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
Dr. Alice Fuisz Testifies on Medical Record Bill
On Wednesday, MSDC member and ACP DC former governor Alice Fuisz, MD, MACP, testified before the Committee on Health on B24-133. This bill would, among other things, set high fines for failing to provide requested medical records within 30 days, extend the requirement to keep records to 10 years, and limit the charges on providing medical records.
Dr. Fuisz testified on behalf of ACP DC but MSDC assisted ACP DC and associated itself with her comments. The Society is concerned that the bill as written could overburden smaller physician practices and open the door to more frivolous lawsuits.
Below is Dr. Fuisz's written testimony. To learn how to testify before the Council, check out our guide here.
Dear Chair Gray:
My name is Alice Fuisz, MD, MACP, and I am a Managing Partner of the Washington Internists Group. For over 90 years, the Washington Internists Group has served the Washington metropolitan area's primary care needs. Our physicians are all board-certified and practice general internal medicine with a focus on preventive care. I am a former governor of the Washington DC Chapter of the American College of Physicians (DC ACP) and former Executive Committee member of the Medical Society of DC (MSDC).
Today I am pleased to speak on B24-0133, the Personal Medical Record Fee Amendment Act of 2021. As physicians we support the right of a patient or their caregiver/surrogate to have access to their medical records if needed. However, even in this electronic age, immediate access to years of medical records on demand is in some cases an overwhelming task. This is especially true for smaller private practices like mine, who lack the large infrastructure and support system of my colleagues who work in healthcare systems and hospitals. If a patient requests their complete medical record, it will often be hundreds of pages of documents. The time it takes to print out these records, review them for completeness, and mail them is tremendous. My practice, like many, is currently on an electronic medical record system so the records are in an electronic format, but the work involved remains significant.
I would like to focus on two specific aspects of the bill, to make the bill more practical for the District’s medical practices:
- The bill separates electronic requests and physical copy requests. The fee for an electronic request is $6.50. When I surveyed my staff, I was told that it takes on average 30 minutes to process an electronic request. That time does not include the time spent by the physician to review the records for completeness. $6.50 does not adequately compensate for an employee’s time to process the request. As for the paper copies, my practice charges a set fee so as to be able to tell a patient what the charge is prior to starting the work. I think the per page fee is fair assuming the records are on site and simply need to be copied, but what if the records are held off site and need to be retrieved before being copied? There are costs associated with the storage of paper records and collecting them from an off-site location. In this situation, perhaps a processing fee is fair.
- The new requirement for all physician practices to hold medical records for 10 years is well beyond the current requirement for non-hospital practices, and exceeds the 7 years recommended by most medical malpractice insurance carriers. For a small practice like mine, holding all of my patients’ records for 10 years (and longer if the person seen is under 18 years of age) is a major infrastructure cost to my practice. In addition, we are routinely asked by colleagues closing their practices to retain their patient records, to ensure these patients have the legally required time to access their records. Adding new patient records and either needing to digitize them or holding them ready to provide is an infrastructure burden to our practice.
I suggest the fee for electronic records be raised to cover the true costs to a practice like mine.
I suggest you eliminate the language regarding holding records for 10 years from this bill. It is a “side topic” that I do not think is relevant to the concerns related to access to medical records.
The DC Chapter of the American College of Physicians and MSDC want to ensure the District is a place where physicians and patients can not only practice good medicine, but are leaders in the medical field. This bill as written adds new onerous requirements that opens practices up to unnecessary lawsuits or incentivizes them to leave the District for surrounding jurisdictions. Please contact me, DC ACP, or MSDC if we can assist with making needed changes to this bill.
Respectfully submitted,
Alice Fuisz, MD, MACP, Past Governor
Shmuel Shoham, MD, FACP, Governor
Leave a comment