Oppose SB 491, 492 & 493 Today!

  • Yost, Paul, MD
| Apr 21, 2013

Your optometrist (that health care practitioner whom you may see working at Wal-Mart, and who issues your contact lenses and glasses) is now qualified to perform surgery and treat a myriad of medical conditions including HIV, Leukemia, and diabetes! This is NOT an exaggeration or joke; If Senate Bill 492, written by Senator Hernandez (an optometrist) passes the State Senate, Assembly and is signed by the Governor as currently written, this will be the law of the land in California! And that’s not all….

On March 13, 2013, Ed Hernandez, OD held a press conference during which he introduced three incredibly far reaching “Scope of Practice” bills SB 491, SB 492 and SB 493 which would dramatically increase the scope of practice of not only Optometrists, but Nurse Practitioners and Pharmacists as well. According to Senator Hernandez, he introduced this legislation to “to deal with the serious shortage of primary care providers in California, a problem that will only grow worse when up to 7 million more Californians seek health coverage next year under the Affordable Care Act.” That’s right, because of the passage of health care reform, and the influx of patients with insurance into the medical system, we need to allow Nurse Practitioners to practice medicine, pharmacists to prescribe the medications they dispense, and optometrists to treat Leukemia (or any other medical condition with eye manifestations). A breakdown of what these three bills will do is as follows:

SB 491: Gives NPs independent practice. Under this bill, NPs will no longer need to work pursuant to standardized protocols and procedures or any supervising physician and would basically give them a plenary license to practice medicine.

NPs can:

  • Supervise medical assistants without limitations
  • Dispense drugs without standardized procedures or protocols
  • Order durable equipment and perform a physical examination, including certifying disabilities without standardized procedures or protocols
  • Approve, sign, modify, or add treatment plan without consulting a physician
  • Assess patients, synthesize and analyze data, apply principles of health care at an advanced level
  • Manage physical and psychosocial health status of patients
  • Analyze multiple sources of data, identify nature of health care problem and select, implement and evaluate appropriate treatment
  • Make independent decisions in solving complex patient care problems
  • Diagnose patients and perform diagnostic and therapeutic procedures
  • Order, furnish and prescribe drugs
  • Refer patients to other health care providers when appropriate
  • Delegate to a medical assistant
  • Perform any additional acts recognized by the Board as proper for an NP
  • Requires NPs to carry medical malpractice insurance
  • Furnish, order and PRESCRIBE drugs including controlled substances

SB 492: Makes optometrist ophthalmologists. Under this bill, optometrists would diagnose and treat any disease relating to the eye or any medical condition with and ocular manifestation.

Optometrist can:

  • Treat and diagnose any disease, condition or disorder of the visual system, the human eye adjacent and related structures
  • Prescribe and administer drugs including controlled substances
  • Perform surgical procedures with local or topical anesthetic
  • Order laboratory and diagnostic tests
  • Administer immunizations
  • Diagnose and initiate treatment for any condition with ocular manifestations.

SB 493: Under this bill, pharmacists furnish and initiate prescriptions for certain medications. Advanced practice pharmacists can evaluate and manage disease and health conditions in collaboration with other health care providers.

Under the bill, pharmacists can:

  • Provide consultation, training and education to patients about medication therapy, disease management and prevention
  • Participate in multi-disciplinary review of patient progress, including access to medical records
  • Furnish contraceptives (including non-emergency), prescription smoking cessation drugs and devices and prescription medications for travel purposes
  • Order and interpret tests for monitoring and managing efficacy and toxicity of medication therapy
  • Independently initiate and administer routine vaccines for persons 3 years of age and older.

SB 493 Creates a new “advanced practice pharmacist.” Advanced practice pharmacists would have to do one of the following:

  • Earn additional certification in an undefined area of practice.
  • Complete a one-year post graduate residency that includes provision of direct patient care as part of an interdisciplinary team.
  • Have experience managing patients for at least one year through a collaborative practice agreement or protocol with specified provider or entity.

Under this bill, the new "advanced practice pharmacist" can:

  • Perform physical assessments
  • Order and interpret medication therapy related tests
  • Refer patients to other health care providers
  • Initiate, adjust or discontinue medication therapy in collaboration with other health care providers
  • Participate in the evaluation and management of disease and health conditions in collaboration with other health care providers

The CMA, and your CSA believe that health care should be delivered in a coordinated team approach with a physician involved in patient care. We believe physician “extenders” are beneficial for patient care and extend the reach of physicians. However, allowing mid-level providers independent medical practice and prescribing authority creates a fragmented, uncoordinated, and dangerous situation for patients in California. In conjunction with the CMA, the CSA is issuing a legislative alert on the three Hernandez Scope of Practice Bills; SB 491, SB 492, and SB 493.

Please visit the CSA Grassroots Network and take action now!! Help us defeat or amend these bills and protect the people of California!!

Together We Are Stronger!

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