When we make medical appointments, we expect to receive care from a trained and highly experienced physician. Yet the reasonable expectation that we will see a highly qualified doctor will soon disappear.
Assembly Bill 890, which will take effect next year, will make it difficult for the Latin American community to have confidence in the care we will receive due to the new categories of nurse practitioners created by this law. . We have learned to trust a doctor because of their training and experience, but that experienced doctor may no longer play a role in the treatment we receive.
Outcomes and access to health care are already disparate for Latino residents of our state. Although AB 890 claims to improve access to equitable and affordable care, it probably won’t. Instead, the soon-to-be-implemented law will create an inequitable system of care for our families and communities.
As the implementation of the law continues to be developed, the regulatory process being formed raises many outstanding concerns and frustrations. Most aggravating is the utter disregard the Board of Registered Nursing has shown for the Latino population — a population they are allegedly trying to help close the health care gap with this new policy.
At a Board of Registered Nursing regulatory hearing in November, members of the Latino community who raised concerns were sidelined and scorned as their comments – delivered in Spanish – were ignored and their translator requests were ignored. Many letters of concern submitted to the board by members of the Latino community have never been acknowledged.
If the board’s attitude and treatment of the Latino population in any way reflects how the new categories of nurse practitioners the board oversees will address the concerns of their Latino patient population, they have no their place in providing care for my community.
With this bias in mind, Spanish-speaking patients should be told clearly and explicitly that they will be treated by a nurse practitioner instead of a physician. AB 890 states that “A nurse practitioner must verbally inform all new patients in a language understandable to the patient that a nurse practitioner is not a physician and surgeon. For the purposes of Spanish speakers, the nurse practitioner should use the standardized phrase “enfermera especializada”.
But a verbal disclosure is not sufficient to inform a patient that they are not receiving the services of a physician and that a physician may have no control over the nurse’s care. In addition to verbal disclosure, formal, written disclosure – in a language the patient understands – with corresponding signage in a prominent location in each area where the nurse practitioner practices should be required.
Under AB 890, the nurse practitioner is limited to providing certain services. Often low-income people face life-threatening medical conditions and need to be aware that a nurse practitioner may not provide the urgent medical services they need. The patient should be advised in writing that they still have the right to see a physician, especially in cases where a nurse practitioner is required by law to refer a patient to a physician.
AB 890 should be guided by proven measures to provide respectful, quality and affordable care to patients like those in my community. The current implementation of this bill is far from good and causes me grave concern for the future of care for Latino-Californis.
We cannot create an unfair health care system that negatively impacts our communities. Our communities deserve the ability to see a doctor when seeking medical services, and the Council of Registered Nurses should pay more attention to community concerns.
Marco César Lizárraga is the executive director of La Cooperativa Campesina de California, the national association of agencies implementing and administering farmworker service programs.