BILL ANALYSIS                                                                                                                                                                                                    

                                                                  AB 64
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          Date of Hearing:   April 24, 2007

                            ASSEMBLY COMMITTEE ON HEALTH
                                Mervyn Dymally, Chair
                      AB 64 (Berg) - As Amended:  April 18, 2007
          SUBJECT  :   Uniform Emergency Volunteer Health Practitioners Act.

           SUMMARY  :   Creates the Uniform Emergency Volunteer Health  
          Practitioner Act (Act) that establishes procedures for the  
          purpose of registering volunteer heath practitioners in order to  
          allow those licensees from other states to practice health or  
          veterinary services in California in an emergency, as defined.   
          Specifically,  this bill  :  

          1)Creates the Act that does the following:
             a)   Applies to volunteer health practitioners registered  
               with a registration system, as defined, and who provide  
               health or veterinary services in this state for a host  
               entity while an emergency declaration is in effect;
             b)   Requires a host entity to consult and coordinate its  
               activities with the Emergency Medical Service Authority  
               (EMSA), as specified; and,
             c)   Allows EMSA, while an emergency declaration is in  
               effect, to limit, restrict or otherwise regulate the  
               duration and geographic area of the practice by a volunteer  
               health practitioner, the types of practitioners that may  
               practice, and any other matters necessary to coordinate  
               effectively the provisions of health and veterinary  
               services during an emergency.

          2)Establishes qualifying criteria for a volunteer health  
            practitioner registration system, including requiring that  
            such a system:
             a)   Accept applications for registration of volunteer health  
               practitioners before and during an emergency;
             b)   Include information about the licensure and good  
               standing of health practitioners that is accessible by  
               authorized persons; and,
             c)   Is capable of supplying sufficient information about the  
               registered volunteer health practitioner to EMSA in order  
               to allow EMSA to confirm the accuracy of information  
               concerning whether the health practitioner is licensed and  
               in good standing before health services or veterinary  
               services are provided.


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          3)Requires a registration system for volunteer health  
            practitioners to meet specified conditions, including the  
             a)   Be a local unit consisting of trained and equipped  
               emergency response, public health, and medical personnel,  
               as defined; 
             b)   Be an emergency system for advanced registration of  
               volunteer health care practitioners established by a state  
               and funded through the Health Resources Service  
               Administration (HRSA); 
             c)   Be designated by EMSA as a registration system pursuant  
               to this bill; or, 
             d)   Be operated by: a disaster relief organization; a state  
               specified licensing board or bureau; a national or regional  
               association of licensing boards or health practitioners; a  
               health facility that provides comprehensive inpatient and  
               outpatient health care services, as defined; or, a  
               governmental entity.

          4)Authorizes EMSA or a host entity, while an emergency  
            declaration is in effect, to confirm whether a volunteer  
            health practitioner utilized in this state is registered with  
            an approved registration system in this state, and limits that  
            confirmation to obtaining identities of the practitioners from  
            the system and determining whether the system indicates that  
            the practitioners are licensed and in good standing.

          5)Provides that a host entity is not required to use the  
            services of a volunteer health practitioner even if the  
            practitioner is registered with a registration system that  
            indicates that the practitioner is licensed and in good  

          6)Authorizes, while an emergency declaration is in effect, a  
            registered volunteer health practitioner in good standing in  
            the state in which the practitioner's registration is based,  
            to practice in this state to the extent authorized by this  
            bill, as if the practitioner were licensed in this state.

          7)Requires a volunteer health practitioner to adhere to the  
            scope of practice for similarly licensed practitioners  
            established by licensing provisions, practice act, or other  
            laws of this state.


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          8)Clarifies that a volunteer health practitioner is not  
            authorized to provide services outside the practitioner's  
            scope of practice, even if similarly licensed practitioners in  
            this state would be permitted to provide the service.

          9)Authorizes the applicable licensing board or bureau to modify  
            or restrict the health services or veterinary services  
            regulated by that body provided by volunteer health  

          10)Authorizes a host entity to restrict the health or veterinary  
            services that a volunteer health practitioner may provide.

          11)Authorizes licensing boards and other appropriate  
            disciplinary authorities of this state to impose  
            administrative sanctions upon a health practitioner licensed  
            in this state for conduct outside of this state in response to  
            an out-of-state emergency and upon practitioners not licensed  
            in this state for conduct in this state in response to an  
            in-state emergency.

          12)Considers a volunteer health practitioner who is providing  
            health or veterinary services in this state or who is  
            traveling to or from this state to provide those services, an  
            employee of this state for purposes of worker's compensation  
            coverage concerning any injury, occupational illness, or death  
            incurred by the practitioner in providing the services or in  
            traveling to or from this state to provide the services.   
            Worker's compensation benefits for volunteer health  
            practitioners are limited to those benefits provided to state  
            employees under the law of this state.

          13)Defines relevant terms of this bill, including the following:
             a)   "Volunteer health practitioner" means a health  
               practitioner who provides a health or veterinary service,  
               whether or not the practitioner receives compensation for  
               those services.  The definition does not include a  
               practitioner who receives compensation pursuant to a  
               preexisting employment relationship with a host entity or  
               affiliate that requires the practitioner to provide health  
               services in this state, unless the practitioner is not a  
               resident of this state and is employed by a disaster relief  
               organization providing services in this state while an  
               emergency declaration is in effect;
             b)   "Host entity" means an entity operating in this state  


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               that uses volunteer health practitioners to respond to an  
               emergency and that consults and coordinates with EMSA and  
               complies with the provisions set forth in this bill; and, 
             c)   "Emergency" means an event or condition that is a state  
               of emergency proclaimed by the Governor or the Office of  
               Emergency Services (OES), a local emergency, a health  
               emergency, or a state of war.

           EXISTING LAW  : 

          1)Ratifies, approves, and sets forth the provisions of the  
            Interstate Civil Defense and Disaster Compact (ICDDC) between  
            the State of California and other states which are parties to  
            the compact.  The purpose of the compact is to provide mutual  
            aid among the states in meeting any emergency or disaster from  
            enemy attack or other cause (natural or otherwise).  

          2)Ratifies, approves, and sets forth provisions of the Emergency  
            Management Assistance Compact (EMAC).  The purpose of EMAC is  
            to provide for mutual assistance between states in managing  
            any emergency or disaster duly declared by the Governor,  
            whether arising from natural disaster, technological hazard,  
            man-made disaster, emergency aspects of resource shortages,  
            civil disorders, insurgency or enemy attack.  EMAC does the  
             a)   Requires each party state to develop plans and programs  
               for interstate cooperation; 
             b)   Requires party states to render mutual aid, except that  
               the state rendering aid may withhold the resources  
               necessary to provide reasonable protection for that state;
             c)   Deems licenses, certificates or other permits issued by  
               one state to be licenses, certificates or other permits  
               issued by the state requesting assistance;
             d)   Deems officers or employees rendering aid in another  
               state to be agents of the other state for tort liability  
               and immunity purposes.  Protects any party state or its  
               officers or employees rendering aid in another state  
               pursuant to this compact from liability for any good faith  
               act or omission;
             e)   Allows for supplementary agreements between member  
             f)   Requires each party state to provide compensation and  
               death benefits for injury or death suffered in another  
               state pursuant to the compact in the same manner and to the  
               same extent as if the injury or death had occurred within  


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               the state; 
             g)   Requires any party state rendering aid to be reimbursed  
               by the state receiving the aid; and,
             h)   Sunsets on March 1, 2007.

          3)Allows the Governor to enter into reciprocal aid agreements or  
            other interstate arrangements with other states and the  
            federal government for the protection of life and property.

          4)Establishes EMSA in the California Health and Human Services  
            Agency to coordinate and integrate all state activities  
            concerning emergency medical services.

          5)Establishes the OES to coordinate the emergency activities of  
            all state agencies in connection with such emergency during a  
            state of war emergency, a state of emergency, or a local  
            emergency, as specified.

           FISCAL EFFECT  :   Unknown
           COMMENTS  :   

           1)PURPOSE OF THIS BILL  .  According to the author, this bill is  
            needed to prevent the kind of red-tape barriers that hindered  
            medical professionals who tried to help during the Hurricane  
            Katrina disaster.   The author states that this Act is  
            designed to significantly aid the pre-credentialing process  
            for volunteers before or during an emergency.  California's  
            EMSA has a version of this in its early stages, but it does  
            not allow all health professionals to register and does not  
            address scope of practice issues.  In addition, this bill is  
            designed to work with Emergency System for Advance  
            Registration of Volunteer Health Professionals (ESAR-VHP), the  
            program's formal name, not conflict with it.  The author  
            asserts that the National Conference of Commissioners on  
            Uniform State Laws (NCCUSL) drafted the model Act to address  
            issues that prevent out-of-state medical professionals from  
            practicing in afflicted areas.  According to the author, with  
            the passage of this bill, which is intended to adopt  
            California's version of the uniform Act, both public and  
            private health care practitioners may register to provide  
            emergency services before or during an emergency in any state.  
             Most importantly, California will be able to recognize  
            volunteer practitioners from other states should it undergo a  
            mass emergency.  The Act will ensure that healthcare  
            practitioners can be more quickly and effectively deployed to  


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            healthcare facilities and disaster relief organizations and it  
            will reassure states in need of assistance, including  
            California that the volunteers they receive have gone through  
            the proper verification.

           2)EMAC  .  According to an Assembly Governmental Organization  
            Committee analysis of AB 1564 (Nava), currently pending in the  
            Assembly Appropriations Committee, the purpose of EMAC is to  
            provide mutual aid among the states in meeting any emergency  
            or disaster.  The State of California took the lead in the  
            1970s to create an interstate compact for sharing resources  
            between states during disasters.  That compact, ICDDC, was  
            eventually adopted by nearly all other states and ratified by  
            Congress.  ICDDC enables states to share emergency management  
            resources during times of disaster and encourages the  
            coordination of emergency preparedness activities between  
            states.  ICDDC was adopted by legislation in 1977.  In the  
            early 1990s, a group of southern states initiated a project to  
            update the existing compact.  This project resulted in EMAC,  
            which was ratified by Congress in 1996 and now been adopted by  
            all 50 states, as well as, Puerto Rico, and the Virgin  
            Islands.  As states adopted EMAC into their state laws, many  
            of the states rescinded the older ICDDC.  At this time, only a  
            few states are still members of ICDDC.  Although California is  
            still operating under the statutory ICDDC, California lacks a  
            legally established process for sharing emergency resources  
            with the states that have dropped ICDDC in favor of EMAC. 

          The author states, that the delayed response following  
            Hurricanes Katrina and Rita revealed that although laws exist  
            to provide for the interstate recognition of licenses issued  
            to "federalized" healthcare workers and state public employees  
            (EMAC provides for the deployment of "state resources"), no  
            uniform and readily understood system exists to recognize  
            licenses issued to other health professionals traveling from  
            one state to another to assist during these disasters.   
            According to the author, not even EMAC could adequately  
            support the "surge capacity" required to deliver health  
            services during an emergency.  EMAC falls short because, aside  
            from its application to state government employees, the  
            compact only extends its benefits to other emergency  
            responders who go through a complicated process of entering  
            into agreements with their home jurisdictions to be deployed  
            to other states pursuant to mutual aid agreements. As a  
            result, very few private sector volunteers were able to be  


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            deployed to the Gulf Coast through the compact and the  
            capacity of state and federal government agencies to  
            immediately provide needed assistance was overwhelmed.

           3)ESAR-VHP  .  The program goal of ESAR-VHP is to assist grant  
            awardees of HRSA's National Bioterrorism Hospital Preparedness  
            Program (NBHPP) cooperative agreements in establishing a  
            pre-registration system for emergency volunteer health  
            professionals. This system of state based systems will, when  
            complete, form a National system that will allow efficient  
            utilization of health professional volunteers in emergencies  
            by providing verifiable, up-to-date information regarding the  
            volunteer's identity and credentials to hospitals or other  
            medical facilities in need of the volunteer's services. Each  
            State's ESAR-VHP system will be built to standards that will  
            allow quick and easy exchange of health professionals with  
            other states, thereby maximizing the size of the population  
            able to receive services during a time of a declared  
            emergency.  California has an ESAR-VHP administered by EMSA.   
            It is called the California Medical Volunteer Site, located at  
     .  The site currently  
            allows nurses, doctors, pharmacists, and paramedics to  
            register for volunteer service.  In the future the site will  
            permit other mental health and allied health professionals to  
            also register.

            Assistance Teams (DMATs) are a national network of response  
            teams composed of approximately 35 - 100 civilian volunteers  
            from the medical, health and mental health care professions.   
            DMATs are a component of the National Disaster Medical System,  
            a cooperative asset-sharing program among federal government  
            agencies.  DMATs can be federalized and activated to provide  
            supplemental or replacement medical care and other services to  
            communities impacted by a disaster.  The State of California  
            currently has seven DMAT teams.  Nationally, there are more  
            than 20 teams. DMATs receive initial equipment and supplies  
            from the federal government.  The California teams are  
            partially funded by the EMSA, which also finances the annual  
            statewide training exercise.  Additional funds are raised  
            through membership/training fees and the provision of first  
            aid services at local mass gathering events. 

             a)   AB 1564 (Nava), pending in the Assembly Appropriations  


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               Committee, extends the operation of EMAC to March 1, 2012,  
               and repeals EMAC on January 1, 2013.  AB 1564 prohibits the  
               state from giving assistance to, or receiving assistance  
               from, any state for any condition resulting from a labor  
               controversy.  Takes effect immediately as an urgency  
             b)   AB 880 (Nava), pending in the Assembly Judiciary  
               Committee,  requires any private business entity or  
               nonprofit organization that voluntarily and without the  
               expectation or receipt of compensation, that provides  
               services, goods, facilities or any other resources or  
               assistance in preparation for, in anticipation of, or  
               during any state of war emergency, state of emergency, or  
               local emergency at the express or implied request of any  
               responsible state or local official or agency, to have no  
               liability for any injury sustained by any person by reason  
               of those services, goods, facilities, or resources,  
               regardless of how or under what circumstances or by what  
               course the injury is sustained.  
             c)   Public Law 107-188, the Public Health Security and  
               Bioterrorism Preparedness and Response Act of 2002  
               authorizes the development of ESAR-VHP.   HRSA was  
               delegated the responsibility for carrying out this  
               legislation and assisting each state (and territory) in  
               establishing a standardized, volunteer registration system.  
                Each state-based system will include readily available,  
               verifiable, up-to-date information regarding the  
               volunteer's identity, licensing, credentialing,  
               accreditation, and privileging in hospitals or other  
               medical facilities. 

           6)SUPPORT  .    The California State Conference of the NAACP is  
            sponsoring this bill, which is implements in California a  
            national effort to create a uniform system that enables out of  
            state health professionals to be timely engaged during an  
            emergency and allows disaster-stricken states to receive the  
            rapid response they deserve.  The California Nurses  
            Association sent 300 nurses from around the country to staff  
            hospitals, clinics and mobile units in the wake of Hurricane  
            Katrina, and believes that this bill is important legislation.  
             The Regional Council of Rural Counties, in support of this  
            bill, writes that successful emergency response and recovery  
            depends upon adequate preparedness planning and anticipation  
            of potential needs in all sectors of the community.  Having a  
            system in place to register and activate qualified medical  


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            volunteers to help in any emergency situation will be a  
            valuable tool?For example, in response to a major event in an  
            urban area, California's rural counties may experience a  
            dramatic influx of people, which could seriously strain the  
            health network.  The county's ability to request assistance  
            from neighboring states may be integral to saving thousands of  

           7)POLICY QUESTION  .  Is this bill needed to enhance California's  
            existing medical volunteer registration site?  Specifically,  
            how will the implementation of this bill work with the  
            existing site?  


          California State Conference of the NAACP (sponsor)
          Animal Switchboard
          California Association of Physician Groups
          California Dental Association
          California Funeral Directors Association
          California Federation for Animal Legislation
          California Nurses Association
          California Primary Care Association
          California Society of Health-System Pharmacists
          Humane Society of the United States
          Regional Council of Rural Counties
          United Animal Nations
          Two individuals

          None on file.
          Analysis Prepared by  :    Teri Boughton / HEALTH / (916) 319-2097