BILL ANALYSIS SB 1069 Page 1 Date of Hearing: June 15, 2010 ASSEMBLY COMMITTEE ON BUSINESS, PROFESSIONS AND CONSUMER PROTECTION Mary Hayashi, Chair SB 1069 (Pavley) - As Amended: May 5, 2010 SENATE VOTE : 30-0 SUBJECT : Physician assistants. SUMMARY : Authorizes physician assistants (PAs) to perform and certify physical examinations and other specified medical services, as specified, authorizes state and local government agencies to rely on certificates executed by PAs, as specified, and establishes statute of limitations regulations for claims brought against PAs. Specifically, this bill : 1)States that a PA acts as an agent of his or her supervising physician when performing any authorized activity, as specified. 2)Permits a PA to perform certain physical examinations and other medical services, as specified, and sign and attest to any certificate, card, form, or other documentation evidencing the examination or other specified medical services. 3)Authorizes state and local government agencies to rely on certificates executed by PAs. 4)Permits a delegation of services agreement to authorize a PA to do the following: a) Order durable medical equipment, subject to any limitations in current law, the delegation of services agreement, or third-party payer requirements; b) Certify disability pursuant to the Unemployment Insurance Code after performance of a physical examination by the PA under the supervision of a physician and surgeon; and, c) Approve, sign, modify, or add to a plan of treatment or plan of care for individuals receiving home health services or personal care services after consultation with the SB 1069 Page 2 supervising physician. 5)States that this bill shall not be construed to affect the validity of any delegation of services agreement in effect prior to the enactment of this bill or adopted subsequent to its enactment. 6)Requires any accusation filed against a licensee that would jeopardize his or her license to be filed within three years after the PA Committee (committee) discovers the act or omission alleged as the ground for disciplinary action, or within seven years after the act or omission alleged as the ground for disciplinary action occurs, whichever occurs first. However, the time limitations 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. The following situations are exceptions to the time limitations: 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 of the licensee upon proof that the licensee intentionally concealed from discovery his or her incompetence, gross negligence, or repeated negligent acts; c) If an alleged act or omission involves a minor, the time limitations period 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, as specified, after the limitations periods have otherwise expired, and there is independent evidence that corroborates the allegation, an accusation shall be filed within three years from the date the committee discovers that alleged act; and, d) An accusation alleging sexual misconduct shall be filed within three years after the committee discovers the act or omission alleged as the ground for disciplinary action, or within 10 years after the act or omission alleged as the ground for disciplinary action occurs, whichever occurs first. This shall apply to a complaint alleging sexual SB 1069 Page 3 misconduct received by the committee on and after January 1, 2011. 7)Permits PAs to authorize children to take prescribed medications, including auto-injectable epinephrine, during the school day. 8)Permits PAs to waive vision tests for schoolchildren. 9)Permits PAs to certify the needs of an individual who has been diagnosed by a physician and surgeon as being deaf or hearing impaired after reviewing the medical records or copies of the medical records containing that diagnosis. 10)Permits PAs to certify that an individual has a visual or medical need for specialized telecommunications equipment, as specified. 11)Defines the following terms: a) "Delegation of services agreement" means the writing from a supervising physician delegating to a PA the medical services a PA is authorized to perform, as specified; b) "Other specified medical services" means tests or examinations performed or ordered by a PA practicing in compliance with current law; c) "Discovers" means the latest of the occurrence of any of the following with respect to each act or omission alleged as the basis for disciplinary action: i) The date the committee receives a complaint or report describing the act or omission; ii) 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; or, iii) The date the committee receives from the complainant a written release of information pertaining to the complainant's diagnosis and treatment. d) "Practitioner" is expanded to include a PA. SB 1069 Page 4 EXISTING LAW : 1)Provides for the regulation and licensing of PAs by the committee of the Medical Board of California (MBC). 2)Provides that a PA may perform medical services, as specified, when the services are rendered under the supervision of a licensed physician and surgeon approved by the MBC, except as otherwise provided. 3)Authorizes PAs to administer medications, as specified. 4)Authorizes state and local government agencies to accept certification of medical examinations by PAs for certain agency safety requirements. 5)Provides for statutes of limitations on claims against health professionals, including physicians, psychologists, respiratory care practitioners, marriage and family therapists, social workers, and dentists. FISCAL EFFECT : Unknown COMMENTS : Purpose of this bill . According to the author's office, "California is in the midst of an access to care crisis and these inconsistencies and omissions in existing law overburden physicians with routine duties that should be performed by clinically competent PAs. Particularly in medically underserved areas, it is not always practical for a physician to be available at all times. "[This bill] simply builds upon existing law by permitting clinically competent PAs to perform necessary medical examinations and sign corresponding certificates or forms for their patients. This bill would also help to reduce the cost of an increased access to these examinations and services without negatively affecting patient care or safety." Background . PAs practice medicine under the supervision of physicians and surgeons. PAs are formally trained to provide diagnostic, therapeutic, and preventive healthcare services. Many PAs work in primary care specialties, such as general SB 1069 Page 5 internal medicine, pediatrics, and family medicine. Other specialty areas include general and thoracic surgery, emergency medicine, orthopedics, and geriatrics. PAs specializing in surgery provide preoperative and postoperative care and may work as first or second assistants during major surgery. The duties of PAs are determined by the supervising physician and by current law. The supervising physician has full legal responsibility for the services performed by the physician, including liability for any negligence on the part of the physician. This bill codifies this agency relationship. Current California law authorizes PAs to perform and certify medical examinations for purposes of obtaining disability placards, commercial vehicle licenses, and employment. This bill brings consistency across the codes by permitting PAs to perform other, similar examinations and certifications. Existing law does not provide for a statute of limitations on claims against PAs, although many other health professionals are protected by such statutes. This bill's language is modeled the statute of limitations for physicians and surgeons. Prior legislation . SB 171 (Pavley), Chapter 23, Statutes of 2009, allowed PAs and advanced practice registered nurses to perform a physical examination and submit directly to the governing board or county superintendent of schools the medical certificate of a person wishing to be employed in a position requiring certification qualifications, or in a retirant position, as a condition of initial employment. AB 3 (Bass), Chapter 376, Statutes of 2007, authorized PAs to administer and order medications. REGISTERED SUPPORT / OPPOSITION : Support California Academy of Physician Assistants (sponsor) California Academy of Family Physicians California Assisted Living Association California Chapter of the American College of Emergency Physicians California Medical Association California Psychiatric Association SB 1069 Page 6 California Radiological Society Medical Board of California Osteopathic Physicians and Surgeons of California The American Congress of Obstetricians and Gynecologists, District IX, California The American Federation of State, County and Municipal Employees, AFL-CIO United Nurses Associations of California/Union of Health Care Professionals Opposition None on file. Analysis Prepared by : Sarah Weaver / B.,P. & C.P. / (916) 319-3301