QUESTION: Some states have allowed nurse practitioners and physician assistants to practice “independently.” If our hospital is located in one of these states and does not permit these types of practitioners to provide services independently, can this be considered discriminatory?
ANSWER: Many hospitals are struggling with these types of issues because of the need for practitioners to provide services and the expanding role and state scope of practice laws for advanced practice providers. For example, several years ago, Oregon passed a law allowing nurse practitioners to perform vasectomies. The law instructs that nurse practitioners “may” perform these types of procedures. The key is that most of these laws are permissive and not mandatory. In other words, in Oregon you may permit nurse practitioners to perform this procedure in, for example, an outpatient department of your hospital but you do not have to allow it. Some hospitals, especially those in rural areas where it is difficult to recruit practitioners, view these state scope of practice expansions with enthusiasm and perceive them as an opportunity to provide needed services to underserved populations.
Even though we are unaware of any cases successfully challenging a hospital’s decision to take a more restrictive approach than what is permitted under the state scope of practice laws/regulations (e.g., only permitting physicians to perform certain procedures even though state law permits nurse practitioners to provide the service), any decision to grant clinical privileges must take into account, among other things, the practitioner’s current competence to perform the privileges. If a practitioner is unable to demonstrate current competence and meet any other threshold criteria, as specified in your delineation of privileges form, he or she would not be eligible for a grant of those privileges regardless of what that practitioner’s state scope of practice says.
By way of comparison, a medical license provides a physician with an almost unlimited scope of practice. Yet routinely hospitals limit the scope of practice for physicians by the privileges that are granted and not granted. The same would be true for advanced practice providers.
To help avoid a legal challenge, it’s a good idea to document the reasons underlying a decision to take a more restrictive approach to the grant of privileges. For instance, there may not be a need in the community for the service because that need is already being met. Your documentation should also reflect that conflicts of interest were appropriately managed and that the reasons were not based on discriminatory intent or purpose.