BILL ANALYSIS Ó
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|Hearing Date:June 11, 2012 |Bill No:AB |
| |1621 |
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SENATE COMMITTEE ON BUSINESS, PROFESSIONS
AND ECONOMIC DEVELOPMENT
Senator Curren D. Price, Jr., Chair
Bill No: AB 1621Author:Halderman
As Introduced: February 8, 2012Fiscal: No
SUBJECT: Physicians and surgeons: prostate cancer.
SUMMARY: Exempts physicians and surgeons working on a trauma case
from having to provide patients with specified information regarding
examination of a patient's prostate gland when treating a patient who
needs trauma care.
Existing law:
1) The Medical Practice Act provides for the licensure and regulation
of physicians and surgeons by the Medical Board of California.
2) Requires, under the Grant H. Kenyon Prostate Cancer Detection Act,
that when a physician and surgeon is examining a patient's prostate
gland during a physical examination to provide the patient with a
written summary of the availability of appropriate diagnostic
procedures, including, but not limited to, the prostate antigen
(PSA) test if any of the following conditions are present: (BPC §
2248 (a); Health and Safety Code (HSC) § 109280)
a) The patient is over 50 years of age.
b) The patient manifests clinical symptomatology.
c) The patient is at an increased risk of prostate cancer.
d) The provision of the information to the patient is medically
necessary in the opinion of the physician and surgeon.
3) Provides that violation of the requirements regarding the
examination of a patient's prostate gland constitute unprofessional
conduct and is subject to a misdemeanor penalty.
(BPC § 2248 (b))
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4) Authorizes the Department of Health Services to approve the use of
a publication from a recognized cancer authority as the written
summary and to review the publications every three years in order
to ensure that the summary comprises timely, new and revised
information regarding prostate cancer treatment options. (BPC §
2248.5)
5) Authorizes the Medical Board of California to disseminate the
written summary to physicians and surgeons and post it on its Web
site for public use. (BPC § 2248.5)
6) Defines trauma case as any injured person who has been evaluated by
pre-hospital personnel according to policies and procedures
established by the Emergency Medical Services (EMS) agency and who
has been found to require transportation to a trauma facility.
(HSC § 1798.160)
This bill: Exempts a physician or surgeon working on a trauma case
from providing a written summary about the risk and treatment options
for prostate cancer to a trauma patient.
FISCAL EFFECT: This bill has been keyed "non-fiscal" by Legislative
Counsel.
COMMENTS:
1.Purpose. The bill is sponsored by the Northern California Chapter
of the American College of Surgeons . This bill exempts surgeons and
other physicians working on a trauma case from providing patients
with a written summary about the risk and treatment options for
prostate cancer before conducting a prostate exam.
According to the Sponsor, current law does not provide exemptions
for situations where providing written information is impossible or
impractical and this bill provides a "common-sense emergency
exemption."
The Sponsor cites the example of an unconscious patient who may be
transported to an emergency room with severe injuries requiring the
placement of a urinary catheter. The Sponsor indicates that, in
this situation, the physician would need to conduct an examination
to determine the extent of the injuries including a rectal
examination to determine the status of the prostate gland. The
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physician may also conduct an examination, similar to a prostate
examination, in order to check for pelvic fracture or internal
bleeding. However, by the time the patient is stabilized or regains
consciousness, he may have been transported to a different unit or
facility making it difficult for the physician to locate the patient
to provide him with the written summary.
2.Background.
a) Prostate Examination Procedures. According to the American
Cancer Society, prostate cancer is the second deadliest cancer
among men, and occurs most often in African American men.
However, survival rates are quite high. In fact, 91% of all men
with prostate cancer will live for 15 years beyond their
diagnosis. According to the U.S. Preventative Services Task
Force, 95% of men with cancer who are followed for 12 years do
not die from prostate cancer including those who do not receive
treatment. Additionally, the National Cancer Institute found
that 70% of prostate cancer deaths occur after age 75.
The examination of a patient's prostate is a common procedure
that is recommended for men over 50 years of age. There are
several techniques that can be utilized to conduct a prostate
examination including an ultrasound, CT scan, physical
examination or blood test. In regards to trauma cases, a
physician or surgeon may utilize a physical prostate examination
if there is significant blood, laceration or obvious trauma to
the prostate. Otherwise, a rectal examination, consisting of a
physician or surgeon inserting their finger into a patient's
rectum, is commonly utilized to determine if the prostate is
dislocated or deformed. This simple procedure is not considered
to be a formal prostate examination, but rather a preliminary
check. If a nodule or significant deformity to the prostate is
detected during this procedure, the physician or surgeon would
note this in the patient's chart. However, if the trauma patient
is transported to another location, there is a risk that the
patient will not be provided with further information regarding
the need for further assessment.
b) Required Written Information. For specific testing procedures
and/or in the course of certain patient-provider relationships,
health care practitioners are required to provide written
information to their patient. The purpose of this information is
to ensure that patients are educated about the potential benefits
and dangers of treatments and procedures, understand their rights
and remedies and are protected from unscrupulous health care
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practitioners. According to California law, health care
practitioners are required to provide the following written
information to patients:
HSC § 1645 (Paul Gann Blood Safety Act) requires physicians to
provide a standardized summary of the positive and negative
aspects of receiving blood from volunteers whenever there is a
reasonable possibility that a blood transfusion may be necessary
as a result of a medical/surgical procedure.
HSC § 109275 requires primary care physicians to provide a
summary discussing alternative breast cancer treatments and their
risks and benefits to women upon diagnosis of breast cancer, or,
if the physician chooses, prior to a biopsy.
HSC § 109278 requires medical care providers, primarily
responsible for providing patients with an annual gynecological
exam, to provide a standardized summary containing a description
of the symptoms and appropriate methods of diagnoses for
gynecological cancers.
BPC § 728 requires physicians specializing in psychiatry to
provide written information on the rights and remedies for
patients who have been involved sexually with their
psychotherapist when the physician becomes aware that the patient
had alleged sexual intercourse or sexual contact with a previous
psychotherapist during the course of a prior treatment.
BPC § 2259 (Cosmetic Implant Act of 1992) requires physicians to
provide written information to patients considering silicone
implant surgery. Physicians may substitute written information
authorized for use by the federal Food and Drug Administration
prepared by the manufacturer based upon the physician package
insert.
BPC § 2248, HSC § 109280 (Grant H. Kenyon Prostate Cancer
Detection Act) requires physicians to provide a standardized
summary about the availability of appropriate diagnostic
procedures when examining a patient's prostate gland during a
physical examination.
3.Arguments in Support. The Sponsor along with three other
professional organizations and one surgeon support the bill.
Specifically, the Medical Board of California states that the
exemption for trauma cases is a "reasonable exemption" especially
since patients are unconscious and a "trauma case" is already
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defined in existing law.
The California Chapter of the American College of Emergency
Physicians notes that trauma patients require immediate attention
to save their lives. In some instances, physicians may perform a
physical examination of a trauma patient for diagnostic testing
having nothing to do with prostate cancer. In these instances,
requiring a physician to provide prostate cancer screening
information to the patient is not only burdensome, it is misleading
to the patient who may incorrectly believe they had a prostate
examination.
The California Hospital Association indicates that a rectal
examination is a critical physical examination that can help to
determine the course for triage and further care.
Dr. Herbert E. Gladen , a surgeon and advanced trauma life support
instructor, states that the bill corrects a flaw in current law and
allows doctors and surgeons to care for patients effectively.
SUPPORT AND OPPOSITION:
Support:
Northern California Chapter of the American College of Surgeons
(Sponsor)
California Chapter of the American College of Emergency Physicians
California Hospital Association
Medical Board of California
1 surgeon
Opposition:
None on file as of June 4, 2012
Consultant:Le Ondra Clark