How are legislators supposed to decide on the relative competencies of health care practitioners?
In these matters, we are asking lawmakers to make a tough decision on topics outside their expertise. In some cases, it’s not the public that’s asking but the practitioners of health care professions.
The dental therapist bill came back this year but did not have enough –pardon the pun – teeth.
The bill was widely publicized and debated in 2014. It attempted to create a new mid-level category of dental practitioner to provide care in underserved rural communities, based on a model that has been successful in other states. Last year the bill,was stopped in a Senate committee. This year, the House version of the bill (HB 349, sponsored by Rep. Dennis Roch, R. – Logan), passed the House and went no further. Its companion Senate bill, sponsored by Sen. Benny Shendo (D. – Jemez Pueblo), did not get a single hearing.
Though the details are technical, the argument is simple. Small rural communities need dental services, which the state’s dentists are not providing – but dentists are concerned about competency and training. As a dentist told me, you never know when a simple procedure like an extraction is going to be complicated until you do it and see what’s underneath.
The bill received considerable public support. The web site of Health Action New Mexico has a long list of supporting organizations (healthactionnm.org/learn/dental).
Over the years we have seen many “scope of practice” bills as professions like acupuncture, physical therapy and so on have sought to expand what the law allows them to do. Many of these bills attract very little attention outside the affected professions.
This year’s success was the optometry bill. SB 367, sponsored by Majority Floor Leader Michael Sanchez (D. – Belen). It passed the Senate unanimously, then passed the House – also unanimously — 13 hours before the end of the session. It is now before the Governor. It would expand the authority of optometrists to prescribe drugs.
Many patients don’t even know there are two kinds of eye doctors, optometrists and ophthalmologists. Optometrists are not medical doctors. Ophthalmologists are, and were not in favor of this legislation. One ophthalmologist told me optometrists don’t have enough training. Sound familiar?
If the governor signs this bill, it will be up to you as a patient to decide whether you want your optometrist prescribing medication.
The chiropractors’ bill was SB 376, sponsored by Sen. Cisco McSorley, (D. – Albuquerque), who has carried similar legislation at least twice before. This bill also dealt with the right to prescribe. It would have created two levels of advanced certification for chiropractors and allowed the advanced practitioners to prescribe, inject or dispense “dangerous drugs.”
The term “dangerous drugs” is defined in the New Mexico statutes (paragraph 26-1-2). It does not include illegal drugs but it does include drugs that have the potential to be toxic or addictive.
The Fiscal Impact Report for this bill stated that if it is passed, “New Mexico will be the only State in the U.S. that allows Chiropractors to prescribe dangerous medications.”
The bill passed one Senate committee and did not go any further.
I have heard suggestions that the national associations of various professions target New Mexico as a relatively easy state to pass legislation expanding their scope of practice. If New Mexico approves an expansion, that makes it easier to get the same expansion approved in other states.
Many public health needs are identified in New Mexico. Vision health is not a top priority. If we have children going without eye exams or glasses, this legislation will not increase their access.
What we know is that the dire need for dental health care is well established and it’s been left unresolved once again.
Triple Spaced Again, © New Mexico News Services 2015