Vital Times 2020 - 90

Scope Creep, and What Our Role
Should Be

what, if anything, distinguishes the two from each
other. And I think we very much should point out this
fundamental flaw.

The North Carolina appellate court decision I wrote
about in my first article reiterated North Carolina's longstanding precedent that nurses " are not supposed to be
experts in the technique of diagnosis or the mechanics
of treatment. " But California differs in that we have
no such legal interpretation on record that maintains
that nurses are not supposed to be experts in the
technique of diagnosis or treatment. All we have is BPC
2052 that makes it illegal to diagnose, treat, or operate
for any physical or mental condition without a valid
physician and surgeon's certificate. But the unaddressed
legal description remains: Is the administration of
general anesthesia and all its attendant intricacies-
including acutely developing surgical and anesthetic
complications, and the rapid nature of accurate
diagnosis and treatment-the practice of medicine?

I think it is entirely possible to carefully and clearly
outline the diagnostic and treatment elements
inseparable from and paramount to the administration
of a general anesthetic-elements that distinctly
require licensed and specially trained physicians to
safely and successfully carry out. To establish this
basic foundation in the eyes of the courts would mean
the unsupervised administration of anesthesia by nurses
might be reversed.

I, and I believe every patient, would agree that the
practice of delivering and managing anesthesia is
unquestionably is the practice of medicine. In addition,
and quite notably, The Nurse Anesthetist Act (1983)
strictly forbids nurse anesthetists from practicing
medicine:
BPC 2833.5. Except as provided in Section 2725
and in this section, the practice of nurse anesthetist
does not confer authority to practice medicine or
surgery.
But the American Association of Nurse Anesthetists
says the following:
" When anesthesia is administered by a nurse
anesthetist, it is recognized as the practice
of nursing; when administered by a physician
anesthesiologist, it is recognized as the
practice of medicine. "
This arbitrary statement has no foundation, no
evidence to support its validity, and does not address

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CSA Vital Times

An Ongoing Battle, a Strategic Shift
As long as we take a passive approach, praising the
contributions of nurses, embracing a team care model,
and tiptoeing around brazen lobbying efforts, we will
never be able to ensure the safety our patients, or the
integrity of our profession. Scope creep will continue,
and we will continue to see legislation that removes
practice safeguards and eliminates the lines that
separate nursing from medicine. Of great concern, AB
890 expressly allows certain nurses to practice medicine
truly independently under specific circumstances.
Unchecked, the list of these specific circumstances will
continue to be expanded. Unchecked, the small subset of
nurses will grow to include more and more. Unchecked,
some of them will even call themselves " doctor. "
I encourage you to stand behind your degree, your
unique and highly specialized skills and training, and not
back down from a great and monstrous disservice to the
sick. We cannot fight misinformation and propaganda
without directly, persistently, and intentionally pursuing
false and harmful narratives and calling them out for
what they are. Otherwise, we can say all we want, but
they will continue getting their fictionalized message
out, calling themselves doctors, and maneuvering
into a custody of care that is, at its best, an arrogant
miscarriage of the practice of medicine.

Vital Times 2020

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