BILL ANALYSIS                                                                                                                                                                                                    







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        |Hearing Date:June 14, 2010         |Bill No:AB                         |
        |                                   |2386                               |
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                      SENATE COMMITTEE ON BUSINESS, PROFESSIONS 
                               AND ECONOMIC DEVELOPMENT
                         Senator Gloria Negrete McLeod, Chair

                         Bill No:        AB 2386Author:Gilmore
                        As Amended:May 28, 2010  Fiscal:   Yes

        
        SUBJECT:   Armed Forces:  medical personnel.
        
        SUMMARY:  Authorizes a hospital to enter into an agreement with the  
        Armed Forces of the United States to authorize a physician and  
        surgeon, physician assistant, or a registered nurse to provide medical  
        care in the hospital under specified conditions.

        Existing Federal law:

        1) States that a person under the jurisdiction of the Secretary of a  
           military department may not provide health care independently as a  
           health-care professional unless the person has a current license to  
           provide such care.  Provides that in the case of a physician, the  
           physician may not provide health care as a physician unless the  
           current license is an unrestricted license that is not subject to  
           limitation on the scope of practice, as specified.  Allows the  
           Secretary of Defense to waive these provisions in unusual  
           circumstances, as specified.

        2) Allows a health care professional who has a current license to  
           practice medicine, osteopathic medicine, dentistry, or another  
           health profession, and who is performing authorized duties of the  
           Department of Defense, to practice the health profession or  
           professions of the healthcare professional in any State, the  
           District of Columbia, or a Commonwealth, territory, or possession  
           of the United States, regardless of whether the practice occurs in  
           a health care facility of the Department of Defense, a civilian  
           facility affiliated with the Department of Defense, or any other  
           location authorized by the Secretary of Defense. 

        3) Defines a health care professional for purposes of item #1) above  





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           as a physician, dentist, clinical psychologist, marriage and family  
           therapist certified as such by a certification recognized by the  
           Secretary of Defense, or nurse and any other person providing  
           direct patient care as may be designated by the Secretary of  
           Defense in regulations.

        Existing State law:
        
        1)Establishes the Department of Consumer Affairs (DCA), comprised of  
          more than 40 boards, bureaus, committees, commissions, and other  
          programs that set minimum standards of competence, education, and  
          skills for various professions and vocations.

        2)Establishes the Medical Board of California (MBC) to license and  
          regulate physicians and surgeons.

        3)Establishes the Physician Assistant Committee within the MBC to  
          license and regulate physician assistants.

        4)Establishes the Board of Registered Nursing to license and regulate  
          nurses.

        5)States that it is the policy of the state that, consistent with high  
          quality health care services, persons with skills, knowledge and  
          experience obtained in the armed services of the United States  
          should be permitted to apply such learning and contribute to the  
          health manpower needs of the state at the maximum level of  
          responsibility and skill for which they are qualified.

        6)States that the rules and regulations of boards within DCA shall  
          provide for methods of evaluating education, training, and  
          experience obtained in military service if such training is  
          applicable to the requirements of that profession.

        7)Prohibits, unless otherwise required by federal law or regulations,  
          a board within the DCA which licenses dentists, physicians and  
          surgeons, podiatrists, or nurses, from requiring a person to obtain  
          or maintain any license to practice a profession or render services  
          in California if one of the following applies:

           a)   The person practicing a profession or rendering services does  
             so exclusively as an employee of a department, bureau, office,  
             division, or similarly constituted agency of the federal  
             government, and provides medical services exclusively on a  
             federal reservation or at any facility wholly supported by and  
             maintained by the United States government.





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           b)   The person practicing a profession or rendering services does  
             so solely pursuant to a contract with the federal government on a  
             federal reservation or at any facility wholly supported and  
             maintained by the United States government.

           c)   The person practicing a profession or rendering services does  
             so pursuant to, or as a part of a program or project conducted or  
             administered by a department, bureau, office, division, or  
             similarly constituted agency of the federal government which by  
             federal statute expressly exempts persons practicing a profession  
             or rendering services as part of the program or project from  
             state laws requiring licensure.

        8)Allows a board to deny issuance of a license to an applicant or take  
          disciplinary action against the holder of a California license for  
          acts or omissions committed by the applicant or licensee in the  
          course of professional practice or rendering services described in  
          item #7) above if both of the following apply:

           a)   The acts or omissions committed by the applicant or licensee  
             constituted grounds for denial or discipline pursuant to the laws  
             of this state governing licensees or applicants for licensure for  
             the profession or vocation in question.

           b)   The acts or omissions constituting the basis for denial or  
             discipline by the agency were not authorized, exempted or  
             rendered inconsistent by federal statute.

        9)States that a physician and surgeon who is not licensed in this  
          state but who is a commissioned officer on active duty in the  
          medical corps of any branch of the armed forces of the United States  
          may engage in the practice of medicine as part of a residency,  
          fellowship, or clinical training program if all the following  
          conditions are met:

           a)   The residency, fellowship, or clinical training program is  
             conducted by a branch of the armed forces of the United States at  
             a health facility on a federal reservation and limited in  
             enrollment to military physicians on active duty in the medical  
             corps of a branch of the armed forces of the United States.

           b)   The residency, fellowship, or clinical training program, as  
             part of its program, contracts with or affiliates with a similar  
             program in or at a health facility not on a federal reservation  
             to offer specific courses or training not available at the  





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             facility located on the federal reservation.

           c)   The officers enrolled in the residency, fellowship, or  
             clinical training program restrict their practice only to  
             patients who are seen as part of their duties in the program.

           d)   The compensation received by the officers enrolled in the  
             residency, fellowship, or clinical training program is limited to  
             their regular pay and allowances as commissioned officers.

           e)   The officers enrolled in the training programs or portions of  
             training programs not conducted on a federal reservation shall  
             register with the Division of Licensing of the Medical Board of  
             California on a specified form.

        This bill:

        1)Authorizes a hospital to enter into an agreement with the Armed  
          Forces of the United States to authorize a physician and surgeon,  
          physician assistant, or registered nurse to provide medical care in  
          the hospital if all of the following apply:

           a)   The physician and surgeon, physician assistant, or registered  
             nurse holds a valid license in good standing to provide medical  
             care in the District of Columbia or any state or territory of the  
             United States. 

           b)   The medical care is provided as part of a training or  
             educational program designed to promote the combat readiness of  
             the physician and surgeon, physician assistant, or registered  
             nurse.

           c)   The agreement complies with federal law and any regulations or  
             guidelines adopted pursuant to this bill.

        2)Requires a physician and surgeon, physician assistant, or registered  
          nurse who is authorized to practice pursuant to item #1) above to  
          disclose, while working, on a name tag in at least 
        18-point type, his or her name and license status, his or her state of  
          licensure, and a statement that he or she is a member of the Armed  
          Forces of the United States.

        3)States that if an agreement is entered into pursuant to item #1)  
          above, no board under this division that licenses physicians and  
          surgeons, physician assistants, or registered nurses may require  
          such person to obtain or maintain any license to practice his or her  





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          profession or render services in the State of California.

        4)Requires a physician and surgeon, physician assistant, or registered  
          nurse who enters into an agreement with a hospital pursuant to item  
          #1) above, to register with the board that licenses his or her  
          respective health care profession in this state on a form provided  
          by that board.

        5)Sunsets the provisions of this bill on January 1, 2016.

        FISCAL EFFECT:  Unknown.  This bill has been keyed fiscal by  
        Legislative Counsel with the most recent amendments.  

        COMMENTS:
        
        1. Purpose.  According to the Author who is the sponsor of this  
           measure, this bill would provide the statutory framework to allow  
           military health care professionals to improve their skills prior to  
           being deployed to war.  The Author states that a similar successful  
           model was achieved in Nevada in 2009, in which a program was  
           created at the UMC Trauma Center near Nellis Air Force Base.  The  
           program was very popular and mutually beneficial to the hospital  
           because the Air Force was able to provide fully-trained and  
           certified physicians free of charge.  

        1) Background.  Current law allows physician and surgeons,  
           podiatrists, nurses, or dentists who are licensed in other states  
           to practice their professions in California without obtaining state  
           licensure as long as they are practicing or rendering services as  
           an employee of, or pursuant to a contract with the federal  
           government, and provides health care services at facilities  
           supported or maintained by the United States government.  However,  
           current law does not permit these health care practitioners, who  
           may also be military personnel, to be afforded an opportunity to  
           receive their training or education in California hospitals.  This  
           bill would allow, pursuant to an agreement between a hospital and  
           the Armed Forces of the United States, physicians and surgeons,  
           physician assistants, or nurses licensed in other states to provide  
           medical care at California hospitals as part of a training or  
           educational program designed to promote the combat readiness of  
           these heath care practitioners.    
            
        1. Other States.  According to the Author, in 2009, the Nevada State  
           Legislature passed Senate Bill 302, which is substantially similar  
           to the provisions of this bill.  Senate Bill 302 authorized a  
           hospital to enter into an agreement with the Armed Forces to allow  





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           a medical officer to provide medical care in the hospital under  
           specified conditions.  In testimony before the Nevada State  
           Assembly Committee on Health and Human Services, the sponsors of  
           the bill, the United States Air Force, stated that this bill would  
           greatly benefit the military by giving its physicians, many of whom  
           are new, the volume and diversity of medical calls and patient care  
           that just do not exist on the base and the opportunity to hone  
           their skills.  Additionally, the Air Force stated that the bill  
           would benefit the county hospitals by adding additional licensed  
           physicians in the emergency rooms.     

        2. Arguments in Support.  The  California Academy of Physician  
           Assistants  states that this bill would improve access to  
           appropriately trained health care providers.

        




        SUPPORT AND OPPOSITION:
        
         Support:  California Academy of Physician Assistants

         Opposition:  None on file as of June 8, 2010



        Consultant: Rosielyn Pulmano