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 Asks SHPDA to Clarify Certificate of Need Process
Today, MSDC President Dr. Kirstiaan Nevin sent an email letter to DC Health asking for clarification in the DC certificate of need (CON) process.
At its November Advocacy Committee meeting, Society leadership heard a presentation on the CON process and how some recent communication from the State Health Planning and Development Agency (SHPDA) to medical practices may indicate changes in the CON process. Healthcare facilities trigger the need for a CON when they establish new medical facilities or make changes to existing facilities, but MSDC has heard concerns that the regulatory language governing the CON is being interpreted in a new way. The letter asks for written clarification so the physician community can better understand the process, especially at a time when healthcare services are in such high demand.
The letter in full is below:
December 2, 2021
Terri A. Thompson
Director, State Health Planning & Development Agency
Center for Policy, Planning, and Evaluation Administration
899 North Capitol Street NE, 6th Floor
Washington, DC 20002
Dear Director Thompson,
The Medical Society of DC is the largest medical organization representing metropolitan Washington physicians in the District. We advocate on behalf of all 12,000 plus licensed physicians in the District and seek to make the District “the best place to practice medicine”.
MSDC has received feedback from medical practices about recent interpretations of DC regulations from SHPDA regarding certificate of need (CON). To assist us and the physician community in understanding the certificate of need process and any recent changes to interpretations, we request written clarification in the areas outlined below.
The concerns we have heard focus on three areas:
1. Definition of “group practice”. Physicians are concerned that there is ambiguity in the definition of group practice and when a certificate of need is required for the practice. We have been told your office uses 22-B DCMR 4099’s definition of ambulatory care facilities in determining what a group practice is, despite there being no stated definition of what one is, simply what it is not. It is important to know what aspect of this regulation is definitive.
2. Definition of “individual practitioner”. We have also heard that the same DCMR section has caused confusion for physicians looking to hire additional healthcare employees for their office. Because the statute defines what a group practice is not and does not have clear language on when adding employees requires a certificate of need, we have heard from our community they feel they need to apply for a CON if they want to hire an additional healthcare practitioner. As the demand for healthcare services increases, new staff to meet existing services may trigger the CON process. If this is the case, we seek clarity to understand when and why.
3. Scope of office services. The same section under “health care facility” lists the areas where a CON is not needed – conventional office services. This is a vague phrase and the explanatory clause following offers limited guidance. We have heard from practices that they do not know if any changes to their practice need a CON determination.
MSDC believes clarification to these issues is important, especially as our healthcare system changes due to the ongoing pandemic. We request written answers to the following questions, so we can better advise our members when they ask questions about changes to their practices:
1. Under 22-B DCMR 4099, how does SHPDA define a “group practice”?
2. How does SHPDA read 22-B DCMR 4099 to define a sole practitioner, and what is the dividing line between a sole practitioner and a group practice?
3. How can a practice determine if they offer a “conventional office service” or do they need to receive a determination from SHPDA?
If you have any questions, please contact Robert Hay Jr., Executive Vice President, at 202-355-9401 or hay@msdc.org to contact me. Thank you for your assistance with this matter.
Sincerely,
Kirstiaan Nevin, MD
President, Medical Society of the District of Columbia
CC: Fern Johnson-Clark, Ph. D, Deputy Director for Policy, Planning, and Evaluation
Edward Rich, Deputy Counsel
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