BILL ANALYSIS
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|Hearing Date:April 12, 2010 |Bill No:SB |
| |1069 |
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SENATE COMMITTEE ON BUSINESS, PROFESSIONS
AND ECONOMIC DEVELOPMENT
Senator Gloria Negrete McLeod, Chair
Bill No: SB 1069 Author:Pavley
As Amended: April 5, 2010 Fiscal: Yes
SUBJECT: Physician assistants.
SUMMARY: Authorizes a physician assistant, pursuant to a delegation
of services agreement, to order durable medical equipment, certify
unemployment insurance disability, and for individuals receiving home
health services or personal care services, after consultation with the
supervising physician, approve, sign, modify, or add to a plan of
treatment or plan of care. Also, authorizes physician assistants to
conduct specified medical examinations and sign corresponding medical
certificates for various individuals. Specifies certain statutes of
limitations for the filing of an accusation against a licensee by the
Physician Assistant Committee similar to other health care licensing
acts.
Existing law:
1) Establishes the Physician Assistant Practice Act administered by
the Physician Assistant Committee (Committee) of the Medical Board
of California (MBC) to regulate physician assistants.
2) Provides that a physician assistant (PA) may perform those medical
services as set forth by the regulations of MBC when the services
are rendered under the supervision of a licensed physician and
surgeon approved by MBC, except as otherwise provided.
3) Requires a PA and his or her supervising physician and surgeon to
establish written guidelines for the adequate supervision of the
PA, which may be satisfied by the adoption of protocols for some or
all of the tasks performed by the PA. Requires the protocol to
meet specified requirements.
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4) Allows PAs to administer or provide medication to a patient, or
transmit orally, or in writing on a patient's record or in a drug
order, an order to a person who may lawfully furnish the medication
or medical device as specified.
5) States that an accusation filed against a licensee shall be filed
within three years from the date the board discovers the alleged
act or omission that is the basis for the disciplinary action or
within seven years from the date the alleged act or omission that
is the basis for the disciplinary action occurred, whichever occurs
first. This statute of limitations provision is included in the
practice act of the following health care practitioners: dentists ,
physicians and surgeons , psychologists , respiratory care
therapists , marriage and family therapists , social workers , and
educational psychologists . Defines discovers for purposes of this
provision, but only for the practice act that applies to marriage
and family therapists, social workers, and educational
psychologists.
6) Exempts an accusation alleging the procurement of a license by
fraud or misrepresentation from the statute of limitations
specified in item #5) above.
7) States that an accusation alleging sexual misconduct shall be filed
within three years after the boards discover the act or omission or
within 10 years after the act or omission.
8) States that If an alleged act or omission involves a minor , the
seven-year limitations specified in item #5) above and the 10-years
limitations specified in item #7) above shall be tolled until the
minor reaches the age of majority. Further states that for
marriage and family therapists, social workers, and educational
therapists, if specified acts are committed against a minor, the
Board of Behavioral Sciences (BBS), which regulates these health
care licensees, is authorized to take action regardless of whether
or not the act occurred prior to or after the time the license was
issued by BBS.
9) States that the limitations specified in item #5) above shall be
tolled during any period if material evidence necessary for
prosecuting or determining whether a disciplinary action would be
appropriate is unavailable to the boards due to an ongoing criminal
investigation.
10)States that an accusation is a written statement of charges against
a healing arts licensee which shall set forth in ordinary and
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concise language the acts or omissions with which a licensee is
charged.
11)Allows a PA to do the following:
a) Certify any person as disabled for purposes of the
issuance of disabled placards.
b) Perform medical examinations and provide necessary
medical certificates for applicants seeking a license to
drive standard commercial vehicles.
c) Perform medical examination and provide necessary
medical certificates for any person who operates a school
bus.
d) Perform medical examination and provide necessary
medical certificates for any applicant of a school district
or county superintendent of schools for certificated
positions.
12)Specifies under the certain individuals may be compensated in part
for the wage loss and who is unable to work due to the employee's
own sickness or injury, the sickness or injury of a family member,
or the birth, adoption, or foster care placement of a new child, as
specified.
This bill:
1) Defines delegation of services agreement as the writing that
delegates to a PA from a supervising physician the medical services
the PA is authorized to perform, as specified.
2) Defines other specified medical services as tests or exams
performed by or ordered by a PA practicing in compliance with the
Physician Assistant Practice Act.
3) Specifies that a delegation of services agreement may authorize a
PA to do any of the following:
a) Order durable medical equipment, as specified.
States that this does not limit the ability of a third-party
payer to require prior approval for the medical equipment.
b) Certify unemployment insurance disability, as
specified, after performance of a physical examination by
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the PA under the supervision of a physician and surgeon, as
specified.
c) For individuals receiving home health services or
personal care services, after consultation with the
supervising physician, approve, sign, modify, or add to a
plan of treatment or plan of care.
4) States that nothing in item #3) shall be construed to affect the
validity of any delegation of services agreement in effect prior to
the enactment of this bill, as specified.
5) Requires any accusation filed against a licensee, except as
provided in item #6) below, to be filed within three years after
the Committee discovers the act or omission alleged as the grounds
for disciplinary action or within seven years after the act or
omission alleged as the grounds for disciplinary action occurs,
whichever occurs first.
6) Exempts the following from the statutes of limitations specified in
item #5) above:
a) An accusation alleging the procurement of a license
by fraud or misrepresentation.
b) An accusation alleging unprofessional conduct based
on incompetence, gross negligence, or repeated negligent
acts, as specified.
7) States that if an alleged act or omission involves a minor , the
seven-year limitations period provided for in item #5) above and
the ten-year limitations provided in item #8) below shall be tolled
until the minor reaches the age of majority.
8) An accusation alleging sexual misconduct shall be filed within
three years after the Committee discovers the act or omission
alleged as the grounds for disciplinary action, or within ten years
after the act or omission alleged as the grounds for disciplinary
action occurs, whichever occurs first. Specifies that this
provision applies to complaints alleging sexual misconduct received
by the Committee on or after January 1, 2011.
9) States that the statute of limitations provided for in item #5)
above shall be tolled during any period if material evidence
necessary for prosecuting or determining whether a disciplinary
action would be appropriate is unavailable to the Committee due to
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an ongoing criminal investigation.
10)Authorizes a PA to do the following:
a) Certify that an applicant for a teacher
certification or renewal of certification is free from any
contagious or communicable disease or other disabling
disease or defect, as specified.
b) Conduct medical examinations and certify that an
individual that is initially employed by a school district
in a certificated or classified position, is free from
tuberculosis, as specified.
c) Order medications for any pupil to take during the
regular school day, as specified, and provide written
statements to the school district detailing information
about the medication.
d) Certify the results of a determination of a child's
vision to be presented by a parent to the school district
for waiving a required vision assessment of school-aged
children.
e) Perform a physical examination of a student
participating in an interscholastic athletic program, as
specified.
f) Conduct medical examination and certify that an
applicant for an academic position at a community college
district is free from any communicable disease, including
tuberculosis.
g) Conduct medical examination and certify that a
retirant applicant of a community college district is free
from any disabling disease.
h) Conduct medical examination and certify that anyone
who wishes to be employed in an academic or classified
position at a community college is free of active
tuberculosis, as specified.
i) Certify the need for an individual who has been
diagnosed by a licensed physician and surgeon as being deaf
or hearing impaired to participate in a program implemented
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by the California Public Utilities Commission (PUC) to
provide telecommunications devices for deaf or hearing
impaired, as specified.
j) Certify an individual's disability, thereby
qualifying an individual to participate in the state's
specialized or supplemental telephone communications
equipment program, as specified.
11)Includes PAs in the definition of practitioner who could certify
medical eligibility for unemployment disability benefits.
12)Authorizes a physician and surgeon to perform a required physical
examination of a student as a condition of participation in an
interscholastic athletic program.
FISCAL EFFECT: Unknown. This bill has been keyed "fiscal" by
Legislative Counsel.
COMMENTS:
1.Purpose. The California Academy of Physician Assistants (CAPA) is
the sponsor of this bill. CAPA states that this measure would
clarify various inconsistencies and omissions in existing law by
allowing PAs to order durable medical equipment, certify disability
for purposes of unemployment insurance eligibility, approve, sign,
modify or add to a treatment plan for home health or personal care
services, and conduct specified physical examinations and sign
corresponding certificates or forms. CAPA points out that all of
these functions would be performed under physician supervision and
consistent with existing PA scope of practice.
Additionally, CAPA points out that there is a need to establish
statute of limitations provisions for PAs. CAPA states that the
primary purpose for statute of limitation provisions is to assure
fairness to defendants. The ability to prepare a defense is clearly
undermined in cases where a claim is not pursued for a long period
of time because evidence is lost, memories fade and witnesses
disappear. Statute of limitation provisions also assures the
prosecuting agencies can devote their resources to more recent
misdeeds.
2.Background.
a) Scope of Practice of Physician Assistants. PAs are medical
practitioners who perform services under the supervision of
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physicians. The scope of practice of the PA is described in the
Physician Assistant Practice Act and in regulations promulgated
by MBC. Pursuant to these laws, each PA may perform only those
services he or she is authorized to perform pursuant to a written
delegation of authority by the supervising physician.
Supervising physicians are required to delineate the services
their PAs may render in a Delegation of Services Agreement (DSA).
The regulations provide that PAs may only provide those medical
services which he or she is competent to perform and which are
consistent with the PAs education, training, and experience, and
which are delegated in writing by a supervising physician who is
responsible for the patients cared for by that physician
assistant. This bill would define DSA consistent with current
regulations.
Current law also authorizes a PA to certify any person as disabled
for purposes of the issuance of disabled placards; perform
medical examination and provide necessary medical certificates
for applicants seeking a license to drive standard commercial
vehicles; perform medical examination and provide necessary
medical certificates for any person who operates a school bus;
and, perform medical examination and provide necessary medical
certificates for any applicant of a school district or county
superintendent of schools for certificated positions. This bill
expands these provisions and would authorize PAs to conduct
medical examinations and provide medical certification for other
purposes.
b) Statutes of Limitations for Filing an Accusation. This bill
would provide that any accusation filed against a PA, except
under specified exemptions, must be filed within three years
after the Committee discovers the act or omission alleged as the
grounds for disciplinary action or within seven years after the
act or omission alleged as the grounds for disciplinary action
occurs, whichever occurs first. The exemptions include
accusations alleging the procurement of a license by fraud or
misrepresentation or alleging unprofessional conduct based on
incompetence, gross negligence, or repeated negligent acts.
Moreover, a different time limitation applies to acts involving
minors or acts involving sexual misconduct and, provides that the
limitations is tolled or temporarily suspended if material
evidence is unavailable, as specified. Similar statute of
limitations is included in the practice acts of dentists,
physicians and surgeons, psychologists, respiratory care
therapists, marriage and family therapists, social workers, and
educational psychologists
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3.Related Legislation this Session. SB 1111 (Negrete McLeod), pending
in this Committee, among other provisions, would provide that any
proposed decision issued by an administrative law judge that
contains a finding that a healing arts licensee, including a PA,
engaged in any act of sexual exploitation, as defined, with a
patient, or has committed an act or has been convicted of a sex
offense, as defined, shall contain an order of revocation.
Additionally,
SB 1111 provides that a conviction of sexual misconduct or a felony
requiring registration as a registered sex offender shall be
considered a crime substantially related to the qualifications,
functions, or duties of a healing arts licensee, including a PA.
4.Suggested Author's Amendments to be taken in Senate Judiciary
Committee. The Author should amend this bill to include a
definition of "discovers," for purposes of the statute of
limitations for filing disciplinary actions against a PA, which is
similar to the definition which currently exists for licensees for
the Board of Behavioral Sciences (BBS). This definition was
recently required by the Senate Business, Professions and Economic
Development Committee to clarify the term "discovers" and will be
applied to other health care practice acts this year pursuant to
legislation in an omnibus bill of this Committee. Additionally,
conforming changes should be adopted by the Author to allow the
Physician Assistant Committee to take a disciplinary action against
a licensee beyond the statute of limitations if a licensee has
engaged in specific sexual acts against a minor. This is a recent
exemption to the statute of limitations requirement which will again
be applied to certain health care practice acts.
5.Arguments in Support. The California Assisted Living Association
states that for assisted living providers and their residents, this
bill would increase and speed access to necessary examinations and
corresponding paperwork required in order for a senior to move into
an assisted living community and begin receiving the 24 hour care
and supervision they need.
NOTE : Double-referral to Senate Judiciary Committee (second.)
SUPPORT AND OPPOSITION:
Support:
California Academy of Physician Assistants (Sponsor)
American Congress of Obstetricians and Gynecologists
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American Federation of State, County, and Municipal Employees
California Assisted Living Association
California Radiological Society
United Nurses Association of California/Union of Health Care
Professionals
Opposition: None on file as of April 6, 2010
Consultant: Rosielyn Pulmano