Nurse practitioner autonomy bill fails in state Assembly (updated)

A bill that would have given California’s nurse practitioners more autonomy died in an Assembly committee Tuesday.

The vote in the Assembly Committee on Business and Professions was 9 to 4 with one abstention against SB 323. The bill, which cleared the Senate last month, would have allowed nurse practitioners to work independently, without a doctor's supervision, as long as they contracted with a medical group.

Nurse practitioners are registered nurses with masters or doctorate degrees and additional certifications.

The bill, authored by Sen. Ed Hernandez (D-West Covina), faced fierce opposition from doctor groups — particularly the California Medical Association — that argued it would compromise patient safety and fragment care.

"I am baffled by the opponent’s argument that this bill will somehow put patient safety at risk without producing a shred of evidence to support their position," Hernandez said in a statement after the committee vote.

Those who supported the bill said nurse practitioners already worked fairly independently and that the bill would codify much of what was going on in the industry. They also said it would increase opportunities for nurse practitioners to work in areas where doctors are scarce.

The scope of practice for nurse practitioners has been under discussion in recent years across the nation as more healthcare providers have been needed under the Affordable Care Act. According to the American Association of Nurse Practitioners, 21 states allow nurse practitioners "full practice" authority. California is one of 13 states, including Texas and Florida, categorized as "restricted practice" by the national nurses group.

Hernandez said his goal was to increase access to healthcare in rural and inner city locations by allowing nurse practitioners, who provide nearly all of the same primary care support as doctors, to operate as outposts of larger medical groups. The bill would not have allowed nurse practitioners to set up completely independent shops.

“Granting Nurse Practitioners authority to practice to the full extent of their training is not a new concept nor is it revolutionary," said Hernandez, who is an optometrist. "NPs have been practicing safely in states across the country without physician supervision for more than 20 years and the Institute of Medicine has clearly shown that patient outcomes with NPs are as good or better than with physicians."

The California Medical Association noted the measure's defeat with satisfaction.

"SB 323 would have done nothing to address access to care, and absent a bar on the corporate practice of medicine, adequate physician and medical board oversight, and the extensive training necessary, this legislation would have only put Californians at risk," CMA President Luther Cobb said in a statement.

Under current law, nurse practitioners must work under a physician, although the law does not prescribe how much supervision or consultation is required. Nurse practitioners diagnose and treat patients and prescribe medications.  Some nurse practitioners run facilities that doctors own but rarely visit.

The California Association of Nurse Practitioners supported the bill. According to the association, there are 18,000 nurse practitioners in the state.

 "SB 323 would have allowed California’s nurse practitioners to do what they are already doing every day — providing vital healthcare services often without a physician in the room or even in the building," said Donna Emanuele, president of the California Association of Nurse Practitioners. 

This was the second time Hernandez proposed such a bill, and his office told KPCC that he plans to reintroduce the measure next year.

Meanwhile, efforts are ongoing in other states to expand nurse practitioners' authority and responsibility.

This story has been updated.

This story has been updated to reflect that Donna Emanuele is the president of the California Association of Nurse Practitioners.