BILL ANALYSIS ----------------------------------------------------------------------- |Hearing Date:June 14, 2010 |Bill No:AB | | |2386 | ----------------------------------------------------------------------- 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 AB 2386 Page 2 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. AB 2386 Page 3 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 AB 2386 Page 4 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 AB 2386 Page 5 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 AB 2386 Page 6 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