BILL ANALYSIS                                                                                                                                                                                                    



                                                                       



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          |SENATE RULES COMMITTEE            |                  AB 2600|
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                                 THIRD READING


          Bill No:  AB 2600
          Author:   Ma (D)
          Amended:  3/25/10 in Assembly
          Vote:     21

           
           SENATE BUSINESS, PROF. & ECON. DEV. COMMITTEE  :  5-0,  
            6/21/10
          AYES:  Negrete McLeod, Aanestad, Calderon, Florez, Yee
          NO VOTE RECORDED:  Wyland, Correa, Oropeza, Walters
           
          SENATE APPROPRIATIONS COMMITTEE  :  Senate Rule 28.8

           ASSEMBLY FLOOR  :  56-17, 5/6/10 - See last page for vote


           SUBJECT  :    Medicine:  licensing:  continuing education  
          requirements

           SOURCE  :     California Hepatitis Alliance


           DIGEST  :    This bill requires the Medical Board of  
          California to consider including a continuing medical  
          education course in the diagnosis and treatment of  
          hepatitis to be taken by those whose practices may require  
          such knowledge.

           ANALYSIS  :    

          Existing law:

          1. Establishes the Medical Board of California (MBC) to  
                                                           CONTINUED





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             license and regulate physicians and surgeons.

          2. Requires the MBC to adopt and administer standards for  
             the continuing medical education (CE) requirements for  
             licensed physicians and surgeons.  Requires each  
             licensed physician and surgeon to demonstrate  
             satisfaction of CE requirements at intervals of not less  
             than four nor more than six years.  Further requires  
             that on and after July 1, 2006, all CE courses to  
             contain curriculum that includes cultural and linguistic  
             competency in the practice of medicine, as specified.

          3. Provides that CE standards must meet any of the  
             following criteria:

             A.    Have a scientific or clinical content with a  
                direct bearing on the quality or cost-effective  
                provision of patient care, community or public  
                health, or preventive medicine.

             B.    Concern quality assurance or improvement, risk  
                management, health facility standards, or the legal  
                aspects of clinical medicine.

             C.    Concern bioethics or professional ethics.

             D.    Are designed to improve the physician-patient  
                relationship.

          4. Requires all physicians and surgeons to complete  
             mandatory CE courses in the subject of pain management  
             and the treatment of terminally ill and dying patients,  
             except for physicians and surgeons practicing in  
             pathology or radiology specialty areas.

          5. Allows the MBC to consider several courses in  
             determining CE requirements, including courses in human  
             sexuality, nutrition, child and elder abuse detection  
             and treatment, acupuncture, and early detection and  
             treatment of substance abusing pregnant women to be  
             taken by physicians whose practices may require  
             knowledge in those areas.

          6. Requires students in grades K-12 to obtain specified  







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             immunizations prior to their first admission into an  
             educational institution, including immunization for  
             hepatitis.

          This bill requires MBC to consider including a continuing  
          medical education course in the diagnosis and treatment of  
          hepatitis to be taken by those whose practices may require  
          such knowledge.

           Background  

           CE requirements for physicians  .  California law requires  
          all licensed physicians to complete no less than 50 hours  
          of approved CE during each two-year period immediately  
          preceding the expiration date of the license as a condition  
          of license renewal.  According to MBC, certain educational  
          activities that meet the content standards for CE credit  
          include programs accredited by the California Medical  
          Association, the American Medical Association, the  
          Accreditation Council for Continuing Medical Education,  
          programs which qualify for prescribed credit from the  
          American Academy of Family Physicians, and other programs  
          offered by other organizations and institutions acceptable  
          to the MBC.  Additionally, the MBC is authorized to  
          consider several courses for CE, including courses in  
          nutrition, human sexuality, detection of elder child abuse,  
          and acupuncture.  This bill includes in this list a course  
          in the diagnosis and treatment of hepatitis for physicians  
          whose practice may require such knowledge.

           Hepatitis  .  According to the Centers for Disease Control  
          and Prevention (CDC), hepatitis is an inflammation of the  
          liver and also refers to a group of viral infections that  
          affect the liver.  The most common types are Hepatitis A,  
          Hepatitis B, and Hepatitis C.  Viral hepatitis is the  
          leading cause of liver cancer and the most common reason  
          for liver transplantation.  In the United States, an  
          estimated 1.2 million Americans are living with chronic  
          Hepatitis B, and 3.2 are living with chronic Hepatitis C;  
          and each year an estimated 25,000 persons become infected  
          with Hepatitis A, 43,000 with Hepatitis B, and 17,000 with  
          Hepatitis C Many do not know they are infected.  According  
          to an estimate, from 2010 to 2030, the number of liver  
          cancer cases in the United States is expected to rise 59  







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          percent, with the highest increases expected among  
          Hispanics and Asian American and Pacific Islanders.

          The CDC points out that the different types of hepatitis  
          have different modes of transmission and can affect the  
          liver differently.  Hepatitis A is caused by the Hepatitis  
          A virus (HAV), and the HAV infection produces a  
          self-limited disease that does not result in chronic  
          infection or chronic liver disease.  HAV infection is  
          primarily transmitted by the fecal-oral route, by either  
          person-to-person contact or through consumption of  
          contaminated food or water.  Hepatitis A vaccination is the  
          most effective measure to prevent HAV infection and is  
          recommended for all children at age 1, certain  
          international travelers, and others at risk for HAV  
          infection.  Hepatitis B is caused by the HBV, and infection  
          can cause acute illness and lead to chronic or lifelong  
          infection, cirrhosis (scarring) of the liver, liver cancer,  
          liver failure, and death.  HBV is transmitted through  
          percutaneous (puncture through the skin) or mucosal contact  
          with infectious blood or body fluids.  Hepatitis B  
          vaccination is the most effective measure to prevent HBV  
          infection and its consequences and is recommended for all  
          infants and others at risk for HBV infection.  African  
          American adults have the highest rate of acute HBV  
          infection in the United States and the highest rates of  
          acute HBV infection occur in the southern region.  People  
          from Asia and the Pacific Islands comprise the largest  
          foreign-born population that is at risk for chronic HBV  
          infection.  Hepatitis C is caused by the HCV that sometimes  
          results in an acute illness, but most often becomes a  
          silent, chronic infection that can lead to cirrhosis  
          (scarring), liver failure, liver cancer, and death.   
          Chronic HCV infection develops in a majority of  
          HCV-infected persons, most of whom do not know they are  
          infected since they have no symptoms.  HCV is spread by  
          contact with the blood of an infected person. There is no  
          vaccine for Hepatitis C.

           Hepatitis in California  .  The Center for Infectious  
          Diseases at the Department of Public Health, among other  
          functions, identifies, prevents and interrupts the  
          transmission of vaccine-preventable diseases, HIV/AIDS,  
          viral hepatitis and other diseases.  Additionally, the  







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          Office of Adult Viral Hepatitis Prevention works in  
          partnership with local, state and national health  
          officials, community-based organizations, service  
          providers, and individuals to reduce the impact of viral  
          hepatitis among adults in California.  

          In 2008, the Office of Adult Viral Hepatitis Prevention  
          began working with various stakeholders to develop a viral  
          hepatitis strategic plan for adults in California, which  
          was released January 11, 2010.  According to the report  
          entitled "California Adult Viral Hepatitis Prevention  
          Strategic Plan, 2010-2014" (report), while it is unclear  
          exactly how many people are living with viral hepatitis, in  
          2007 alone, HBV- and HCV-related hospitalization costs in  
          the state totaled $2 billion.  The report outlined three  
          strategic visions: improving surveillance capacity and data  
          use; educating the public, providers, and policy makers,  
          and targeting and integrating services and building  
          infrastructure.  

           FISCAL EFFECT  :    Appropriation:  No   Fiscal Com.:  Yes    
          Local:  No

           SUPPORT  :   (Verified  8/4/10)

          California Hepatitis Alliance (source)

           OPPOSITION  :    (Verified  8/4/10)

          California Academy of Family Physicians
          Department of Consumer Affairs

           ARGUMENTS IN SUPPORT  :    According to the California  
          Hepatitis Alliance (Alliance), the bill's sponsor, this  
          bill will allow physicians to stay up-to-date on hepatitis  
          prevention and treatment, improve their ability to  
          vaccinate and counsel at-risk patients, and improve health  
          outcomes for chronically infected patients in order to  
          prevent liver cancer and liver disease.  The Alliance  
          states that liver cancer and liver diseases are leading  
          causes of death in California, with most of those cases  
          directly related to chronic infection with HBV and HCV.   
          The Alliance states that screening, detection and  
          treatments for hepatitis B and hepatitis C are  







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          cost-effective approaches to preventing liver cancer, liver  
          disease and costly organ transplants, but a critical first  
          step is education of physicians and other health and social  
          service providers.

           ARGUMENTS IN OPPOSITION  :    The California Academy of  
          Family Physicians states that it opposes any disease  
          specific mandates for continuing education.  It points out  
          that there are many diseases and conditions that warrant  
          attention and continuing education, and mandating one above  
          all others is too broad of an approach that has no  
          guarantee in improving the health of a physician's specific  
          patient population.  They also believe that this bill has  
          the potential to divert scarce time and resources from  
          other important training that may more be relevant to a  
          physician and their medical practice.  
           

           ASSEMBLY FLOOR  : 
          AYES:  Ammiano, Arambula, Beall, Blakeslee, Blumenfield,  
            Bradford, Brownley, Buchanan, Caballero, Charles  
            Calderon, Carter, Chesbro, Conway, Coto, Davis, De La  
            Torre, De Leon, Eng, Evans, Feuer, Fletcher, Fong,  
            Fuentes, Furutani, Galgiani, Garrick, Hall, Hayashi,  
            Hernandez, Hill, Huber, Huffman, Jones, Lieu, Bonnie  
            Lowenthal, Ma, Monning, Nava, Niello, Nielsen, V. Manuel  
            Perez, Portantino, Ruskin, Salas, Saldana, Skinner,  
            Solorio, Audra Strickland, Swanson, Torlakson, Torres,  
            Torrico, Tran, Villines, Yamada, John A. Perez
          NOES:  Adams, Anderson, Bill Berryhill, Tom Berryhill,  
            Cook, Emmerson, Fuller, Gaines, Harkey, Jeffries, Knight,  
            Logue, Miller, Nestande, Norby, Silva, Smyth
          NO VOTE RECORDED:  Bass, Block, DeVore, Gilmore, Hagman,  
            Mendoza, Vacancy


          JJA:mw  8/4/10   Senate Floor Analyses 

                         SUPPORT/OPPOSITION:  SEE ABOVE

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