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
What to know about DC and the 2024 election
Locally, the 2024 election is over. The implications, however, are just beginning.
MSDC staff are analyzing the results of the national and local elections, and while there is still much we do not know, there are still some things that are clear the day after this election.
DC elections
- The DC Council members up for reelection all won: Robert White (at large), Christina Henderson (at large), Brooke Pinto (Ward 2), Janeese Lewis-George (Ward 4), and Trayon White (Ward 8). In Ward 7, Wendell Felder won the election to replace MSDC award winner Vincent Gray.
- Councilmember Gray would vacate the Hospital and Health Equity Committee Chairmanship in the next Council. However, the committee may go away with Gray stepping away from the Council. Council Chair Phil Mendelson will announce in the coming weeks the committee structure for 2025-2026 which will include Chairs and committee jurisdictions. Committee on Health Chair Christina Henderson should continue having oversight of the health realm.
National elections
- Congress oversees the District through two committees: Senate Committee on Homeland Security and Governmental Affairs, and House Committee on Oversight and Accountability. The Senate Committee's subcommittee of jurisdiction is Oversight of Government Management.
- NB there will be changes as members of Congress move around due to seniority and as other committee positions come available. But based on what we know, here are the players in Congress that could oversee DC affairs.
- The Senate will be controlled by Republicans. The current Homeland Security Ranking Member (presumed Chair) is Rand Paul (KY) and subcommittee ranking member is James Lankford (OK). Senator Paul trained as an ophthalmologist but has fought many of the health policies of the Biden Administration.
- The House majority is still up in the air. The Chair of the Oversight Committee is James Comer (KY) and the ranking member is Jamie Raskin (Maryland). DC Delegate Eleanor Holmes Norton serves on the committee and 119th Congress rules could determine how active she could be.
How national election results can influence DC medicine
- Congress has a required review period for all District laws passed into law. Congress or the relevant committees can hold a vote to override a law before it goes into effect - this requires a majority in both chambers and the president signing the override bill. This means any bill passed by the Council, if it catches the eye of the Congressional majority or president, could be subject to review.
- As many know, the appropriations process allows the federal government to place restrictions or permissions for executing DC law. Long-time political people know that abortion riders and marijuana riders restricting how the District can implement policy in these areas are common. In the current Congress, proposed riders expanded to include things as mundane as no turn on red light laws. The new Congress could expand riders to prohibit DC government money from being spent on numerous health policies.
Want to learn more, stay engaged in this conversation, or be proactive on health policy in the District? Join the MSDC Advocacy Committee - our next call is tonight at 6pm. Contact Robert Hay at hay@msdc.org to learn more.