Dan Walters: California's health turf war should cause fear

dwalters@sacbee.comApril 30, 2013 

Senate Bills 491, 492 and 493 won approval of a Senate committee Monday and we should all be afraid – very afraid – because once again, state legislators are voting on "scope of practice."

It means that politics – sometimes raw politics – are determining which medical practitioner can perform which procedure on which part of the human body, rather than leaving those decisions in the hands of medical experts.

It's not a new phenomenon. Scarcely a legislative session passes without at least one scope-of-practice issue arising. Some of those political battles have been barn-burners, such as podiatrists' hard-fought battle to win the right to perform surgery on ankles, overcoming opposition from orthopedic surgeons.

That was 30-plus years ago, and since then we've seen opticians battle with optometrists, dental surgeons vs. plastic surgeons, psychologists vs. psychiatrists, nurses vs. physicians – even dog groomers vs. veterinarians over who had the legal right to brush dogs' teeth.

This year, there's a wave of bills to expand the scope of practices for a wide variety of medical specialists, generally intruding on the exclusive turf of medical doctors.

Why? Their sponsors say it's because the state has too few doctors to deal with millions of Californians who now lack health insurance, but will obtain coverage under the new Affordable Care Act, so the state should expand access by allowing nurses, optometrists, pharmacists and others to take up the slack.

Cynics would say that billions of new dollars will be injected into the state's medical care system, and lots of folks want pieces of the larger pie.

The three bills that cleared the Senate Business, Professions and Economic Development Committee on Monday would expand the practices of nurse-practitioners, optometrists and pharmacists over the objections of most physician groups.

They are all being carried by Sen. Ed Hernandez, D-West Covina, who is an optometrist himself, and the sponsoring organizations are scratching each others' backs with expressions of political support.

We should be afraid because truly, the legislators who voted for the bills Monday, all Democrats, have absolutely no idea whether nurses, optometrists and pharmacists are qualified by dint of their training to perform the medical duties that the legislation would allow.

The physicians who oppose the bills question their readiness to diagnose and treat medical maladies – even prescribing drugs in the case of nurse-practitioners – but by approving the bills, members of the committee are overriding those concerns and, implicitly, concluding that the doctors are just trying to protect their turf and their incomes.

When life-and-death issues are being decided on the basis of political pull, we should all be afraid.

Call The Bee's Dan Walters, (916) 321-1195. Back columns, www.sacbee.com/walters. Follow him on Twitter @WaltersBee.

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