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What’s In A Name? Health Panel Seeks Clarity on Health Care Providers

Leon County Judge John Cooper on June 30, 2022, in a screen grab from The Florida Channel.
The Florida Channel
Rep. Ralph E. Massullo (News Service of Florida)

Each year, one of the more-heated health care issues in Tallahassee surrounds “scope of practice” --- or what services providers can legally offer. 

But members of a House panel wrestled Wednesday with a somewhat different issue: what health-care providers should be allowed to call themselves.

The House Health Quality Subcommittee approved a bill (HB 309) that would make clear non-physicians are not allowed to identify themselves as physicians, surgeons, medical doctors, doctors of osteopathy, cardiologists, dermatologists, endocrinologists and many other doctor monikers.

The bill was filed to blunt a unanimous decision by the Florida Board of Nursing to allow John McDonough, an advanced practice registered nurse, to identify himself as a “nurse anesthesiologist” without facing repercussions.

“Members, we strive for transparency and clarity in the bills that we try to move forward to become law. And we do that because of the people we are elected to serve. We want to keep them as safe as possible, and this bill facilitates that goal,” said Rep. Ralph Massullo, a Lecanto dermatologist who is sponsoring the bill.

The bill also would amend state law to make clear non-physicians are banned from using “any other words, letters, abbreviations, or insignia indicating or implying” that they are licensed physicians.

It would authorize licensing boards to take disciplinary actions against providers who are not physicians but use monikers that could imply they are, such as “anesthesiologist.”

While the subcommittee approved the bill in a 12-2 vote, some members want to see changes.

For example, committee member Rene Plasencia, R-Orlando,  proposed an amendment that would have precluded anesthesiologist assistants from using the title “anesthetists,” a term that has long been associated with advanced practice nurses, such as McDonough, who specialize in the administration of anesthesia.

The amendment had support from several lawmakers, including Rep. Mike Beltran, R-Lithia, who noted, “in fairness, if we are going to prevent the registered nurses from changing their title, we ought to at least protect the title they have,”

But Plasencia withdrew the amendment, noting he was going to work with Massullo “to make sure that we provide the right bill for us to be voting on if in fact it gets to the floor.”

It’s more than nurse anesthetists, though, that have concerns with the measure, which is filed for the upcoming 2020 legislative session.

David Ramba, a lobbyist for the Florida Optometric Association, said that, as written, the bill would preclude board-certified optometrists from using the word physician, even though they are authorized to do so today.

“If you are talking about clarity and transparency, we have now diametrically opposed positions,” Ramba said, adding that under Medicaid rules and regulations, board-certified optometrists are identified as “physicians.”

“We just have to whisper the word physician, we are optometric physicians, just in case the Department of Health is listening?” Ramba asked. “But right now, with the passage of this bill, you have a direct conflict.”

Likewise, the bill would preclude board-certified chiropractors from using the word “physician” even though they, like optometrists, are authorized to do so today.

“I don’t know if we got lumped in this inadvertently, but it would impact hundreds if not thousands of our doctors who are board certified,” said Florida Chiropractic Association Assistant General Counsel Kim Driggers.

Rep. Carlos Guillermo Smith, D-Orlando, opposed the bill, saying he didn’t think it was an issue that the Legislature should delve into.

“My issue is that it appears from the outside looking in that the physicians and the doctors didn’t like what the Board of Nursing did,” he said. “I think that we should allow the Board of Nursing and (its) interpretation to stand, and getting in the middle of this, I just don’t think is a good idea.”

While Massullo assured subcommittee members that he would work with interested parties, he underscored what he sees as the need for the measure.

“Words do matter, and definitions are important,” he said.