Dan Walters

Dan Walters: No California legislative session is complete without a medical turf war

Published: Friday, Aug. 24, 2012 - 12:00 am | Page 3A
Last Modified: Tuesday, Feb. 26, 2013 - 8:16 pm

No session of the California Legislature would be complete without at least one "scope-of-practice" bill.

What's that?

Health care is the largest single piece of the California economy, involving about $200 billion a year. That cornucopia fuels competition among medical specialists over the legal scope of their practices. As some seek to expand their fields, they encroach on others' turf.

One would think that such highly technical, life-and-death matters would be regulated by medical experts.

Inexplicably, however, the Legislature controls which medical practitioner can perform which procedure on which part of the human body.

That brings scope-of-practice conflicts into the Capitol.

Legislators, of course, don't know any more about the ins and outs of medical care than anyone else. Therefore, they approach that function like every other issue – politically.

Medical trade organizations hire lobbyists, distribute campaign contributions and otherwise play the political game to either push or resist bills that change scopes of medical practice.

The syndrome has sparked some of the Capitol's most notable political clashes over the years, such as an epic struggle three decades ago by podiatrists to gain official permission to perform surgery on ankles. They won, defeating orthopedic surgeons and their lobby, the California Medical Association.

Other clashes have included those between optometrists and opticians, psychologists and psychiatrists, plastic surgeons and dentists who are maxillofacial surgeons, and physicians and nurses. There has even been a long-running battle between veterinarians and dog groomers over who may legally brush dogs' teeth.

This year's version is a renewed effort by physical therapists to treat patients without a diagnosis from a physician.

The legislation, Senate Bill 924, won unanimous approval in the Senate and easily cleared the Assembly Business and Professions Committee despite opposition from the California Medical Association, its old scope-of-practice rivals in the California Podiatric Association, and other medical specialties.

However, another aspect of legislative politics then emerged. As if by magic, the Assembly Appropriations Committee inserted into the bill a provision requiring a diagnosis from a physician or a podiatrist for physical therapy after 30 days or 12 visits, thus giving the doctor lobby and its allies a win.

It was a classic example of the strange things that happen to legislation in the last days of a legislative session.

So would allowing therapists to treat patients without a physician's diagnosis be a benefit or a threat to the public welfare?

That quite pertinent question rarely arises in the superheated, high-dollar politics of medical care.

© Copyright The Sacramento Bee. All rights reserved.

Read more articles by Dan Walters



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