Vital Times 2020 - 88

SPECIAL FEATURES

The Practice of Medicine:
How California May Be Losing Its Way
(Part III)
Christopher G. Tirce, MD, FASA

As scope battles continue, there is an urgent need for stronger and more
direct tactics to counter misinformation and increase understanding
of the practice of medicine. In modern debate on this issue, diagnosis
and treatment-the fundamental skills that distinguish the practice of
medicine from support medical care roles-have not received enough
attention...and maybe they should.

S

o now you know
that we as
anesthesiologists
are legally liable for nurse
anesthetists' mistakes-
as can be a surgeon or
gastroenterologist-even
though California is an
opt-out state. Furthermore,
the American Association
of Nurse Anesthetists (AANA) purports that they are
just as capable and safe, if not more safe, than doctors
at administering anesthesia (We Are the Answer); all
nurse anesthetist schools will be required to be doctoral
programs by 2025; some DNPs are already deceiving
patients and inappropriately referring to themselves as
" doctor " in the course of patient care; and Assembly
Bill 890 has just been signed by Governor Newsom
(making it possible for nurse practitioners to diagnose
and treat patients without any physician involvement).
If anyone doubted the nursing lobby is seeking scope
encroachment, by now there should be no question.

88 |

CSA Vital Times

How we go about combating scope creep, ensuring
patient safety and the integrity of medical practice, is
a very daunting, fraught, and sometimes emotional
topic. History, laws, changes in knowledge, skill sets,
and technology, as well as money and politics, are
all involved. It is these last two that may prove most
problematic for physicians. What doesn't change,
however, is that conducting and managing general
anesthesia is the practice of medicine, and this has yet-
at least in California-to be the basis of any challenge
to nursing practices and legislation that attempts to
misappropriate these duties.
Taking a closer look at California's opt-out (2009-2012),
existing laws, and tying that in with the new legislation
we are seeing today (i.e., AB 890) might provide us some
useful guidance.

The Legal Definition of the Practice of
Medicine
Legally speaking, states define what is the practice
of medicine, and that differs from state to state. In



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