Affiliated with AFSCME and AFL-CIO

 MAY 2007

  

Nurse Practitioners and Physician Assistants Try to Expand Their Jurisdiction

The nurse practitioners and the physician assistants proposed legislation to expand their scope of practice. AB 1436 by Assemblyman Ed Hernandez, an Optometrist, was amended a few days before its first hearing to give nurse practitioners virtual independence in practice. It would eliminate current requirements that nurse practitioners work under protocols under the supervision of a physician and instead allow nurse practitioners to “work in consultation with a physician” but would not spell out what that meant. The bill would also expand the number of physician assistants that one physician could supervise.
 
The UAPD opposed the bill as do all of the medical associations. The bill was scheduled for hearing in its first committee on April 24th but was pulled from the agenda at the last minute. The removal of a bill from a committee’s agenda often signifies that there was strong enough opposition to defeat the bill. The UAPD will work in conjunction with the physician groups in opposition to this bill to ensure that it does not pass.
 
 

UAPD Defeats Psychologist Prescribing Bill

The psychologist prescribing bill, SB 993, sponsored by the Service Employees International Union and the psychological association, was defeated in the Senate Business and Professions Committee on April 23 by a vote of 1 Yes and 5 No. The only Senator to vote Yes was the bill’s co-author Senator Sam Aanestad, a dentist before he became a professional politician.
 
The UAPD worked aggressively to defeat this special interest bill. UAPD lobbyist Doug Chiappetta told legislators that SB 993 was bad for patients and would increase malpractice risk and costs for the state, counties, and private hospitals.   UAPD President Dr. Stuart Bussey testified against the bill in committee. He also obtained written testimony from a psychiatrist in New Mexico about the failure of that state’s psychologist prescribing legislation.

The psychological association issued a false press release claiming that AFSCME International Union endorsed their bill. AFSCME sent a strong letter to the Business and Professions Committee chairman saying that AFSCME was neutral and the psychology association had misrepresented AFSCME’s position.   AFSCME remains neutral whenever two of its locals (Local 2620 and the UAPD/AFSCME) take opposite positions on a bill.

Also testifying against the bill was UAPD Vice President and psychiatrist Dr. Allen Doran. He and Dr. Bussey were able to counter much of the inaccurate information that the psychologists spread during this failed attempt to expand their scope of practice beyond the limits of what they were trained to do.

The committee granted the bill''s author Senator Ron Calderon permission to reconsider the bill at a future date.  The overwhelming defeat of the bill in its first committee will make it very difficult for proponents to get it passed in the future.  The UAPD will carefully moniotor this bill and will continue its aggressive opposition to any form of psychologist prescribing.
 

Medicare Formula Needs to Change

Under the current Medicare sustainable growth rate formula, physicians are scheduled for a fee reduction of ten percent in the year 2008. If that reduction were carried out it would have a devastating effect on the Medicare program. Physicians and their elderly patients would suffer as many doctors would quit the program. The UAPD strongly opposes the fee reduction.

In 2007 a proposed reduction in the reimbursement for physicians was narrowly averted by intensive lobbying campaigns in Washington, D.C. Even so, physicians received no cost of living increase for 2007 although their costs for rent, insurance, and support staff, along with all of the other costs of running a private practice, continued to increase.
 
The Union of American Physicians and Dentists has made it a top priority to change the antiquated Medicare physicians’ formula now and not wait until another payment crisis in December. Our AFL-CIO international union AFSCME, the American Federation of State, County and Municipal Employees, is working in Washington, D.C. with the new Democratic majority in Congress to overhaul the payment formula for physicians.   AFSCME, with 1.4 million members nationwide, has the lobbying
clout to convince key congressional committees to properly fund Medicare and the other important federal healthcare programs. We will keep you informed of developments in this important battle.
 

 

Sham Peer Review

A young Russian writer, involved in anti-establishment politics, was arrested in 1851. He and some colleagues were put against a wall. The firing squad, rifles at the ready, stood waiting for the order to shoot. Instead, a messenger, riding hard on horseback, galloped in and delivered a new order to the firing squad commander. The Czar had called off the execution. Later it was learned that the execution scenario was staged. The writer was to have learned a lesson – don’t interfere with government. Luckily, the writer didn’t learn that lesson. He went on to write several famous novels, Crime and Punishment and The Brothers Karamazov among them. His name was Fyodor Dostoyevsky.
 
SHAM PEER REVIEW is today’s medical-legal counterpart. It is used to punish so-called disruptive doctors. Some allegations of disruption may be true and correct. Other allegations are blatantly false and malicious, for instance, when contrived allegations are secretly compiled and allowed to become a premeditated process for getting rid of doctors who oppose hospital administrations. The basis for sham peer review is malicious motivation disguised to look like efforts to protect quality healthcare. Some administrations enlist the support of compliant doctors from the same medical staff as the accused doctor. These efforts would often fail were the rest of the medical staff to object. Unfortunately, too often the general medical staff keeps quiet, the damage is done, a career is ruined.

The Union of American Physicians and Dentists has helped to expose sham peer review, e.g., when Gil Mileikowsky, MD, was ordered by the Medical Board to submit to a psychiatric examination. The court hearing this case determined that the Medical Board lacked good cause. The UAPD was on board in asking the U.S. Supreme Court to hear Mileikowsky’s case at a later stage (see www.uapd.com, scroll to “Legal”).
 
We are hearing from doctors generally that the net for so-called disruptive doctors is being increasingly widely cast. There are a number of effective ways to fight back. One way is to support the UAPD’s efforts on behalf of doctors facing sham peer review. Another is to make sure that you fight back early if you are accused, that you file counter charges where so doing is appropriate, and that you also know your rights.