Two views: Lack of oversight for health care providers

State lawmakers and regulatory agencies oversee the licensure of a number of professions, including the profession of medicine by licensing doctors.

This oversight ensures that we are providing services that are accurate and safe and meet standard of care protocols as most of these services are based on years of extensive training. When state agencies give their stamp of approval, you are assured that you and your family’s safety and well-being should be a given professional’s priority. Unfortunately, there are two bills moving through the Legislature that do not ensure that level of oversight.

Senate Bill 622 would broadly expand the procedures that optometrists are allowed to perform for patients in California. These procedures are currently provided by ophthalmologists.

The distinction between optometrists and ophthalmologists is important: Ophthalmologists are medical doctors and spend years in medical school and residency training, whereas optometrists have no equivalent surgical residency training available to build up the skills they need for more advanced medical procedures.

The bill would allow optometrists to perform complex and risky procedures, including injections into the eye and advanced laser treatments on the eye, after undergoing a minimal amount of training procedures. For eye injections, the bill does not require optometrists to have any training on live human patients. That’s serious business when we’re talking about someone’s vision.

Likewise, SB 323 would allow nurse practitioners to perform certain medical procedures independent of physician supervision, collaboration or oversight, including that of the Medical Board of California. Those services have been offered under supervision with trained doctors for years, and the success of this team-based model of care has improved patient services throughout California.

I have worked with nurse practitioners my whole career, and I find them to be valuable members of our team. They are wonderful, caring and thoughtful, but they are not physicians. A physician-led team is crucial to the safe practice of medicine.

Passage of these pieces of legislation as they currently read would mean patients would be getting care from people who not only aren’t trained to give the care but who aren’t regulated or overseen by any agency with proper experience with such oversight. By removing proper oversight, SB 622 and SB 323 may put patients in harm’s way.

In addition, the bills fail to consider safeguards for many of the expanded services that have long protected the public with regard to physicians. For example, systems of peer review are hugely important for patient safety. Ensuring there is review of care by medical staffs and others with experience in those professional practices exist to ensure care meets appropriate standards. It should also be clear that health care professionals are referring patients to other services that serve their best interest, not what financially benefits the health care provider. Protections like this exist now but wouldn’t expand to the other health professionals under these bills.

So, before we allow lesser-trained health professionals to treat our parents and our kids, let’s be sure they have the tools and oversight to do it correctly. SB 622 and SB 323 as drafted just don’t do that.

Dr. Peter Bretan is chief of urology at Sonoma West Medical Center in Sebastopol.