New Era Looms For California Medicine

Saturday, 7 Dec 2013, 9:01:00 AM

Tom Elias

Thomas B. Elias, Columnist
Santa Monica Mirror Archives
Thomas B. Elias, Columnist

As the new year approaches, a new era also looms for California medicine, and the changes are not due only to the Affordable Health Care Act, better known as Obamacare.

Other big changes will come as pharmacists expand their role in patient care and nurse practitioners, nurse midwives and physican assistants begin performing first-trimester abortions – unless a current attempt to qualify a referendum to stop the abortion expansion qualifies for next November’s ballot and delays it by a year.

Even larger changes may come in 2015, depending on how the newly expanded roles for non-physicians work out.

Although he did not carry the abortion-related bill, the effort to bestow new privileges on non-doctors is spearheaded by Democratic state Sen. Ed Hernandez of West Covina, who achieved only part of his goals this year. Hernandez, an optometrist, also sought wider privileges for both nurse practitioners and his own profession.

But most MDs opposed the changes, with the California Medical Association managing to stymie much of what Hernandez sought. He has said he’ll be back with similar measures next year.

How well they do will likely be tied closely to whether problems crop up in the expanded pharmacist roles and the abortion changes.

With the new law, pharmacists soon will be administering drugs and vaccinations directly to their customers (they already do some vaccinations), conducting patient assessments, ordering tests and overseeing drug regimens. The shift is meant partly to compensate for a shortage of primary care doctors to handle the increased patient load Obamacare will bring.

It represents a sea change. Not many years ago, pharmacists couldn’t even give flu shots. Now thousands of pharmacies across California post prominent signs inside and outside their stores offering those vaccinations almost year-‘round.

That’s worked out fine, relieving doctors of a routine chore, making vaccinations more convenient for patients and producing virtually no negative incidents. If pharmacists do as well with their new roles, it’s a virtual certainty optometrists and nurse practitioners will also see theirs expand.

And the odds are things will work out fine, although the occasional malpractice claim is to be expected.

Less certain is what might happen to women getting first-trimester vacuum aspiration abortions from non-physicians who have received special training.

Some liberal groups were delighted with the change because it essentially treats abortions like many other medical procedures. “The fact that abortion is singled out for special consideration (in other states) is a relic of the days when it was a felony. It’s a reflection of where this country is politically,” ACLU spokeswoman Margaret Crosby told a reporter.

Pro-life activists, however, see the change as a trivialization of pregnancy. From now on, California Pro-Life Council director Brian John complained, “animals will have more dignity under California law than human beings.”

One thing for sure: If medical complications crop up in a significant number of cases, early abortions will go back to being doctors-only affairs.

But that doesn’t seem likely, one reason this bill passed and won Gov. Jerry Brown’s signature. That guess is based on a UC San Francisco study of 11,000 procedures over the last five years, which found virtually no difference in the prevalence of complications between early abortions done by doctors and those carried out by skilled non-physicians.

Researchers conducted the study, which involved more than 5,000 non-physician abortions, using a little-known provision of California law allowing health care professionals other than MDs to take part in some pilot projects.

In a state where teenage pregnancies are rampant (even if reduced slightly from a decade ago), there is little doubt that, barring the possible referendum reversing it, the new law will make abortion more accessible.

Even so, it’s highly unlikely this will lead to change in other states, as many previous California laws have done. This state is far to the left of many others.

But the increased responsibility given pharmacists is something that could spread now that California has joined more than a dozen other states in granting it. More loosening up in health care will depend on how the druggists do next year.

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