BILL ANALYSIS                                                                                                                                                                                                    



                                                                       



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                              UNFINISHED BUSINESS


          Bill No:  SB 1069
          Author:   Pavley (D), et al
          Amended:  8/16/10
          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

           SENATE FLOOR  :  30-0, 5/10/10
          AYES:  Aanestad, Alquist, Ashburn, Calderon, Cedillo,  
            Cogdill, Correa, Cox, DeSaulnier, Ducheny, Florez,  
            Hancock, Hollingsworth, Huff, Kehoe, Leno, Lowenthal,  
            Negrete McLeod, Padilla, Pavley, Price, Romero, Runner,  
            Simitian, Steinberg, Walters, Wolk, Wright, Wyland, Yee
          NO VOTE RECORDED:  Corbett, Denham, Dutton, Harman, Liu,  
            Oropeza, Strickland, Wiggins, Vacancy, Vacancy

           ASSEMBLY FLOOR  :  75-0, 8/18/10 - See last page for vote


           SUBJECT  :    Physician assistants

           SOURCE  :     California Academy of Physician Assistants
                                                           CONTINUED





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           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  
          for various individuals.  

           Assembly Amendments  prohibit a physician assistant from  
          certifying disability after performing a physical  
          examination under the supervision of a physician and  
          surgeon, as specified, delete provisions relating to the  
          timing of accusation filings, and delete "physician  
          assistant" from the definition of "practitioner" in the  
          Unemployment Insurance Code.

           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 (PAs).

          2. Provides that a 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  







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             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 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.

          6. 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 either 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.    For individuals receiving home health services or  
                personal care services, after consultation with the  







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                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. 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  







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                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.

          6. 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  8/18/10)

          California Academy of Physician Assistants (source)
          American Congress of Obstetricians and Gynecologists
          American Federation of State, County and Municipal  
          Employees  
          California Academy of Family Physicians
          California Assisted Living Association
          California Chapter of the American College of Emergency  
          Physicians
          California Medical Association
          California Psychiatric Association
          California Radiological Society
          Medical Board of California
          Osteopathic Physicians and Surgeons of California
          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  







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          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. 


           ASSEMBLY FLOOR  : 
          AYES:  Adams, Ammiano, Anderson, Arambula, Bass, Beall,  
            Bill Berryhill, Tom Berryhill, Block, Blumenfield,  
            Bradford, Brownley, Buchanan, Caballero, Carter, Chesbro,  
            Conway, Cook, Coto, Davis, De La Torre, De Leon, DeVore,  
            Eng, Feuer, Fletcher, Fong, Fuentes, Fuller, Furutani,  
            Gaines, Galgiani, Garrick, Gatto, Gilmore, Hagman, Hall,  
            Harkey, Hayashi, Hernandez, Hill, Huber, Huffman,  
            Jeffries, Jones, Knight, Lieu, Bonnie Lowenthal, Ma,  
            Mendoza, Miller, Monning, Nava, Nestande, Niello,  
            Nielsen, Norby, V. Manuel Perez, Portantino, Ruskin,  
            Salas, Saldana, Silva, Skinner, Smyth, Solorio, Audra  
            Strickland, Swanson, Torlakson, Torres, Torrico, Tran,  
            Villines, Yamada, John A. Perez
          NO VOTE RECORDED:  Blakeslee, Charles Calderon, Evans,  
            Logue, Vacancy


          JJA:mw  8/18/10   Senate Floor Analyses 

                         SUPPORT/OPPOSITION:  SEE ABOVE








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