As New
York state climbs the steep face of its COVID-19
curve, Gov. Andrew Cuomo (D) issued an executive order vastly
widening the scope of practice for some healthcare providers and absolving
physicians of certain risks and responsibilities.
Among the order's provisions:
- Eliminating physician supervision of physician
assistants (PAs), nurse practitioners (NPs), certified registered nurse
anesthetists, and others
- Enabling foreign medical graduates with at least
a year of graduate medical education to care for patients
- Allowing emergency medical services personnel to
operate under the orders of of NPs, PAs, and paramedics
- Allowing medical students to practice without a
clinical affiliation agreement, and lifting 80-hour weekly work limits for
residents
- Granting providers immunity from civil liability
for injury or death
- Suspending usual record-keeping requirements
- Allowing several types of healthcare
professionals -- including NPs, PAs, nurses, respiratory therapists, and
radiology techs -- with licenses in other states to practice in New York. However,
physicians were not specifically included in the order, as the Department
of Health and Human Services has not yet issued the necessary regulation
- Suspending or revoking hospitals' operating
certificates if they don't halt elective surgeries
The order, which
remains in place through at least April 22, was met mostly with applause,
though with some hesitation around work-hour limits.
C. Michael
Gibson, MD, of Harvard, called it "stunning in both the breadth and depth
of recommendations" on
Twitter.
Shariq Shamim, MD, described it as a
"great move," with the exception that trainee work hour limits
shouldn't be scrapped: "They are already working equivalent to 2
[full-time employees] without Chinese-style PPE. More hours = more risk of
exposure," he
tweeted.
Art
Gianelli, president of Mount Sinai Morningside hospital in New York City, told MedPage Today that
his team is "grateful to the governor for throwing the regulations out the
window right now. He's encouraging us and enabling us to do what we have to do
to get through this. It's the right thing to do."
John Puskas,
MD, chair of cardiovascular surgery at Mount Sinai Morningside, agreed that the
steps are the right ones given that New
York City "hasn't flattened the curve adequately
to avoid a big wave crashing. We're really going to feel it in the next 2 or 3
weeks."
"If
simultaneously with that, we lost a meaningful number of healthcare providers
to home quarantine, then we'd have a shortage not just of ventilators, but of
people to run them and care for patients," Puskas said.
https://www.medpagetoday.com/infectiousdisease/covid19/85618