By George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law
On August 8, 2016, a California bill was announced that would allow certified nurse-midwives (CNMs) to practice in hospitals independently. It is apparently upsetting many of teh state’s physicians. The California Hospital Association and the California Medical Association (which represents doctors), agree that nurse-midwives have the training and qualifications to practice without physician supervision. But they differ greatly over whether hospitals should be able to employ midwives directly — a dispute the certified nurse-midwives fear could derail the proposed law.
The Supervision of Nurse-Midwives.
The proposed bill would override an existing law that requires certified nurse-midwives to practice only under the supervision of licenced medical doctors. California is one of only six states that requires full supervision. Several other states mandate other looser forms of supervision or monitoring by physicians, such as through collaboration agreements or preceptor agreements, especially for such issues as prescribing medications.
The American College of Nurse-Midwives has been attempting to chisel away for decades at state laws that require physician supervision, and it has finally passed the tipping point nationally, said Jesse Bushman, director of federal government affairs for the organization. Nurse-midwives aren’t seeking permission to go off and do whatever they want without consulting anyone, Bushman said. “They’re just asking to be able to do what they are trained to do.”
Additionally, in the states where nurse-midwives can practice independently, there is much more access to care, he said, citing a recent report published by the George Washington University’s Jacobs Institute of Women’s Health.
To read the report in full, click here.
Corporate Practice of Medicine.
Now, the debate between the doctors and the hospitals centers on the state’s prohibition of what’s known as the “corporate practice of medicine.” The state of California does not allow corporations, including hospitals, to hire physicians directly, though there are several exceptions. The intent of the ban is to avoid undue corporate influence on doctors’ medical judgment and patient care. Under the current law, hospitals can hire nurse-midwives, though many don’t. However, there is no such bar on hiring nurses directly
According to Dr. Jaun Thomas, a lobbyist with the medical association, patients should have the same consumer protections whether they see a nurse-midwife or a doctor. “It should be a level playing field,” he said. “We believe very strongly that the corporate practice of medicine bar language provides an important layer of patient protection.”
Assemblywoman Burke’s office is continuing to talk to representatives of both the physicians and the hospitals to try and find a solution to the issue.
“For both of them, it is an issue they don’t want to compromise on,” Burke said. “The bill became a pawn in the fight between the hospitals and the physicians. It still is.”
To learn more, click here to read one of my prior blogs.
Turf Battle or Antitrust Violation, or Both?
This appears to me to be just another one of those turf battles that we have seen in the practice of medicine through recent history. Whether its podiatrists trying to get their foot in the door and orthopedic surgeons trying to shut them out, or dermatologists being criticized by plastic surgeons for doing to many “cosmetic procedures,” or chiropractors being ostracized by medical doctors, or allopathic doctors discriminating against osteopathic physicians, this seems to be just another turf battle. After all, midwives have been delivering babies before there were hospitals and before Hippocrates was born (probably delivered by a midwife).
I would think the recent flurry of antitrust lawsuits against healthcare systems and against professional licensure boards over attempted monopolization would give most doctors cause to think twice before supporting such efforts to shut out nurse-midwives. This seems like a good time for the nurse midwives to be thinking about this type of litigation.
After all, sometimes you just have to wake up and smell the coffee and give up on hoping for a return to the ways of the Twentieth Century. I know it’s been hard for me!
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Gorman, Anna. “California Doctors And Hospitals Tussle Over Role Of Nurse-Midwives.” Kaiser Health News. (August 8, 2016). Web.
About the Author: George F. Indest III, J.D., M.P.A., LL.M., is Board Certified by The Florida Bar in Health Law. He is the President and Managing Partner of The Health Law Firm, which has a national practice. Its main office is in the Orlando, Florida area. www.TheHealthLawfirm.com The Health Law Firm, 1101 Douglas Ave., Altamonte Springs, FL 32714, Phone; (407) 331-6620.
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