A medical turf war played out in the Capitol on Tuesday as lawmakers defeated a bill increasing the scope of practice for nurse practitioners while approving another for pharmacists.
The bills are part of a slew of proposed legislation, including three measures by Democratic Sen. Ed Hernandez of West Covina that aim to increase the medical duties of optometrists, nurse practitioners, pharmacists and other medical professionals. At issue is how to best increase access to care once federal law requires nearly everyone to have health insurance.
Nurse practitioners were seeking through Senate Bill 491 to increase their autonomy in order to see more patients for routine care without the supervision of a doctor. The bill, opposed by doctors represented by the powerful California Medical Association, failed 6-3 in an Assembly committee after four Democrats did not vote.
"I think the policy is right," said Susan Talamantes Eggman, D-Stockton, who voted for the measure. "I think the politics is hard."
SB 493, which increases the role pharmacists can play in medical care, passed 12-0 on Tuesday in the same committee. Pharmacists are seeking more authority in order to give immunizations and prescribe some drugs.
Hernandez's SB 492, which increases the scope of practice for optometrists, is scheduled to be heard next week. The nurse practitioner bill can be reconsidered, but Hernandez said he knew the vote would be tough. "I did everything I could so that we could address every question and more importantly every concern," he said. "Unfortunately, the reality of the political process is that was not the case."
Not voting were Assembly Democrats Raul Bocanegra of Los Angeles, Nora Campos of San Jose, Richard Gordon of Menlo Park, Chris Holden of Pasadena and Republican Curt Hagman of Chino Hills.
Assemblywoman Nancy Skinner, D-Berkeley, said she struggled with the nurse practitioner bill at first, but independent studies ultimately showed her that it would not be dangerous, as opponents suggested.
Dr. Paul Phinney, president of the California Medical Association, said the nurse practitioner bill did not expand access, but rather would fragment care. The association changed its opposition to the pharmacists' bill to neutral after working with Hernandez, but it still opposes the nurse practitioner bill.
"Collaboration is part of the pharmacy bill," Phinney told committee members. "It's not in this (nurse practitioner) bill."
Call Melody Gutierrez, Bee Capitol Bureau, (916) 326-5521. Follow her on Twitter @melodygutierrez.