With an expanding, increasingly sophisticated system of health-care delivery, there is continuing need to modernize licensing standards and to bring new entities such as hospices, home-care agencies and maternity centers under regulation.

Health professions also have evolved rapidly, each increasingly well trained to be an integral part of a modern health-care system. Although exceedingly rich in health resources, the District lags in its recognition of the critical role played by alternative health professionals in hospitals throughout the country.

With these issues in mind I introduced Bill 5-166, on which the committee on human services has completed two days of hearings. As with all legislation, we are reviewing comments carefully and will be working to clarify the language to address appropriate concerns and misunderstandings.

Section 8 of the bill would prohibit class-based exclusion of nurse-midwives, podiatrists, psychologists, nurse practitioners and nurse anesthetists. Several of the most prestigious university teaching hospitals in the country, including Johns Hopkins, Massachusetts General, Columbia Presbyterian, Beth Israel and Stanford, currently grant clinical privileges to members of these groups.

The bill would not, as some have alleged, open the gates to all, mandate particular privileges, or usurp the powers of the governing body. Each applicant, whether physician or non- physician, would be evaluated on an individual basis, and the scope of privileges accorded would be commensurate with his or her education, training, experience and demonstrated current competence. These criteria are used by the Joint Commission on Accreditation of Hospitals and are necessarily broad to give a credentials committee a wide margin of flexibility in evaluating an applicant's competence.

The prime motives behind this provision are consumer choice and continuity of care. In many instances, consumers who choose treatment by a trusted professional do not have a right to continued care by that professional in District hospitals. Several women testified that they gave birth at home or in suburban birth centers because nurse- midwives are prohibited from delivering babies in most District hospitals. We heard of psychologists waiting hours to find physicians willing to sign admissions for suicidal patients and then not being allowed to treat the patients.

Physicians do compete with these practitioners, despite statements to the contrary. The most egregious example of local physicians' excluding their competitors was a vote at the Washington Hospital Center to exclude all nurse-midwives after a successful program. Bill 5-166 would prevent these injustices to consumers and practitioners.

The D.C. Medical Society has suggested mandating physician supervision for these professionals. The bill does not speak to this issue, nor is it appropriate to do so. Nurse-midwives work under protocols that mandate physician backup by providing for medical consultation, collaborative management, and referral. Dr. Cortland Robinson, chief of the OB/GYN department at Baltimore City Hospitals, and Kathy Slone, a nurse-midwife and assistant professor at Johns Hopkins, testified to the "collegial," not "hierarchical," non-supervisory relationships between nurse-midwives and obstetricians at these institutions.

The relationships among the many health professionals in a hospital are complex and changing. These issues must be addressed because of the clear antitrust potential of physicians' denying staff privileges to their competitors. The attorney general of Maryland aptly described this problem:

"Where doctors with privileges are empowered to, and do in fact, deny privileges to applicants for their personal competitive advantage, a group boycott exists. . . . Restraints of trade are contrary to our most basic national policy and cannot be tolerated . . ."