Physician Voices for Patient Safety

Currently the Board of Medicine is composed of 10 physicians and 4 members of the public. The bill as amended would reduce the number of physicians to 9 and adds 2 physician assistants but keep the four members of the public health.

The concern: The bill would codify that APRNs could independently diagnose, prescribe, and administer medicine.

The details: See the analysis from G2L Law Firm on the APRN provisions

The solutions: 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 is the scope expansion that could permit nurse anesthetists to practice without physician collaboration.

The solution: This bill asks to repeal Section 603 of DC official code ₰3-1206.03, and this action will allow 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.

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 bill would not longer have physicians overseeing their work but instead a clinical laboratory director

The bill would expand pharmacists' scope to include:

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

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.

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 the analysis from G2L Law Firm on the podiatrists' provisions

The solution: This bill amends Paragraph (14) of D.C. Official Code § 3-1201.02(14) to define "Practice of podiatry” to include the administration of local anesthesia, monitored anesthesia care, and conscious sedation. Other scope of practice expansions for podiatry include care of human hand and wrist, and administration of injections, vaccinations, and immunizations. Podiatrists should not be administering monitored anesthesia care. Podiatrists do not have the qualifications and training to manage a patient's airway so this language should be stricken.

Throughout the bill, restrictions on nursing scope of practice are removed or loosened throughout. 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.