BILL ANALYSIS ------------------------------------------------------------ |SENATE RULES COMMITTEE | AB 2600| |Office of Senate Floor Analyses | | |1020 N Street, Suite 524 | | |(916) 651-1520 Fax: (916) | | |327-4478 | | ------------------------------------------------------------ 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 AB 2600 Page 2 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 AB 2600 Page 3 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 AB 2600 Page 4 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 AB 2600 Page 5 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 AB 2600 Page 6 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 **** END ****