Proponents of this bill are using the guise of health care reform to say that independent practice will expand access to care. That is just not the case.
  • The same economic factors that I face as a physician will impact NPs, optometrists and pharmacists. (Expand on the economic considerations you face each day).
  • The number of physicians in California is unevenly distributed with regards to the general population, but these bills do not solve the problem. The majority of allied health professionals are practicing in the same regions as physicians now. There is no proof that indicates NPs, optometrists and pharmacists will indeed move to rural or under-served areas.
We believe patients are best served when they are provided with meaningful access to safe medical care provided by medical teams led by highly trained and qualified physicians.


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