Physician Voices for Patient Safety
On this page:
About the bill
Impact on patients in DC
Impact of physicians in DC
What can you do?
Resources
About the bill
In November 2023, DC Health introduced B25-545, the Health Occupations
Revisions General Amendment Act of 2023. This bill was a comprehensive
rewrite of the law overseeing medical licensing and regulation in
Washington, DC. Unfortunately, the bill as written overhauled
scope of practice, place allied health professionals in oversight
positions of medical licensing, and remove the physician from the center
of the care team. After much work and a number of legislative wins, the bill passed the Council on May 7.
MSDC has long advocated that a physician is the most qualified professional at the head of a care team. Physicians have the most health education and pre-practice experience of any health professional, and thus must be involved in all but the most mundane health care decisions. Allied health professionals are a valuable part of the care team, but their medical education and experience limits their role.
The Medical Society of the District of Columbia (MSDC) is the leading voice for physicians in Washington, DC, committed to uniting physicians to advocate for physician-led health care in Washington, DC that protects patients from harm and increases access to quality care. MSDC is leading a coalition of Washington, DC specialty medical societies to advocate against the Health Occupations Revisions General Amendment Act of 2023.
Impact on DC medicine
Below is a breakdown of some of the major changes the bill contains; click on the title to expand how the bill would change that item.
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 | See our one-pager on this issue that you can share with colleagues and the Council
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 details: See our one-pager on this issue that you can share with colleagues and the Council
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 details: See our one-pager on this issue that you can share with colleagues and the Council
The bill would expand 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 that you can share with colleagues and the Council
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 our one-pager on this issue that you can share with colleagues and the Council
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.
Articles on scope of practice
MSDC President Testifies at DC Health Oversight Hearing
On March 19, 2021, MSDC President Dr. E.W. Emanuel testified on behalf of the Medical Society at the Committee on Health's DC Health oversight hearing. Below is his written testimony.
March 19, 2021
Councilmember Vincent Gray
Chair, Committee on Health
1350 Pennsylvania Ave NW
Washington, DC 20004
Dear Chair Gray,
Thank you for allowing me the opportunity to testify today at this oversight hearing. My name is E.W. Emanuel, and I am the 2020-2021 President of the Medical Society of DC (MSDC). MSDC is the largest medical organization representing metropolitan Washington physicians in the District. We advocate on behalf of all 11,000 plus licensed physicians in the District and seek to make the District “the best place to practice medicine”.
The SARS-CoV-2 public health emergency has been a major test for the District’s public health infrastructure. DC Health overall has responded heroically, and its staff has gone above and beyond to protect the residents of the District. I want to publicly thank Dr. Nesbitt, Dr. Watson, Dr. Shah, Dr. Lewis, and the many DC Health employees for bringing a public health lens to the tough decisions that have been made during the pandemic. Even where we disagree or choices made were not ideal, they were made with the best interest of District residents in mind.
While MSDC has been involved in numerous initiatives with DC Health during the pandemic, I want to highlight one area of collaboration. Recently MSDC and DC Health stood up the DC Clinician Champions Program, a program that connects physicians and community events to address questions about COVID-19 and the vaccine. To date MSDC and the DC CCP have staffed numerous community events and MSDC looks forward to expanding the program as vaccine availability expands.
Looking ahead, there are some critical issues facing medicine. Many of these areas can be addressed within the budget, and some are issues I want to raise as a point of interest for the committee.
- Make permanent the licensure flexibility permitted by the public health emergency. DC Health quickly allowed medical practices to treat patients across local state lines. This kind of flexibility was promised by the Interstate Medical License Compact, which DC Health is finally implementing. I urge the Council and DC Health to go further and permit freedom to treat patients in the District via telemedicine if (1) the healthcare provider is located in Maryland or Virginia and has a pre-existing treatment relationship, or (2) the physician is located in the District and their practice/health system needs to refer to another healthcare professional within the practice located in Maryland or Virginia. I also urge DC Health to enter negotiations with Maryland and Virginia for a “DMV” license agreement, similar to the Interstate Medical License Compact but covering these three states.
- Fully fund and expand the Health Professional Loan Repayment Program. I thank the Chair for supporting this important program, which allows physicians to practice in medically underserved areas and receive a needed financial support for standing up their practice. As we stated last year, we urge the Council to not only fully fund but consider increasing the funding, as well as expanding eligibility to physicians who work in an ambulatory clinic or hospital setting.
- Support a DC version of the Dr. Lorna Breen Health Care Provider Protection Act. Named after a physician who committed suicide during the pandemic, this federal legislation would create wellbeing programs for healthcare providers and establish a national campaign to encourage healthcare professionals to seek support due to trauma. I encourage the District to create grant programs to support healthcare professionals seeking wellbeing in light of the pandemic. MSDC has a wellbeing program and last year my colleague Dr. Laurie Duncan shared with the committee MSDC’s work. In addition, DC Health can make available data from its healthcare workforce surveys to identify gaps in healthcare professional wellbeing.
Please reach out to the MSDC office if I or our membership can be of assistance on this or any issue. We look forward to working with you and the Committee to make the District the best place to practice medicine.
Sincerely,
EW Emanuel, MD
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