BILL ANALYSIS AB 64 Page 1 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. AB 64 Page 2 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. AB 64 Page 3 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 AB 64 Page 4 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 AB 64 Page 5 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 AB 64 Page 6 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 AB 64 Page 7 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 AB 64 Page 8 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 AB 64 Page 9 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