ShareThisBy DAN WALTERS
Sacramento Bee
Monday, May 07, 2007
While Gov. Arnold Schwarzenegger and legislative leaders chew over whether _ and how _ to bring health insurance to millions of working poor families, medical care providers are refighting long-running turf battles over who can perform which specific medical procedure of which part of the human body.
The public may assume that such matters are highly technical training and licensing issues. In fact, medically ignorant politicians determine "scope of practice" as practitioners flex political muscle to move up in the medical pecking order while fending off those lower on the scale _ with big money at stake for all.
The prototype was the epic battle between podiatrists and orthopedic surgeons over the legal right to perform ankle surgery, which the foot doctors eventually won nearly a quarter-century ago. Countless replays have ensued _ doctors vs. nurses, dentists vs. dental hygienists, plastic surgeons vs. dental surgeons, psychiatrists vs. psychologists _ even veterinarians vs. dog groomers (over the legal right to brush dogs' teeth).
This year's hottest clash has been a renewal of the years-long conflict between psychiatrists and psychologists over legal authority to prescribe psychotropic drugs. This year's version of the psychologists' perennial bid for drug-prescribing power was Senate Bill 993, carried by Sen. Sam Aanestad, R-Penn Valley. It didn't get very far, attracting just a single vote in the Senate Business, Professions and Economic Development Committee. The psychiatrists joined forces with other drug-prescribing medical specialists to administer a fatal dose of political medicine to the psychologists' bill.
Other scope-of-practice battles, however, are still simmering. In no particular order of importance:
_ Dental hygienists, who now must work under supervision of dentists, have renewed their years-long push for professional independence through a bill (Senate Bill 534) by Senate President Pro Tem Don Perata, D-Oakland, which would create a separate state licensing board for the hygienists.
_ Nurse practitioners and physicians' assistants have been waging a similar battle with physicians over independent operation. This year's version is a measure (Assembly Bill 1436) by Assemblyman Ed Hernandez, D-West Covina, which, among other things, would give physicians' assistants the authority to prescribe drugs.
_ Physical therapists also want to practice without direct referral from physicians. A bill (Assembly Bill 1444) by Assemblyman Bill Emmerson, R-Redlands, would grant that authority _ opposed, of course, by chiropractors and orthopedists. But when "massage therapists" sought licensure in a bill (Senate Bill 731) by Sen. Jenny Oropeza, D-Long Beach, chiropractors and physical therapists joined forces in opposition.
_ Speaking of bodily manipulation, Senate Bill 136 by Sen. Gil Cedillo, D-Los Angeles, would authorize acupuncturists to perform "tui na," described as "a hands-on body treatment that uses pressure techniques including myofascial release and manual therapy." Another measure (Assembly Bill 636) by Assemblyman Lloyd Levine, D-Van Nuys, would allow acupuncturists to use "light" as a therapeutic technique.
_ While one measure (Assembly Bill 1367) by Assemblyman Mark De Saulnier, D-Concord, would elevate drug and alcohol counselors into a state-licensed profession, another (Assembly Bill 1486) by Assemblyman Charles Calderon, D-Whittier, would create the same status for "professional counselors."
Psychologists, who want to expand their practices vis-a-vis psychiatrists, are opposing counselors' infringing on their professional turf _ thus underscoring the tribal nature of scope-of-practice battles.
(Contact Dan Walters at dwalters(at)sacbee.com. Back columns: www.sacbee.com/walters.)
(Distributed by Scripps-McClatchy Western Service, www.scrippsnews.com.)
