Physician Voices for Patient Safety

Previously the Board of Medicine is composed of 10 physicians and 4 members of the public. The bill as amended reduced the number of physicians to 9 and added 2 physician assistants but kept the four members of the public health.

The concern. The bill codified that APRNs could independently diagnose, prescribe, and administer medicine.

The details. See the analysis from G2L Law Firm on the APRN provisions | See our one-pager on this issue

The solutions we proposed. Independent Advanced Certified Nurse Practitioners should have a defined scope of practice limited to the following functions:

• Practice only in the field of certification;
• Comprehensive physical assessment of patients;
• Certify to the clerk of the court that an adult has given birth;
• Certify to the Transportation authority that an individual has special needs for certain health reasons;
• Complete date of birth and medical information on a birth certificate;
• Complete a death certificate if medical examiner does not take charge and deceased was under the care of the PN;
• Establish medical diagnosis of common short-term and chronic stable health problems;
• File a replacement death certificate;
• Issue a “do not resuscitate order” in medical emergencies;
• Order, perform, and interpret laboratory and diagnostic tests;Prescribe drugs and devices under DC controlled substance Schedules II-V with a valid DEA license, and medical marijuana under DC laws;
• Provide emergency care within the scope of their skills;
• Refer patients to appropriate licensed physicians or other health care providers;
• Certify to utility company that a client has a serious illness or the need for life-support equipment;
• Witness an advanced directive;
• Sign off on home health/care orders.
  

The concern. As seen below, additional allied health professions are permitted to apply anesthesia. Most concerning was the scope expansion that permitted nurse anesthetists to practice without physician collaboration.

The details. See our one-pager on this issue that you can share with colleagues and the Council

The solution we proposed: This bill asks to repeal Section 603 of DC official code ₰3-1206.03, and this action allows nurse anesthetists to administer anesthesia without an anesthesiologist or other physician's direct collaboration. Language seeking repeal of Section 603 of DC official code ₰3-1206.03 should not be included.

This bill adds Sec. 605a, which contains language that a CRNA may plan and deliver anesthesia, pain management, and related care to patients or clients of all health complexities across the lifespan. Language adding Sec. 605a should be removed from this bill.

The expands audiologists' scope to include "cerumen management" and "interoperative neurophysiologic monitoring" and permits audiologists to screen for cognitive, depression and vision. This was struck from the final version.

The bill completely rewrites the definition of the practice of "chiropractic". Chiropractors could:

• Diagnose and treat biomechanical or physiological conditions that compromise neural integrity or organ system function
• Refer patients for further medical treatment or diagnostic testing

The details: See our one-pager on this issue . This was struck from the final version.

The bill expands pharmacists' scope to include:

• Ordering labs
• Scheduling and monitoring drug therapy
• Ordering, interpreting, and performing more tests

The details: See our one-pager on this issue

The bill would permit physical therapists to independently evaluate and treat disability, injury, or disease. PTs may also order imaging as part of their treatment plan. This provision was struck from the final bill.

The concern: The bill expands podiatrists scope of practice to allow:

• apply anesthesia as part of treatment; and
• administer vaccines and injections.

The details: See our one-pager on this issue

These provisions were struck from the final bill.

Throughout the bill, restrictions on nursing scope of practice were removed or loosened. Specific language outlining what and how nurses can practice is removed and replaced with more vague language giving the Mayor (read DC Health) the ability to dictate scope. This applies to many different nursing types, like APRNs and NPs.