BILL ANALYSIS
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|SENATE RULES COMMITTEE | SB 132|
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THIRD READING
Bill No: SB 132
Author: Denham (R)
Amended: 4/27/09
Vote: 27 - Urgency
SEN. BUS., PROF. & ECON. DEV. COMMITTEE : 10-0, 3/23/09
AYES: Negrete McLeod, Wyland, Aanestad, Corbett. Correa,
Florez, Oropeza, Romero, Walters, Yee
SENATE APPROPRIATIONS COMMITTEE : 10-0, 4/20/09
AYES: Kehoe, Cox, Corbett, Denham, DeSaulnier, Hancock,
Leno, Walters, Wolk, Yee
NO VOTE RECORDED: Oropeza, Runner, Wyland
SUBJECT : Polysomnographic technologists: sleep and wake
disorders
SOURCE : California Sleep Society
California Society for Respiratory Care
DIGEST : This bill (1) requires the Medical Board of
California to adopt regulations to establish qualifications
for certified polysomnographic technologists,
polysomnographic technicians, and polysomnographic
trainees, and (2) authorizes persons who meet specified
education, examination and certification requirements to
use the title "certified polysomnographic technologist" and
engage in the practice of polysomnography under the
supervision and direction of a licensed physician and
surgeon.
CONTINUED
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ANALYSIS :
Existing Law
1.Provides for the licensing and regulation of physician
assistants by the Physician Assistant Committee (PAC) of
the Medical Board of California (MBC), within the
Department of Consumer Affairs (DCA), and prescribes the
medical services set forth by the regulations of the MBC
that may be performed by a physician assistant under the
supervision of a licensed physician and surgeon.
2.Provides for the licensing and regulation of respiratory
care practitioners by the Respiratory Care Board of
California (RCB) within DCA.
3.Defines the practice of respiratory care, and prohibits
its practice without a license issued by the RCB, subject
to certain exceptions.
This bill:
1. Defines "polysomnography" to mean the treatment,
management, diagnostic testing, research, control,
education, and care of patients with sleep and wake
disorders. Includes within the definition:
A. The analysis, monitoring and recording of
physiologic data during sleep and wakefulness to
assist in the treatment of disorders, syndromes, and
dysfunctions that are sleep-related, manifest during
sleep, or disrupt normal sleep activities.
B. The therapeutic diagnostic use of oxygen, the use
of positive airway pressure including continuous
positive airway pressure (CPAP) and bi-level
modalities, adaptive servo-ventilation, and
maintenance of nasal and oral airways that do not
extend into the trachea.
2.Requires the MBC to adopt regulations within one year of
the effective date of the bill, to establish
qualifications for certified polysomnographic
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technologists. The qualifications shall require the
following:
A. Valid, current credentials from a national
accrediting agency approved by the MBC.
B. Graduation from an educational program approved by
the MBC.
C. Passage of a national certifying examination
approved by the MBC, or submission of proof to MBC of
at least five years of polysomnographic practice.
Three years after the bill becomes effective, all
individuals seeking certification shall have passed
the national certifying examination.
3.Requires applicants for registration to submit
fingerprint images in order to conduct a criminal record
information search (CORI) through the Department of
Justice to determine whether the applicant has a state
or federal criminal record.
4.Authorizes an individual to use the title "certified
polysomnographic technologist" and to engage in the
practice of polysomnography only under the following
circumstances:
A. The individual is registered with MBC.
B. The individual works under the supervision and
direction of a licensed physician and surgeon.
C. The individual meets the certification
requirements.
5.Requires the MBC to adopt regulations related to the
employment of polysomnographic technicians and trainees.
Requires the MBC to adopt regulations within one year
that establishes the means and circumstances in which a
licensed physician and surgeon may employ
polysomnographic technicians and polysomnographic
trainees.
6.Authorizes the MBC to adopt regulations specifying the
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scope of services that may be provided by a
polysomnographic technician or trainee, and to specify
the level of supervision required when working under the
supervision of a certified polysomnographic technologist
or licensed health care professional.
7.Exempts from the requirements, allied health
professionals, including respiratory care practitioners
working within the scope of practice of their license.
8.Authorizers the MBC to deny, suspend, revoke, or
otherwise subject to discipline a registration for any
of the following:
A. Incompetence, gross negligence, or repeated
similar negligent acts performed by the registrant.
B. An act of dishonesty or fraud.
C. Committing any act or being convicted of a crime
constituting grounds for denial of licensure or
registration, as specified.
9.Requires each applicant for registration to pay a fee to
be specified by MBC, not to exceed $50, and requires
each person granted registration to pay a fee specified
by the MBC, not to exceed $50. Specifies that:
A. The registration shall expire after two years, and
may be renewed biennially for a fee not to exceed
$50.
B. The MBC's Contingent Fund shall receive the
registration and renewal fees and shall be used for
the administration of the registration program.
10.States that nothing in this bill shall prohibit a clinic
or health facility from employing a polysomnographic
technologist, as specified.
Background . Sleep medicine has been practiced by licensed
physicians for some time and was recognized by the American
Medical Association as a specialty in 1995. Physician
sleep specialists are board certified, and the American
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Board of Sleep Medicine is one of the specialty boards
officially recognized by the MBC.
The author's office states, "Recently the California
Respiratory Care board has threatened to issue significant
fines against those involved in the practice of sleep
medicine. Because of this, uncertainty and concern among
trained medical professionals practicing sleep medicine has
developed, and the availability of these important medical
services has been threatened."
Recent Actions by the Respiratory Care Board . On August
24, 2007, the RCB passed a motion to move forward with
issuing citations against entities engaged in the practice
of sleep medicine. According to both the sponsor and the
RCB, this has caused a great deal of concern and
uncertainty among those who treat sleep disorders and their
patients. Furthermore, the RCB has already initiated
investigations into sleep care physicians for employment of
technicians who are not licensed respiratory therapists,
but the RCB has indicated to the Senate Business,
Professions and Economic Development Committee that any
actions have been put on hold pending the outcome of this
legislation.
According to RCB estimates, there are over 175 sleep
laboratories in California and that 65% of the personnel
are not licensed. The RCB believes these figures will
continue to rise exponentially, because there is a growing
demand for sleep testing, and it is a lucrative field
lacking regulation. Sleep testing is being performed in
homes, hotel rooms, independent and unregulated facilities,
as well as in hospitals according to RCB.
RCB states that hundreds and possibly thousands of
unlicensed technicians are working with patients in
vulnerable circumstances where most have not had a criminal
background check and competency testing is optional. While
the RCB is aware of two specific incidents involving
unlicensed sleep technicians and criminal activity, the RBC
surmises that there are many more similar cases.
RCB states that there have been numerous reports of
incompetence in this field. Inaccurate testing and
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misdiagnoses can result in serious harm to patients and
unnecessary health care costs contributed to retesting.
Statistics and Facts Relating to Sleep Disorders . To
indicate the scope and breadth of the issues related to
sleep disorders, the sponsors have stated the following:
1.It is estimates that 50 million to 70 million Americans
suffer from a chronic sleep disorder.
2.Almost 20 percent of all serious car-crash injuries are
associated with driver sleepiness.
3.It is estimated that there are 100,000 sleep-related
injuries and 5,000 fatalities each year in motor vehicle
crashes involving commercial trucks.
4.About six million people suffer from moderate to severe
obstructive sleep apnea (OSA).
5.OSA is found in at least four percent of men and two
percent of women in them middle-aged workforce; older
adults (65 to 90 years) are three times more likely to
have OSA than middle-aged adults.
6.About 80 to 90 percent of adults with OSA remain
undiagnosed.
7.Insomnia is the most commonly reported sleep problem,
affecting at least 10 percent of adults in the U.S.;
chronic insomnia affects about 30 million Americans.
8.Restless leg syndrome and periodic limb movement
disorder affect about six million people.
9.Over the past century the average amount of time that
Americans sleep has decreased about around 20 percent.
10.About one in five adults report that they get an
insufficient amount of sleep (most adults need about
seven to eight hours of nightly sleep to feel alert and
well rested).
11.Sleep loss and sleep disorders have been associated with
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an increased risk for other health problems such as high
blood pressure, diabetes, obesity, depression, heart
attack and stroke.
12.The majority of people with sleep disorders have not yet
been diagnosed.
13.Billions of dollars are spent each year in the U.S. on
the direct costs of sleep loss and sleep disorders
(doctor visits, hospital services, medications, etc.).
FISCAL EFFECT : Appropriation: Yes Fiscal Com.: Yes
Local: No
According to the Senate Appropriations Committee:
Fiscal Impact (in thousands)
Major Provisions 2009-10 2010-11
2011-12 Fund
Registration program $67 $133
$60 ongoing Special*
*Contingent Fund of the Medical Board of California
SUPPORT : (Verified 4/28/09)
California Sleep Society (co-source)
California Society for Respiratory Care (co-source)
Alto Sleep, Mountain View, CA
California Hospital Association
California Medical Association
Dr. Chandrashekhar, MD, MSEE, Victorville, CA
Dr. Liebman, MD, Long Beach, CA
Eisenhower Medical Center, Rancho Mirage, CA
Executive Committee of the Medical Board
Fremont Rideout Health Group, Sleep Disorder Lab
Ken Cooper, RPSGT, Calif. Sleep Solutions, Roseville, CA
Pacific Sleep Medicine Services, San Diego, CA
Peninsula Sleep Center, Burlingame, CA
Pomona Valley Hospital Medical Center
Respiratory Care Board of California
Stanford School of Medicine
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Santa Rose Sleep Center
USCF Fresno facility
USCF Medical Center Sleep Disorders Center
ARGUMENTS IN SUPPORT : According to the author's office,
polysomnography involves monitoring and recording
physiological data, generally while an individual is
asleep, to assess and help treat sleep disorders. The
author's office indicates that the practice of
polysomnography is a well-established medical discipline
that has been growing in popularity, and is practiced by
licensed physicians who specialize in sleep medicine, with
the aid of trained technicians. The bill establishes
educational requirements, background checks, and other
consumer protections, for those technicians that aid
licensed physicians in the practice of polysomnography.
The bill will also help ensure that patients are able to
continue to seek and receive valuable and needed medical
services in the area of sleep medicine, according to the
author's office.
JJA:cm 4/28/09 Senate Floor Analyses
SUPPORT/OPPOSITION: SEE ABOVE
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