Midwifery, Physical Therapy, Pharmacist Bills Move to Governor's Desk

California's legislators introduced a suite of bills during the legislative session that ended Thursday with an eye toward helping to expand access to primary care. These "scope-of-practice" bills have sometimes been the subject of hot debate in Sacramento, but three of them survived and have moved to Gov. Brown's desk.

Here's a recap of some of the bills and where they stand now:

Midwifery Bill (AB 1308) -- headed to governor's desk

The Center for Health Reporting writes that the bill passed unanimously Thursday night and is now on the governor's desk. From the Center:

(L)icensed midwives were legally obligated to be supervised by physicians. If a doctor supervised a licensed midwife, however, the doctor ran the risk of losing liability insurance. So, collaboration was unattainable and advocates said this put women and babies at risk.

The bill removes the requirement for licensed midwives to be supervised by a physician.

“Because physician supervision was required but not available, the midwives often had to operate in the shadows,” said Shannon Smith-Crowley, a lobbyist for the American Congress of Obstetricians and Gynecologists (ACOG), a group representing OB/GYNs and the bill’s sponsor. “Midwives can be out in the open, helping them develop better relationships, warmer reception and protocols for transfer, ideally leading to earlier transfers in less dire circumstances.”

Physical Therapy (AB 1000) -- headed to governor's desk

This bill would eliminate the need for patients to have a physician's diagnosis to receive physical therapy. Under the bill, patients could access physical therapy directly. But as California Healthline reports, the bill is both supported and opposed by physical therapists, some of whom want the governor to veto the bill:

Paul Gaspar, president of the Independent Physical Therapists of California, said the bill wasn't really about direct patient access to therapy as much as it was about changing the financial relationship between physicians and physical therapists.

"People who own [physical therapy] businesses are very concerned about this," Gaspar said. "We feel threatened that people are going to take advantage of us."

Physician groups now will be able to directly hire physical therapists, and Gaspar said that means they'll be able to make money on the work of other providers. That bucks a national trend, he said, that goes against referral-for-profit plans.

Gaspar said his group will talk to the governor's office about the possibility of a veto, based in part on national legislation (HR 2914) by Rep. Jackie Speier (D-San Mateo) that may conflict with the state law.

Wieckowski said direct access to physical therapists can only be good for consumers.

"This bill helps streamline health care delivery in California and will help patients get the access they need," he said, "rather than losing valuable time with unnecessary and costly delays."

Pharmacists (SB 493) -- headed to governor's desk

This bill allows pharmacists to order some lab tests and prescribe smoking cessation drugs. From The Sacramento Bee:

The legislation is part of what had been a package from Democratic Sen. Ed Hernandez of West Covina intended to help address the state's expected shortage of primary care physicians. ...

Supporters, which include pharmacy schools and Blue Shield of California, say the legislation would allow pharmacists to better use their training and could help control health care costs.

Nurse Practitioners (SB 491) -- stuck in committee

This bill was one of the most hotly contested of all the scope-of-practice bills. On August 30, it failed to move out of committee. The Los Angeles Times captured the mood:

The proposal failed in a committee Friday, under fire from the California Medical Assn., the powerful lobbying arm for the state's physicians. The organization teamed with some specialists and labor unions to mobilize lobbyists, engage doctors across the state and even dedicate Twitter accounts as it waged its campaign against the bill. ...

Jockeying over the scope of medical professionals' practice has intensified this year as California prepares for full implementation of the new national healthcare law, which will bring an influx of newly insured patients.

But "the sticking point for the nurse practitioner bill [was] the word 'independent,'" said Hernandez, who chairs the Senate health committee. "For organized medicine, that's the … line in the sand."

Optometrists (SB 492) -- pulled from consideration by bill's author

The bill would have allowed optometrists to prescribe more drugs and treat certain diseases. But Sen. Ed Hernandez (D-West Covina) opted to hold the bill to the next session, as the Sacramento Bee reported:

"We turned that into a two-year bill just to make sure we can continue working on it in committee, continue to work with the opposition," Hernandez told The Bee.

"What we wanted to achieve we felt needed a little more conversation, and we felt it would just be better to work over the break on it." ...

Molly Weedn, a spokeswoman for the California Medical Association, said doctors hoped to reach compromise with Hernandez on the optometry bill the way they had on the bill regarding pharmacists.

"We're glad there is extra time to work out what some of those difference are," she said. "Our biggest concern has been and remains that patients are being treated by qualified health care professionals."

Hernandez said it's too soon to say what kind of compromise is in order:

"We're not willing to give up on anything because we haven't had that conversation yet with the opposition."

And, as has been widely reported, AB 154, which would permit specially trained clinicians to conduct aspiration abortions, went to the governor's desk earlier this month.