California Senate votes to expand powers of nurse practitioners

May 7, 2015

Reporting from Sacramento

Addressing a doctor shortage that is especially dire in rural parts of California, the state Senate voted Thursday to let nurse practitioners do much more for patients, including diagnosing and ordering treatment and prescribing drugs, without supervision by a physician.

Sen. Ed Hernandez (D-West Covina) said his bill will make sure that Californians have easier access to primary healthcare by giving more responsibility to nurse practitioners in certain settings, including medical clinics.

“More than 18,000 of them are in California and stand ready to help meet our healthcare needs,” Hernandez told his colleagues before the 25-5 vote.

The measure is opposed by the California Medical Assn. and other physician groups that argued that nurse practioners are insufficiently qualified to practice certain functions without supervision.

Sen. Jim Nielsen (R-Gerber) said the bill created a wedge between patients and physicians.

“It undermines the teamwork basis of healthcare, where different individuals such as nurse practitioners work under the supervision of a physician,” Nielsen said.

Sen. Richard Pan (D-Sacramento), a pediatrician, said he also worried about “fragmentation of care,” which he said leads to “poor quality and missed communications.”

Pan also worried that there would not be enough oversight if nurses remained under the watch of the state Board of Registered Nurses, which he said is not set up to oversee diagnosis and treatment decisions. Pan said oversight should be provided by the California Medical Board, which regulates doctors.

Sen. Jeff Stone (R-Murrieta), a pharmacist, supported the bill, saying some rural areas of his district don’t have enough primary care physicians for everyone who needs to get treatment. “It improves access to care,” Stone said. "Certainly it will not jeopardize public safety."

The bill, SB 323, next goes to the state Assembly for consideration.