BILL ANALYSIS                                                                                                                                                                                                    Ó







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        |Hearing Date:May 2, 2011           |Bill No:SB                         |
        |                                   |628                                |
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                      SENATE COMMITTEE ON BUSINESS, PROFESSIONS 
                               AND ECONOMIC DEVELOPMENT
                          Senator Curren D. Price, Jr., Chair
                                           

                           Bill No:        SB 628Author:Yee
                     As Amended:April 25, 2011          Fiscal:Yes

        
        SUBJECT:   Acupuncture: regulation. 
        
        SUMMARY:  Changes the name of the California Acupuncture Board to the 
        "Traditional Chinese Medicine Board," retitles the Acupuncture 
        Licensure Act into the "Traditional Chinese Medicine Licensure Act" 
        and changes the designation of a licensed acupuncturist into a 
        licensed "Traditional Chinese Medicine Practitioner."  Provides for 
        the certification of traumatologists and includes traumatology in the 
        authorized activities of a licensed acupuncturist. 

        Existing law:
        
        1) Establishes the California Acupuncture Board (Board) within the 
           Department of Consumer Affairs (DCA), which licenses and regulates 
           the acupuncture profession pursuant to the Acupuncture Licensure 
           Act. (Business and Profession Code (BPC) § 4925)

        2) Defines an acupuncturist as an individual who has been licensed to 
           practice acupuncture pursuant to the Acupuncture Licensure Act.  
           Defines acupuncture as the stimulation of a certain point  or 
           points on or near the surface of the body by the insertion of 
           needles to prevent or modify the perception of pain or to normalize 
           physiological functions, including pain control, for the treatment 
           of certain diseases or dysfunctions of the body and includes the 
           techniques of electroacupuncture, cupping, and moxibustion. (BPC § 
           4927)

        3) States that a licensed acupuncturist is authorized to do the 
           following: 






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           a)   To engage in the practice of acupuncture.

           b)   To perform or prescribe the use of Asian massage, acupressure, 
             breathing techniques, exercise, heat, cold, magnets, nutrition, 
             diet, herbs, plant, animal, and mineral products, and dietary 
             supplements to promote, maintain, and restore health. Nothing in 
             this section prohibits any person who does not possess an 
             acupuncturist's license or another license as a healing arts 
             practitioner from performing, or prescribing the use of any of 
             these modalities, as specified. (BPC § 4937)

        4) States that the Board shall issue a license to practice acupuncture 
           to any person who applies and meets the following requirements: 
           (BPC § 4938)

           a)   Is at least 18 years of age.

           b)   Furnishes satisfactory evidence of completion of one of the 
             following: 1) an education and training program, as specified; 2) 
             satisfactory completion of a tutorial program in the practice of 
             an acupuncturist which is approved by the Board; or 3) In the 
             case of an applicant who has completed education and training 
             outside the United States and Canada, documented education 
             training and clinical experience, as specified.

           c)   Passage of a written examination administered by the Board, as 
             specified.

           d)   Completion of a clinical internship training program approved 
             by the Board.  

        This bill: 

        1)Renames the Acupuncture Licensure Act as the Traditional Chinese 
          Medicine Licensure Act, renames the Board as the Traditional Chinese 
          Medicine Board, and changes the name of the Acupuncture Fund into 
          the Traditional Chinese Medicine Fund.

        2)Defines Traditional Chinese Medicine (TCM) to be similar to the 
          current definition of acupuncture and changes the designation of an 
          acupuncturist into TCM Practitioner.

        3)Includes in the authorized activities of a licensed acupuncture the 
          performance of traumatology, which includes a range of treatments to 
          address both acute and chronic musculoskeletal conditions, as well 
          as many nonmusculoskeletal conditions.  Techniques include, but are 





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          not limited to, brushing, kneading, rolling, pressing, and rubbing 
          the areas between each of the joints to open the body's defensive 
          chi and stimulate the energy movement in both meridians and the 
          muscles so that the licensee is able to use range of motion, 
          traction, and massage with the stimulation of acupuncture points.

        4)Requires the Board, on or before March 1, 2012, to establish a 
          Traumatology Advisory Committee (Committee) within the Board to 
          consist of six members composed of representatives from the clinical 
          settings of traumatology.

        5)Requires the Committee to determine certification standards, 
          including the level of experience and training needed for an 
          individual to qualify for traumatology certification.  Requires the 
          Committee to advise the Board in developing the application form and 
          the written examination for the certification.  

        6)Requires the Board, commencing May 1, 2012 until December 15, 2012, 
          to issue a certificate for traumatology to any person who makes an 
          application and meets all of the following requirements: 

           a)   Is at least 18 years of age;

           b)   Furnishes satisfactory evidence of training and clinical 
             experience which meets the standards established by the Committee 
             and confirmed by the Board.

           c)   Passes a written examination administered by the Board that 
             tests the applicant's ability, competency, and knowledge of 
             traumatology.  Requires the written examination to be developed 
             by the Office of Professional Examination Services of the DCA.

           d)   Is not subject to denial, as specified. 

        7)Requires an applicant for traumatology certification, commencing 
          January 1, 2012, to apply for a certificate for traumatology until 
          December 15, 2012.  Prohibits the Board, on and after December 15, 
          2012, from issuing an initial license to any applicant.  Specifies 
          that on and after December 15, 2012, the Board may issue only a 
          renewal of a certificate.  State that an individual who is not 
          qualified to receive a certificate or who fails to apply for 
          certification by December 15, 2012, shall not hold himself or 
          herself out as a certified traumatologist.

        8)Defines traumatology as treating both acute and chronic 
          musculoskeletal conditions through stimulation of acupressure points 





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          using a range of hands-on body treatment, including traction and 
          massage.  States that traumatology addresses pain associated with 
          the muscles joints and skeletal system.  Provides that traumatology 
          involves manipulation techniques to realign the musculoskeletal and 
          ligamentous relationships, a technique called bone-setting. 

        9)Requires a certified traumatologist to maintain a relationship with 
          an orthopedic surgeon when involved in manipulation techniques to 
          realign the musculoskeletal and ligamentous relationships, a 
          technique called bone setting.  States that the extent of the 
          relationship between a traumatologist and orthopedic surgeon in the 
          case of bone-setting shall be determined by the Board in 
          consultation with the Medical Board of California.

        10)Requires an applicant for certification as a traumatologist to pay 
          an application fee of $75 when submitting his or her application to 
          the Board.

        11) Requires that the certificate must be renewed every five years, 
          and that an expired certificate may be renewed at any time within 
          the three years after its expiration.  

        12)Specifies fees for the following: renewal ($75), delinquency ($25), 
          duplicate or replacement wall certificates ($15), and duplicate or 
          replacement renewal receipt ($10).

        13)States that moneys received pursuant to certification shall be 
          deposited in the TCM Fund.

        14)Provides that it is an unfair business practice for any person to 
          hold himself or herself out as a certified traumatologist or use the 
          title "certified traumatologist" without meeting the requirements of 
          this bill. 

        15)Applies existing law provisions that currently relates to licensed 
          acupuncturists to certified traumatologists.

        16)Provides that a person who holds a certificate to practice 
          traumatology is subject to existing disciplinary provisions 
          contained in the Acupuncture Licensure Act.

        17)Applies relevant provisions of the Acupuncture Licensure Act to 
          certified traumatologists.  Makes other technical, clarifying and 
          conforming changes.

        18)States findings and declarations relating to TCM and traumatology.





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        FISCAL EFFECT:  Unknown. Legislative Counsel has keyed this bill as 
        "fiscal." 

        COMMENTS:
          .  
        1. Purpose.  This bill is sponsored by the  Author  .  According to the 
           Author, "the current Acupuncture Licensure Act incorrectly refers 
           to practitioners as Acupuncturist when in fact an Acupuncturist 
           practices all modalities of TCM of which Acupuncture is only one 
           modality.  The Author states that this bill "seeks to change the 
           name of the Board and the title practitioners assume to more 
           accurately reflect their scope of practice.  Additionally, this 
           bill provides a way for traumatologists to become certified.  
           Traumatology is one of the modalities that constitute TCM.  Before 
           China systemized their health care system, individuals acquired 
           their mastery of traumatology through a master-apprentice 
           relationship.  These practitioners learned from a master through 
           hands-on training.  Although highly skilled, it is extremely 
           difficult for these practitioners to obtain proof of their training 
           to qualify for the existing requirement for licensure."

        2. Background.  According to the National Institutes of Health's (NIH) 
           National Center for Complementary and Alternative Medicine 
           (Center)," TCM originated in ancient China and has evolved over 
           thousands of years.  TCM practitioners use herbs, and other methods 
           to treat a wide range of conditions.  In the United States, TCM is 
           considered part of complementary and alternative medicine.  Herbal 
           remedies and acupuncture are the treatments most commonly used by 
           TCM practitioners.  Other TCM practices include cupping, mind-body 
           therapy and dietary therapy.  Although TCM is used by the American 
           public, scientific evidence of its effectiveness is, for the most 
           part, limited.  Acupuncture has the largest body of evidence and is 
           considered safe if practiced correctly."  In 1996, the United 
           States Food and Drug Administration approved acupuncture needles 
           for use by licensed practitioners.  The FDA requirements stipulate 
           that the needles must be sterile, nontoxic, and labeled for single 
           use by qualified practitioners only.  In the past two decades, 
           acupuncture's popularity has grown in the United States.  According 
           to the 2002 National Health Interview Survey, the largest and most 
           comprehensive survey of complementary and alternative medicine, an 
           estimated 8.2 million adults have used acupuncture. 

        According to the Board, there are currently 10, 271 licensed 
           acupuncturists and 19 approved acupuncture schools in California.  





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           The Acupuncture Licensure Act (Act) defines acupuncture as the 
           stimulation of a certain point or points on or near the surface of 
           the body by the insertion of needles to prevent or modify the 
           perception of pain or to normalize physiological functions, 
           including pain control, for the treatment of certain diseases or 
           dysfunctions of the body and includes the techniques of 
           electroacupuncture, cupping, and moxibustion.  The Act provides 
           that an acupuncturist's license authorizes the holder to engage in 
           the practice of acupuncture and to perform or prescribe the use of 
           Asian massage, acupressure, breathing techniques, exercise, heat, 
           cold, magnets, nutrition, diet, herbs, plant, animal, and mineral 
           products, and dietary supplements to promote, maintain, and restore 
           health.  The Act further provides an applicant for acupuncture 
           licensure to furnish evidence of completion of an educational and 
           training program approved by the Board or a tutorial program in the 
           practice of acupuncture that is approved by the Board.  Students 
           entering programs on or after January 1, 2005 are required to 
           fulfill a minimum of 3,000 hours of study pertaining to the 
           practice of acupuncture.  Additionally, an applicant must pass a 
           written examination administered by the Board, and complete a 
           clinical internship training program, as specified.   

        3. Related Legislation.   AB 72  (Eng), pending in Assembly Health 
           Committee would require every health care service plan, as 
           specified, to provide acupuncture coverage, as specified.  

         AB 1117  (Yee), Chapter 649, Statutes of 2006, among other provisions, 
           changed the term "oriental medicine" to "Asian medicine" and the 
           term "oriental massage" to "Asian massage." 

        4. Policy Questions.
        
           a)   Will changing the name of acupuncture into Traditional Chinese 
             Medicine and the Acupuncture Board into the Traditional Chinese 
             Medicine Board and in the best interests of consumers?  According 
             to the Board's Website, the term acupuncture has been used in 
             California since 1972 when the Board of Medical Examiners (now 
             Medical Board of California) allowed the practice of acupuncture 
             under the supervision of licensed physicians as part of 
             acupuncture research in medical schools.  Since the creation of 
             the Acupuncture Advisory Committee in 1975, a precursor to the 
             Acupuncture Examining Committee, which was later renamed into the 
             Acupuncture Board, members of the public have identified 
             practitioners of acupuncture to be licensed and regulated by the 
             Acupuncture Board.  Changing the name now could create confusion 
             on members of the public who have known and are familiar with the 





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             practice of acupuncture and the Acupuncture Board.  

           Additionally, it is unclear if designating acupuncture to be 
             similar to TCM would make the public perceive that TCM is as 
             scientific and evidence-based as the practice of acupuncture.  As 
             the NIH had indicated, "Although TCM is used by the American 
             public, scientific evidence of its effectiveness is, for the most 
             part, limited.  Acupuncture has the largest body of evidence and 
             is considered safe if practiced correctly." 

           b)   Is the education, curriculum, and training requirements for 
             acupuncturists sufficient to authorize them to practice 
             traumatology?  This bill includes the performance of traumatology 
             in the list of authorized activities that acupuncturists could 
             perform.  The bill defines traumatology as treating both acute 
             and chronic musculoskeletal conditions through stimulation of 
             acupressure points using a range of hands-on body treatment, 
             including traction and massage, and, involves manipulation 
             techniques to realign the musculoskeletal and ligamentous 
             relationships; a technique called bone setting.   Although the 
             bill requires a certified traumatologist to maintain a 
             relationship with an orthopedic surgeon when involved in bone 
             setting, it remains unclear if current and future practitioners 
             of acupuncture have sufficient education, training, and clinical 
             experience to perform traumatology safely on consumers, 
             especially since bone setting is outside the current scope of 
             practice of acupuncturists. 

        5. Arguments in Support.   Numerous   individuals  who support this bill 
           indicate, "Acupuncture is one of the many modalities within TCM.  
           This nomenclature is misleading and problematic, as the scope of 
           practice of a licensed acupuncturist includes other modalities of 
           TCM, and not just acupuncture.  Additionally, Traumatology is one 
           of the modalities that constitute TCM.  It is a very important part 
           of TCM science, with a complete theoretical system.  Before China 
           systematized its health care system, individuals acquired their 
           competence of traumatology through clinical practicum and 
           internships.  Although highly skilled, these practitioners' 
           trainings are not yet recognized in California." 
        6. Arguments: Oppose Unless Amended.  The  California Orthopaedic 
           Association  (Association) has taken an oppose unless amended 
           position and states that the scope of practice of a traumatologist 
           as specified in this bill is broad, including aspects of 
           orthopedics.  The Association indicates that in the United States, 
           an orthopedic surgeon must complete four years of undergraduate 
           training, four years of medical school and five years of 





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           orthopaedic residency.  This training must be complete in 
           nationally accredited programs and institutions.  However, in this 
           bill, the standards for the traumatologist certificate would be set 
           by a subcommittee of the Acupuncture Board, composed of 
           representatives of unnamed clinical and academic settings of 
           traumatology.  It states that there are too many unanswered 
           questions about what traumatologists will be allowed to do, and 
           what their training and education must be for this practice to be 
           authorized. 
        
        7. Arguments in Opposition.  The  National Guild of Acupuncture and 
           Oriental Medicine  (NGAOM) is opposed to this bill and states the 
           following:  "The Acupuncture Licensure Act specifically 
           distinguishes between acupuncture and "Oriental medicine."  The 
           Legislators specifically intended to only license needling therapy 
           i.e. acupuncture, and not the broader practice of "Oriental" 
           medicine.  Traditional Chinese Medicine remains a non-scientific 
           approach to diagnosing and treating disease that is inconsistent 
           not only with mainstream medicine as it is practiced in the USA but 
           also as it is practiced across different Asian cultures."  NGAOM 
           also states that "traumatology is orthopedics.  Licensing 
           acupuncturists as traumatologists comprises an encroachment on the 
           orthopedist scope of practice.    

        Additionally, the  Association of Korean and Asian Medicine and 
           Acupuncture of California  (AKAMAC) states that this bill is a step 
           backward for the practice of acupuncture and poses a grave danger 
           to public safety.  AKAMAC, in pointing out the history of TCM, 
           states that the California Legislature did not intend to license 
           TCM practitioners when they licensed acupuncturists or they would 
           have done so, and suggesting that acupuncture and TCM are 
           interchangeable is ambiguous and clouds reality.  Though the scope 
           of practice of a licensed acupuncturist in California includes 
           specific related modalities, there is no evidence within this bill 
           that one could conclude that these modalities are the whole of TCM. 
            AKAMAC states that TCM remains a non-scientific, by Western 
           medicine standards, approach to diagnosing and treating disease and 
           is inconsistent with mainstream or Western medicine.  Additionally, 
           AKAMAC states that defining acupuncture by a specific restrictive 
           definition of a country does a disservice to other Asian cultures 
           that share in the practice of this health care modality.  
           Furthermore, like NGAOM, AKAMAC believes that traumatology is 
           orthopedics and allowing acupuncturists to practice traumatology is 
           an encroachment on the orthopedist scope of practice and is clearly 
           outside an acupuncturist's scope of practice and current training, 
           education, and expertise.





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        8. Technical Amendment.  The Author would like to strike the word 
           "license" on page 21, line 15, and replace it with "certificate" to 
           more accurately reflect his intent.  

        






        SUPPORT AND OPPOSITION:
        
         Support:  

        Numerous individuals

         Oppose Unless Amended:

         California Orthopaedic Association
         
        Opposition:  

        Association of Korean Asian Medicine and Acupuncture of California
        National Guild of Acupuncture and Oriental Medicine 
        Numerous Individuals



        Consultant:Rosielyn Pulmano