“They would say Texas is behind the times. I would say Texas puts patients first.”
State Board of Dental Examiners rule took effect, allowing dentists to screen for and treat sleep disorders. The board adopted the rule even though TMA and the Texas Neurological Society (TNS) testified against the change, pointing out its potential to harm patients with severe obstructive sleep apnea (OSA). OSA is a medical condition causing
repeated narrowing of the throat during sleep. It either partially or completely blocks the airway. Continuous positive airway pressure (CPAP) is an OSA treat- ment that uses a machine to release mild air pressure into a patient’s mouth or nose using a mask. The dental board’s rule allows den-
Representative Zerwas also says the
proposed rules would have expanded nurse anesthetists’ scope beyond their education and training. Thomas Oliverson, MD, chair of the Office-based Anesthesia Committee for the Texas Society of Anesthesiologists (TSA), testified in person against the rule change at a public hearing before TBON in July. Dr. Oliverson says TBON is not likely paving the way to give APRNs the ability to practice medicine independently of physicians, but he con- tends the board is jumping on a nation- wide bandwagon. “It sounds like this is part of a national movement … to create some universal standards for APRNs,” he said, rather than having nurses continue to follow the same standards as physicians if they are engaged in medical acts. The problem with having separate
standards for nurses and physicians is it creates a gray area that could affect patient safety, Dr. Oliverson says, add- ing that separate standards would also conflict with Medicare requirements. A condition of participation in Medicare is a uniform standard of care, he says. “You cannot have two different stan-
dards of care for Medicare beneficiaries in the same facility,” he said. Dr. Oliverson says the Texas Legis-
lature would not likely allow nurses to practice independently of physicians, so nursing groups are instead taking a backdoor approach to get more privileg- es, little by little.
28 TEXAS MEDICINE September 2014 “It’s death by a thousand cuts,” he said.
“Independent practice is clearly the goal.” Dr. Oliverson says some states have given nurses more autonomy. “They would say Texas is behind the times. I would say Texas puts patients first,” he said. Fort Worth pediatrician and TMA
Trustee Gary Floyd, MD, testified before the legislature in favor of Senate Bill 406, a scope-of-practice compromise the leg- islature approved last year after years of disagreement between physicians and APRNs. The bill expanded prescribing privileges for APRNs and increased the number of APRNs to whom a physician could delegate. It also gave physicians more leeway in managing nonphysician practitioners (NPPs) by eradicating a re- striction that forced physicians to be on site 10 percent of the time. Dr. Floyd says a nurse’s job is to as- sess a patient’s status and provide care and comfort.
“I do not think it is a good idea for them to change the rule language,” he said. “Their nurse training does not teach them what medicine considers medical diagnosis.” Dr. Floyd adds, “Medical diagnosis is the practice of medicine. They need to go to medical school if that’s what they want to do.”
Safety a priority TBON announced its proposal on the heels of another scope-of-practice de- bate involving dentists. In June, a new
tists to treat patients for OSA and benign snoring using oral devices that keep the tongue and soft tissues in the back of the throat open, allowing the airway to re- main unobstructed. The rule also allows dentists to screen for OSA and benign snoring, including the ability to conduct sleep studies.
Sarah Carnes-Lemp, general coun- sel for the dental board, says the board wanted to address the subject because dentists were treating OSA without a physician’s prescription. She says the dental board revised the proposed rule several times before it adopted the rule. Under the new rule, she said, “den- tists cannot diagnose obstructive sleep apnea, but they can treat it on a medical physician’s prescription.” The board doesn’t allow dentists to
treat OSA without a prescription from a physician, Ms. Carnes-Lemp says. TMA opposed the rule on the basis that diagnosing and treating sleep dis- orders is the practice of medicine and exceeds the scope of dentistry. TMA Past President Stephen Brotherton, MD, and TNS President Kim Monday, MD, submit- ted a letter to the dental board in April opposing the new rule. Screening for a medical condition, such as sleep apnea, is outside the scope of dentistry and should be performed only by a licensed physician, the letter states. Drs. Brotherton and Monday also note TMA and TNS support the Texas Medical Board’s (TMB’s) position state- ment that reads, “… if a dentist were to
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