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
following:
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
standing.
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
practitioners.
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
following:
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
states;
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
https://medicalvolunteer.ca.gov/index.php . 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.
4)EMSA DISASTER MEDICAL ASSISTANCE TEAMS . EMSA Disaster Medical
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.
5)RELATED STATE AND FEDERAL LEGISLATION .
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
statute.
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
lives.
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?
REGISTERED SUPPORT / OPPOSITION :
Support
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
Opposition
None on file.
Analysis Prepared by : Teri Boughton / HEALTH / (916) 319-2097