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, Medical Community Letter Asks for Regional Expedited Licensure
MSDC, joined by seven associations and 36 medical practices, sent a letter Monday to DC Health Director Dr. LaQuandra Nesbitt asking the department for a regional expedited licensure process.
During the public health crisis, DC Health emergency regulations permitted healthcare providers to treat patients in the District if they were in good standing in their home state and practicing within their license. This allowed health systems to refer patients to non-DC specialists and providers of all types to practice telemedicine. When the public health emergency declaration ends, these providers would be unable to continue care for DC patients unless they applied for a license, a process that would take months.
The letter - seen below - asks DC Health to create a process whereby a physician or healthcare provider (1) that meets DC licensure requirements and (2) is in good standing in Maryland and/or Virginia can apply for an expedited license. The online process would permit the provider to receive their license more quickly, thus allowing for easier continuity of care. Both Virginia and Maryland have statutory language that permits regional physicians to apply for an expedited license.
MSDC will continue to push for this issue with the Bowser Administration and Council to make practicing medicine in the District more convenient for physicians, the care team, and patients.
_________________________
June 7, 2021
LaQuandra Nesbitt, MD
Director, DC Department of Health (DC Health)
899 North Capitol Street NE
Washington, DC 20002
Dear Dr. Nesbitt –
The COVID-19 pandemic has shown the value of regional licensure to address the District’s health needs. During the public health emergency, the Mayor and your department waived some licensure requirements that allowed our practices and facilities to operate flexibly to address the pandemic and keep the District safe.
The licensure waivers have helped us staff our practices and see our patients regardless of location. The pandemic has shown that expedited licensure processes for local providers is essential for keeping the District safe and healthy. A return to rigid licensure requirements for local healthcare providers would burden our community at a time when residents expect the highest standard of care.
Both Maryland and Virginia have statutory language permitting physicians in the other state to apply for an expedited license. This process requires the applicant to meet licensure requirements in their state and creates a separate application process that allows them to receive a license more quickly. We urge DC Health to create an expedited regional license process to permit physicians and other healthcare providers in good standing in our area to receive a District license more quickly. Such a process would permit Maryland and Virginia healthcare providers who meet DC licensure requirements already to submit a separate, smaller application with a faster approval timeline.
We have attached language from Virginia and Maryland as a guide on how such regulations or legislation could be constructed.
As practices who provide care for a large percentage of the District population, we urge you to take this step now or in tandem with the Council to bring the District in line with Maryland and Virginia.
Sincerely,
Medical Society of the District of Columbia
Organizations
DC AAP
DC ACP
DC Section, American College of Obstetricians and Gynecologists
District of Columbia Chapter of the American College of Emergency Physicians
District of Columbia Society of Anesthesiologists
MedChi DC
National Hispanic Medical Association
Practices
A Squared Primary Care, LLC
Ashesh D. Patel, MD, FACP
Barnard Medical Center
Barry J. Landau, MD
Brian Crowley, MD
Catherine May, MD
Columbia Associates in Psychiatry, PC
Constance E. Dunlap, MD
Cronin Dermatology and Skin Cancer Center
Daniel Hicks, MD, DLFAPA, FAPM
Daniel J. Levine, MD
David M. Goldstein, MD
DC Internists
Diane Shrier, MD
Edwin C. Chapman, MD, PC
Gerald P. Perman, MD
GW Medical Faculty Associates
Ira Dosovitz, MD
J Desiree Pineda, MD, PLLC
John Zinner, MD
Judith Nowak, MD
Kelly L. Cozza, MD, DFAPA, FACLP
Lise Van Susteren, MD
Maheen Patel, MD, PLLC
Mid-Atlantic Permanente Medical Group
Palisades Pediatrics
Rania Gupta, MD, FAPA
Richard A. Chefetz, MD
Richard K. Kim, MD, FAPA
Robert J. Hedaya, MD
The Ross Center
Sara Imershein, MD, PLLC
Shira Rubenstein, MD
Shugarman Psychiatric & Counseling
Susan D. Rich, MD, MPH, DFAPA
Well-Minded, LLC
CC: The Honorable Phil Mendelson, Chair of the Council of the District of Columbia
The Honorable Vincent C. Gray, Chair of the Council’s Committee on Health
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