BILL ANALYSIS                                                                                                                                                                                                    






                             SENATE JUDICIARY COMMITTEE
                           Senator Ellen M. Corbett, Chair
                              2009-2010 Regular Session


          SB 953 (Walters)
          As Amended March 16, 2010 
          Hearing Date: May 4, 2010
          Fiscal: No
          Urgency: No
          SK:jd
                    

                                        SUBJECT
                                           
                    Podiatrists: Liability for Emergency Services

                                      DESCRIPTION  

          This bill, sponsored by the California Board of Podiatric  
          Medicine, would delete a reference to an obsolete provision of  
          law and would state legislative intent that nothing in the bill  
          is intended to enlarge, reduce, or otherwise modify the scope of  
          practice of podiatrists.

                                      BACKGROUND  

          Podiatrists treat the human foot, including the ankle and  
          muscles and tendons of the leg governing the functions of the  
          foot.   In order to become certified to practice podiatric  
          medicine, candidates must complete four years of undergraduate  
          education, graduate from one of seven approved colleges of  
          podiatric medicine, and complete at least two years of  
          postgraduate podiatric medical and surgical training. 

          In addition to performing foot and ankle surgeries, podiatrists  
          are also licensed to perform surgical procedures, under the  
          direct supervision of a physician as an assistant at surgery,  
          that are otherwise beyond the scope of practice of a podiatrist.  
           A podiatrist may not, however, function as a primary surgeon  
          for any procedure beyond his or her scope of practice. 

          Existing law provides immunity from liability for a podiatrist  
          who, in good faith, renders emergency care at the scene of an  
          emergency, except for willful acts or omissions.  Existing law  
          also provides immunity for a podiatrist who fails to inform a  
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          patient of the possible consequences of a medical procedure, as  
          specified.  This bill would delete a reference to an obsolete  
          provision of law and would state legislative intent that nothing  
          in the bill is intended to enlarge, reduce, or otherwise modify  
          the scope of practice of podiatrists.









































                                                                      



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                                CHANGES TO EXISTING LAW
           
           Existing law  defines the scope of "podiatric medicine" as the  
          diagnosis, medical, surgical, mechanical, manipulative, and  
          electrical treatment of the human foot and the nonsurgical  
          treatment of the muscles and tendons of the leg governing the  
          functions of the foot.  (Bus. & Prof. Code Sec. 2472.)

           Existing law  provides that no podiatrist, who in good faith  
          renders emergency care at the scene of an emergency, shall be  
          liable for civil damages as a result of any acts or omissions by  
          the podiatrist in rendering the emergency care.  This immunity  
          does not apply in the event of a willful act or omission.  (Bus.  
          & Prof. Code Sec. 2395.)

           Existing law  provides that podiatrists are not liable for civil  
          damages for injury or death caused in an emergency situation  
          occurring in the podiatrist's office or in a hospital because of  
          a failure to inform a patient of the possible consequences of a  
          medical procedure when the failure was because: 

          (1) the patient was unconscious; 
          (2) the procedure was undertaken without the consent of the  
            patient because the podiatrist reasonably believed that it  
            should be done immediately and there was insufficient time to  
            inform the patient; or 
          (3) the procedure was performed on a patient legally incapable  
            of giving consent and the podiatrist reasonably believed that  
            the procedure should be done immediately and there was  
            insufficient time to obtain the consent of the person  
            authorized to provide that consent for the patient. This  
            immunity from liability applies only to actions for damages  
            for injuries or death arising out of the podiatrist's failure  
            to inform, and not to actions for damages arising out of the  
            podiatrist's negligence in rendering treatment.  
          (Bus. & Prof. Code Secs. 2397(a), (b).)

           Existing law  provides that nothing in the above-described  
          provisions shall be construed to authorize practice by a  
          podiatrist beyond that set forth in Business and Professions  
          Code Section 2473, which has been repealed. (Bus. & Prof. Code  
          Sec. 2397(d).)

           This bill  would delete Section 2397(d), thus deleting this  
          reference to an obsolete provision of law.

                                                                      



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           This bill  would state legislative intent that nothing in the  
          bill is intended to enlarge, reduce, or otherwise modify the  
          scope of practice of podiatrists.











































                                                                      



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                                        COMMENT
           
          1.  Stated need for the bill 
          
          The author writes, "[d]octors of podiatric medicine are  
          apparently the only licensed or unlicensed health practitioners  
          prohibited from assisting beyond their normal scope during a  
          medical emergency." 

          The sponsor of this bill, the California Board of Podiatric  
          Medicine (BPM), writes:

            In the event of a duly-proclaimed medical disaster, this bill  
            removes a barrier enacted 30-years ago to highly-trained  
            Doctors of Podiatric Medicine providing Good Samaritan  
            emergency care beyond their regular foot and ankle scope in  
            B&P Code Section 2472 (previously 2473).  Following Katrina,  
            the Governor's Office initiated the Healthcare Surge project  
            in 2007 to ensure California would be better prepared in the  
            event of a medical disaster.  The Departments of Public Health  
            and Consumer Affairs directed health licensing boards to alert  
            licensees to be ready.  They also asked that we remove  
            barriers now that could slow medical response when caseloads  
            are soaring, and provider ranks are thinned, immobilized and  
            overwhelmed. 

            BPM reviewed the Good Samaritan statutes  . . .  which  
            [provide] exemptions from liability during medical disasters.   
            We were surprised to find Section 2397(d), . . .  During 2007  
            interagency meetings, there was agreement that Section 2397(d)  
            is an unnecessary, imprudent anachronism that does not reflect  
            good public policy.

            SB 953 does not alter the Doctor of Podiatric Medicine's  
            normal scope of practice in Section 2472.  It does provide  
            DPMs can assist during an emergency as specified in Article 17  
            (Sections 2395-2398) without regard to Section 2472.
            
          2.  Deleting limitations on podiatrists' ability to provide care  
            in an emergency  

          This bill would delete a provision of law which provides that  
          specified sections providing for immunity from liability shall  
          not be construed to authorize practice by a podiatrist beyond  
          that set forth in Business and Professions Code Section 2473,  
          which has been repealed.  This change is intended to delete  
                                                                      



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          limitations on the ability of a podiatrist to provide care in an  
          emergency situation.

          Last year, AB 83 (Feuer, Ch. 77, Stats. 2009) revised existing  
          law to provide that medical, law enforcement, and emergency  
          personnel who, in good faith and not for compensation, render  
          emergency medical or non-medical care at the scene of an  
          emergency are not liable for any civil damages resulting from  
          any act or omission.  The scene of an emergency does not include  
          emergency departments and other places where medical care is  
          usually offered.

          Existing law further provides immunity from liability to  
          physicians and surgeons and podiatrists who, in good faith,  
          provide emergency care at the scene of an emergency.  That  
          immunity does not apply in the event of a willful act or  
          omission.  And, existing law provides that podiatrists are not  
          liable for civil damages for injury or death caused in an  
          emergency situation occurring in the podiatrist's office or in a  
          hospital because of a failure to inform a patient of the  
          possible consequences of a medical procedure when the failure  
          was because of specified circumstances.  Section 2397(d), which  
          this bill would repeal, provides that nothing in these two  
          provisions shall be construed to authorize practice by a  
          podiatrist beyond that set forth in Business and Professions  
          Code Section 2473, which has been repealed.

          The sponsor reads Section 2397(d) as limiting a podiatrist's  
          ability to act in an emergency.  As a result, this bill would  
          delete this sentence in order to clearly permit podiatrists to  
          provide care in an emergency situation that may go beyond their  
          defined scope of practice.  The intent is to provide podiatrists  
          with the same liability protection as doctors.   

          3.  Clarifying amendment needed  

          As noted above, the sponsor indicates that this bill is intended  
          to permit podiatrists to provide services beyond their normal  
          scope of practice in an emergency situation, consistent with  
          existing immunity provisions applicable to other licensees  
          subject to this area of law (i.e., physicians and surgeons).   
          This bill, however, contains legislative intent language  
          providing that nothing in the bill is intended to enlarge,  
          reduce, or otherwise modify the scope of practice of  
          podiatrists.  Because this language is confusing given the  
          sponsor's stated intent, the author has agreed to amend the bill  
                                                                      



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          to clarify that the bill is not intended to enlarge, reduce, or  
          otherwise modify the scope of practice except in situations  
          covered by Article 13, which provides for exemptions from  
          liability.  The following amendment would achieve this:

             Suggested amendment  : 

          1.On page 2, delete lines 1-5

          2.On page 3, after line 6, insert "The amendments made to this  
            section at the 2009-10 Regular Session of the Legislature by  
            the act deleting subdivision (d) are not intended, nor shall  
            they be interpreted, to enlarge, reduce, or otherwise modify  
            the scope of practice of doctors of podiatric medicine as set  
            forth in Section 2472 of the Business and Professions Code,  
            except in situations covered by this article.  This act is  
            intended to delete a reference to an obsolete provision of  
            law." 

           Support  :  None Known

           Opposition  :  None Known

                                        HISTORY
           
           Source  :  California Board of Podiatric Medicine

           Related Pending Legislation  :  None Known
           
          Prior Legislation  :  None Known

           Prior Vote  :  Senate Business, Professions, and Economic  
          Development Committee (Ayes 7, Noes 0)

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