BILL ANALYSIS                                                                                                                                                                                                    



                                                                       



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                                 THIRD READING


          Bill No:  SB 1069
          Author:   Pavley (D), et al
          Amended:  5/5/10
          Vote:     21

           
           SENATE BUSINESS, PROF. & ECON. DEV. COMMITTEE  :  8-0,  
            4/12/10
          AYES:  Negrete McLeod, Wyland, Aanestad, Calderon, Correa,  
            Oropeza, Walters, Yee
          NO VOTE RECORDED:  Florez

           SENATE JUDICIARY COMMITTEE  :  4-0, 4/20/10
          AYES:  Corbett, Harman, Hancock, Leno
          NO VOTE RECORDED:  Walters

           SENATE APPROPRIATIONS COMMITTEE  :  Senate Rule 28.8


           SUBJECT  :    Physician assistants

           SOURCE  :     California Academy of Physician Assistants


           DIGEST  :    This bill 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  
                                                           CONTINUED





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          for various individuals, and 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.  

           Senate Floor Amendments  of 5/5/10 correct a grammatical  
          error an add co-authors.

           ANALYSIS  :    

          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. 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.

          4. Exempts an accusation alleging the procurement of a  
             license by fraud or misrepresentation from the statute  
             of limitations specified in #3 above.

          5. States that an accusation alleging sexual misconduct  







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             shall be filed within three years after the boards  
             discover the act or omission or within 10 years after  
             the act or omission.

          6. States that if an alleged act or omission involves a  
             minor, the seven-year limitations specified in #3 above  
             and the 10-year limitations specified in #5 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.

          7. States that the limitations specified in #3 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.

          8. States that an accusation is a written statement of  
             charges against a healing arts licensee which shall set  
             forth in ordinary and concise language the acts or  
             omissions with which a licensee is charged.  

          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  







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                medical equipment.

             B.    Certify unemployment insurance disability, as  
                specified, after performance of a physical  
                examination by 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 #3 above 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 #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 #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  
             #5 above and the 10-year limitations provided in #8  
             below shall be tolled until the minor reaches the age of  
             majority.  However, if the Committee discovers an  
             alleged act of sexual contact with a minor under  
             specified sections of the Penal Code after the  
             limitations periods have otherwise expired, and there is  
             independent evidence that corroborates the allegation,  







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             an accusation shall be filed within three years from the  
             date the Committee discovers that alleged act.

          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 10 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  
             #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 an ongoing criminal  
             investigation.

          10.Defines "discovers" as the latest of the occurrence of  
             any of the following with respect to each act or  
             omission alleged as the basis for disciplinary action:

             A.    The date the committee receives a complaint or  
                report describing the act or omission.

             B.    The date, subsequent to the original complaint or  
                report, on which the committee becomes aware of any  
                additional acts or omissions alleged as the basis for  
                disciplinary action against the same individual.

             C.    The date the committee receives from the  
                complainant a written release of information  
                pertaining to the complainant's diagnosis and  
                treatment.

          11.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  







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                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 by the 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.








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          12.Includes PAs in the definition of practitioner who could  
             certify medical eligibility for unemployment disability  
             benefits.

          13.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  :    Appropriation:  No   Fiscal Com.:  Yes    
          Local:  No

           SUPPORT  :   (Verified  5/5/10)

          California Academy of Physician Assistants (source)
          American Congress of Obstetricians and Gynecologists
          American Federation of State, County and Municipal  
          Employees
          California Assisted Living Association
          California Medical Association
          California Radiological Society
          United Nurses Association of California/Union of Health  
          Care Professionals

           ARGUMENTS IN SUPPORT  :    The California Academy of  
          Physician Assistants (CAPA) is the sponsor of this bill.   
          CAPA states that this bill clarifies 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  







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          the prosecuting agencies can devote their resources to more  
          recent misdeeds. 


          JJA:mw  5/5/10   Senate Floor Analyses 

                         SUPPORT/OPPOSITION:  SEE ABOVE

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