ANNAPOLIS -- Gov. William Donald Schaefer has been examining chest X-rays lately, and they aren't his own.
The pictures of someone else's ribs and lungs that Mr. Schaefer has been reviewing -- one a bit out of focus, the other in sharp detail -- came from opponents of a bill that would allow Maryland doctors to have unlicensed assistants take basic X-rays.
It's all part of a turf battle -- a rite of spring in Annapolis -- where groups of medical professionals fight every year over who can do what to whom. The public issue is always quality of medical care. The background issue is always money.
The first battleground in these fights is the General Assembly, which occasionally decides to let one group poach on another group's turf. When that happens, the second battleground is the governor's office, and the power of his veto.
Doctors who want their assistants to take X-rays got this particular bill through the legislature. But opponents, mostly licensed radiological technicians, gave Mr. Schaefer the fuzzy X-ray to show him what patients are likely to get if the bill is signed into law.
Bad X-rays -- possibly taken by an untrained receptionist -- could make it hard to detect tumors or other medical problems and force patients to pay extra for a second set of pictures. And that in turn could expose them to potentially dangerous levels of radiation, the bill's opponents warn.
Balderdash, says the state's medical society. Doctors' assistants have been taking X-rays for years without incident, and the bill before Mr. Schaefer will merely assure that those assistants who have already been taking X-rays will have to get at least 30 hours of additional X-ray training.
The doctors and the state's hospital association say there aren't enough radiological technicians to go around. If the bill is vetoed, doctors may be forced to hire them, exacerbating the shortage in hospitals. Or they may have to give up taking X-rays in their offices, making it more inconvenient for patients.
As Mr. Schaefer decides which bills to sign or veto by today's deadline, he'll also settle turf battles between podiatrists and orthopedic surgeons, environmental sanitarians and industrial hygienists, and other groups that annually drag their professional squabbles before the legislature.
It took hundreds of thousands of dollars in lobbyists fees, more than a decade of hearings and votes, a veto and a veto override before the legislature and governor finally settled in 1989 a dispute between ophthalmologists and optometrists over who can dispense certain eye drops.
Architects and interior designers fight over who can move interior walls. Nurses and doctors fight over who can dispense certain drugs or injections. Doctors fight dentists over jaw diseases. Psychologists battle psychiatrists; dental hygienists take on the dentists; cosmetologists fight the barbers; and doctors squabble with midwives.
"One thing all these medical turf battles have in common is the economic element," said David S. Iannucci, the governor's chief legislative officer, who goes over every bill passed by the legislature and recommends a signature or veto.
"What is difficult for a layman to do is sort out the medical issues from what may be an economic argument. It is something the governor takes very seriously. You can assume there is an
economic issue: What you have to determine is how important the medical issues are."
Take the podiatry bill, which would give foot doctors a leg up, literally and figuratively, on their better-trained colleagues, orthopedic surgeons.
A year ago, the General Assembly passed a bill that would have allowed podiatrists to perform surgery on ankles, but the legislation was too broadly drafted for Mr. Schaefer's taste, and he vetoed it.
This year, the legislature passed a more restrictive version that would permit podiatrists to perform certain procedures on the ankle, but only in a hospital. In addition, hospitals would be empowered to determine the qualifications of the podiatrist and to specifically decide which procedures the podiatrist is permitted to perform.
The governor is expected to sign the bill this year, despite continued opposition from some orthopedic surgeons.
The fight between environmental sanitarians and industrial hygienists is a bit different because the industrial hygienists never realized they were in a turf battle until it was too late.
The legislature was trying to decide whether to continue for another 10 years the State Board of Environmental Sanitarians, which licenses food or milk inspectors, insect or rodent control officers, and those who oversee water supplies, wastewater treatment or other issues involving health or environmental hazards. Most environmental sanitarians are government employees.