D.C. City Council member Polly Shackleton (D-Ward 3) has drafted a compromise plan for ensuring that nurse-midwives, psychologists and other nonphysician health-care providers have access to D.C. hospital facilities, in an attempt to meet objections by physicians and hospitals.
Shackleton's plan, revising an original bill that was opposed by doctors and hospital officials, makes clear that hospitals still would establish the standards for granting clinical privileges to such nonphysician professionals, based on their education, training, experience and competence. Hospitals also could require that the practitioners collaborate with physicians.
"There will, of course, be those physicians who remain opposed for reasons of a predominantly economic nature," said Shackleton, chairman of the council's human services committee, in a memo on the revisions to other council members. "And I certainly have no illusions that concerns of status and turf will somehow magically disappear."
Dr. Dennis O'Leary, president of the D.C. Medical Society, said that the redraft takes care of some problems the society had with the original bill, but that others remain.
For example, he said, three of the groups listed in the bill--nurse-midwives, nurse-practitioners and nurse-anesthesists--now are licensed in the District simply as registered nurses, not in those separate categories.
The original bill, which was endorsed by a majority of the City Council and supported by Mayor Marion Barry, would prevent hospitals from barring the nonphysician practitioners as a class.
For example, a hospital could not decide to prohibit all nurse-midwives from delivering babies at its facilities, as some in the D.C. area have done. The hospital could, however, deny privileges to any individual midwife it did not consider qualified.
The bill sparked heated opposition and intense lobbying by D.C. physicians--backed by the hospitals--who said it would result in a lowering of standards at District facilities.
Members of the health-care groups trying to gain access to the hospital facilities charged that the doctors opposed the legislation simply because they could not stand the competition, a charge the doctors deny.
The medical society originally expressed all-out opposition to legislation prohibiting discrimination against the five groups. At committee hearings, O'Leary moderated that stance, saying it "is appropriate to mandate access" to hospitals as long as doctor supervision is assured.
But the society's latest mailing on the bill again talks only of "full-fledged opposition" to the provisions.
Federal Trade Commissioner Patricia P. Bailey, meanwhile, submitted comments to Shackleton, saying that competition between physicians and nonphysician practitioners benefits consumers by giving them alternative choices on treatment and by lowering the overall cost of health care.
Speaking for herself only, Bailey said denial of hospital privileges can violate antitrust laws if one professional group is boycotting another. The FTC is continuing to investigate cases in this area, she noted.
" . . .The pressures and tensions surrounding competition in the health care industry can lead to the outbreak of anti-competitive practices in the granting of hospital privileges which in some cases are both egregious and obvious but in other cases are subtle and hard to detect," she wrote.