BILL ANALYSIS                                                                                                                                                                                                    Ó







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        |Hearing Date:April 23, 2012        |Bill No:SB                         |
        |                                   |1236                               |
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                      SENATE COMMITTEE ON BUSINESS, PROFESSIONS 
                               AND ECONOMIC DEVELOPMENT
                          Senator Curren D. Price, Jr., Chair
                                           

                          Bill No:        SB 1236Author:Price
                     As Amended:April 17, 2012          Fiscal:Yes

        
        SUBJECT:  Healing arts boards. 
        
        SUMMARY:  Extends the provisions establishing the California Board of 
        Podiatric Medicine (BPM), and extends the Physician Assistant 
        Committee (PAC), and its executive officer, and makes other changes, 
        as specified.

        Existing law:
        
       1)Licenses and regulates some 2,000 doctors of podiatric medicine 
          (DPMs) by the California Board of Podiatric Medicine (BPM) under the 
          Medical Board of California (MBC) within the Department of Consumer 
          Affairs (DCA), and makes the BPM inoperative and repealed on January 
          1, 2013.  (Business and Professions Code (BPC) § 2460)

       2)Provides that the BPM is composed of seven members, three public 
          members, and four professional members.  The Governor appoints five 
          members, and the Senate Rules Committee and the Assembly Speaker 
          each appoints a public member.  (BPC § 2462)

       3)Provides that protection of the public shall be the highest priority 
          for the BPM in exercising its licensing, regulatory, and 
          disciplinary functions, and whenever the protection of the public is 
          inconsistent with other interests sought to be promoted, the 
          protection of the public shall be paramount.  (BPC § 2460.1)

       4)Defines the practice of "podiatric medicine" to mean the diagnosis, 
          medical, surgical, mechanical, manipulative, and electrical 
          treatment of the human foot, including the ankle and tendons that 
          insert into the foot and the nonsurgical treatment of the muscles 





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          and tendons of the leg governing the functions of the foot.  (BPC § 
          2472 (b))

       5)Authorizes a DPM to administer local anesthetic, and requires an 
          anesthetic other than local to be administered by another 
          appropriately-licensed health care practitioner.  (BPC § 2472 (c))

       6)Provides that a DPM of podiatric medicine who is ankle certified by 
          the board on and after January 1, 1984, may do the following:  (BPC 
          § 2472 (d))

           a)   Perform surgical treatment of the ankle and tendons at the 
             level of the ankle, as specified.

           b)   Perform services under the direct supervision of a physician 
             and surgeon, as an assistant with surgical procedures beyond the 
             DPM scope of practice.

           c)   Perform a partial amputation of the foot, as specified.

       1)Prohibits a DPM from performing an admitting history and physical 
          examination of a patient in an acute care hospital where doing so 
          would violate the regulations governing the Medicare program.  (BPC 
          § 2472 (f))

       2)Provides that a graduate of an approved school of podiatric medicine 
          may apply for and obtain a resident's license from the BPM, 
          authorizing them to practice podiatric medicine, as specified.  A 
          resident's license may be renewed annually for up to four years.  
          (BPC § 2475)

       3)Provides that podiatric law does not prohibit the manufacture, 
          recommendation or the sale of either corrective shoes or appliances 
          for the human feet.  (BPC § 2477)

       4)Requires applicants for a DPM license to complete at least two years 
          of postgraduate podiatric medical and podiatric surgical training in 
          a general acute care hospital approved by the Council of Podiatric 
          Medical Education.  (BPC § 2484)

       5)Requires "a passing score one standard error of measurement higher 
          than the national passing scale score" on the American Podiatric 
          Medical Licensing Examination (APMLE) Part III, the national 
          examination administered by the National Board of Podiatric Medicine 
          Examiners.  (BPC § 2493 (b))






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       6)Specifies that an Administrative Law Judge's (ALJ's) proposed 
          decision shall be voted on by the BPM by mail, and requires the vote 
          of two members of the BPM to defer final decision until the board 
          has discussed the case as a whole.  (BPC § 2335)

       7)Authorizes the BPM to request an ALJ in a disciplinary matter to 
          direct a licensee found guilty of unprofessional conduct in a 
          proposed decision to pay to the BPM a sum not to exceed the actual 
          and reasonable costs of the investigation and prosecution of the 
          case.  The law provides that the costs shall be fixed by the ALJ and 
          shall not in any event be increased by the BPM.  (BPC § 2497.5)

       8)Licenses and regulates more than 7,500 physician assistants (PAs) 
          under the Physician Assistant Practice Act by the PAC within the 
          MBC, and makes the PAC inoperative and repealed on January 1, 2013.  
          (BPC § 3504)

       9)Authorizes the PAC to appoint an executive officer, and makes that 
          authority inoperative and repealed on January 1, 2013.  (BPC § 3512)

       10)The PAC is comprised of nine members; 4 PAs, 4 public members and 
          one physician representative of MBC.  Four PAs, the physician 
          members and two public members are appointed by the Governor.  
          Senate Rules Committee and the Assembly Speaker each appoint a 
          public member.  (BPC § 3505)

        11)Provides that protection of the public shall be the highest 
           priority for the PAC in exercising its licensing, regulatory, and 
           disciplinary functions, and whenever the protection of the public 
           is inconsistent with other interests sought to be promoted, the 
           protection of the public shall be paramount.  (BPC § 3504.1)

        12)Places specific reporting requirements upon specified health care 
           licensing boards and upon licensees of those boards, including the 
           following:  

           a)   Requires boards to create and maintain a central file on each 
             of its licensees, which shall include information regarding:  
             convictions, judgments, specified public complaints.  (BPC § 800)

           b)   Requires licensees to report to his or her licensing board the 
             occurrence of an indictment or information charging a felony 
             against the licensee or the conviction of the licensee of a 
             felony or misdemeanor.  (BPC § 802.1)

           c)   Specifies procedures when a coroner receives information, as 





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             specified, that a death may be the result of a specified 
             licensee's gross negligence or incompetence, and in connection 
             with disciplinary actions against those licensees.  (BPC § 802.5)

           d)   Requires a district attorney, city attorney, or other 
             prosecuting agency to notify specific health licensing boards 
             whenever a licensee is convicted of or charged with a felony, as 
             specified.  (BPC § 803.5)

           e)   Provides for the professional review of specified  healing 
             arts licentiates through a peer review process.  (BPC § 805) 

        This bill:

       1)Extends the BPM's sunset date 4 years to January 1, 2017.  (BPC § 
          2460)

       2)Amends BPC § 2472 (d) (1) Removes the reference to "ankle 
          certification after January 1, 1984," thereby confirming a single 
          scope of licensure for DPMs.

       3)Repeal an obsolete provision prohibiting a DPM from performing an 
          admitting history and physical exam at an acute care hospital.  BPC 
          § 2472)

       4)Eliminates the four year limit for postgraduate training.  (BPC § 
          2475)

       5)Clarifies that anyone may offer special shoes and inserts without a 
          license to aid comfort and athletic performance, but that a medical 
          license is needed to diagnose and prescribe for medical conditions.  
          (BPC § 2477)

       6)Removes a requirement that applicants obtain a specific score on the 
          licensing examination.  (BPC § 2493)

       7)Authorizes that the vote of only one board member of the BPM is 
          necessary to defer a decision for consideration by the entire board. 
           (BPC § 2335) 

       8)Authorizes BPM to increase costs assessed when a proposed decision is 
          not adopted by the BPM and the BPM finds grounds for increasing the 
          assessed costs (BPC § 2497.5)

       9)Extends sunset dates for PAC/BPM and executive officer to January 1, 
          2013.  (BPC §§ 3504, 3512)





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       10)Changes the name the PAC to Physician Assistant Board (PAB) and 
          correspondingly changes "Board" to "Medical Board of California."  
          (BPC multiple sections)

       11)Changes the composition of the "Board" to replace the physician with 
          a PA.  (BPC § 3505).

       12)Establishes an exemption for active military from payment of the PA 
          license renewal.  (BPC § 3521.3)

       13)Establishes a "retired" license status for PA licensees no longer 
          practicing to retain their license without payment of renewal fees 
          or completion of continuing education.  (BPC § 3521.4)

       14)Clarifies that the reporting requirements in the 800 series apply to 
          PAs.  (BPC §§ 800-805)



        FISCAL EFFECT:  Unknown.  This bill has been keyed "fiscal" by 
        Legislative Counsel.

        COMMENTS:
        
       1.Purpose.  This bill is sponsored by the  Author  .  According to the 
          Author, in 2012, the Business, Professions and Economic Development 
          Committee (BPED) conducted oversight hearings to review 7 regulatory 
          boards within the DCA:  the Board of Podiatric Medicine, the 
          Physician Assistant Committee, the Acupuncture Board, the Board of 
          Pharmacy, the Court Reporters Board, the Board of Behavioral 
          Sciences and the Board of Psychology.  The Committee began its 
          review of these licensing agencies in March and conducted two days 
          of hearings.  This bill, and the accompanying sunset bills, is 
          intended to implement legislative changes as recommended in the 
          Committee's Background Issue Papers for the agencies reviewed by the 
          Committee this year.

          This bill is one of  four  "sunset bills" authored by the Chair of 
          this Committee.  According to the Author, this bill is necessary to 
          extend the sunset date of the BPM and the PAC in order to continue 
          the regulation of the practice of podiatric medicine, and the 
          practice of PAs in California.  The continued regulation will help 
          to ensure that the BPM's and the PAC's mission of protecting the 
          public is in place for an additional four years. 






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       2.Background on the California Board of Podiatric Medicine (BPM).  The 
          BPM in the is responsible for licensing and regulating DPMs in 
          California.  Although the BPM functions in an independent manner, 
          similar to other boards under DCA, the BPM lies within the 
          jurisdiction of the MBC, and it is the MBC that officially issues 
          licenses to these practitioners upon the "recommendation" of the 
          BPM. 

       The BPM licenses approximately 2,000 DPMs.  The BPM issues some 55 
          licenses each year, and approximately 1,000 licenses are renewed 
          each year. 

       The DPM license as defined in the BPC and in the regulations of the BPM 
          are specialists in the foot and ankle.  Some DPMs specialize in 
          conservative care while others practice mostly as surgeons.  Many 
          DPMs specialize in care and preservation of the diabetic foot.  DPMs 
          also assist other doctors in non-podiatric surgeries.  DPMs are the 
          only medical specialty limited to its area of expertise by the 
          license itself, which enhances patient protection.

       Currently, the BPM is composed of seven members.  It has a professional 
          majority with three public members, and four professional members.  
          The Governor appoints five members of the BPM.  The Senate Rules 
          Committee and the Assembly Speaker each appoints one public member.  
          The BPM is required to meet at least three times each calendar year 
          and meets at various locations throughout the state.  Board meetings 
          are open and give the public the opportunity to testify on agenda 
          items and on other issues.

       The BPM currently has five committees that perform various functions:  

               Public Outreach Committee:  external communication & public 
             liaison.
            
               Enforcement Committee:  enforcement procedures.

               Legislative Committee:  legislative liaison.

               Licensing & Medical Education Committee:  licensing, exams, 
             approval of schools & residencies.

               Professional Practice Committee:  guides & advises staff on 
             practice matters.

          As a Special Fund agency, the BPM receives no General Fund support, 
          relying solely on fees set by statute and collected from licensees 





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          and applicants.  The total revenues anticipated by the BPM for FY 
          2011/2012 is $918,000.  The total expenditures anticipated for BPM 
          for FY 2011/2012 are $960,000, and for FY 2012/2013, $979,000.  
          Based upon these figures, the BPM would have approximately 10 months 
          in reserve in FY 2011/2012, and 9.3 months in reserve in FY 
          2012/2013.  The BPM spends approximately 70% of its budget on 
          enforcement-related functions.  The BPM has a staff level of five 
          authorized positions and currently has no vacancies.

       1.Prior Review of the BPM.  The BPM was last reviewed by the former 
          Joint Legislative Sunset Review Committee (JLSRC) in 2002.  At that 
          time, the JLSRC made eight final recommendations regarding BPM.  In 
          November 2011, the BPM submitted its required Sunset Review Report 
          to the Committee.  In this report, the BPM described actions that 
          have been taken since the BPM's last review.  Below are the BPM's 
          responses to the issues raised during the last sunset review.

               Increase Residency Training From One to Two Years.  The JLSRC 
             recommended that the BPM should thoroughly assess the need for 
             this additional training.  The BPM provided evidence that the 
             American Podiatric Medical Association (APMA) and its affiliates 
             had conducted an occupational analysis demonstrating that 
             two-years of postgraduate residency training is the minimum 
             required to achieve entry-level competence.  Subsequently, BPC § 
             2484 was amended to reflect the two-year requirement by AB 932 
             (Koretz, Chapter 88, Statutes of 2004). 

               Model Law Adoption.  Neither the JLSRC nor DCA had a 
             recommendation regarding adoption of a Model Law as had been 
             proposed by the BPM.  The JLSRC emphasized that a model law 
             should reflect the consumer protection goals of this state.  
             Accordingly, following further documentation and justification 
             the BPM was instrumental in legislation enacting many Model Law 
             provisions (AB 1777, Assembly B&P Committee, Chapter 586, 
             Statutes of 2003; AB 932, Koretz, Chapter 88, Statutes of 2004). 

               Renewal Fee Increase Extension.  The BPM implemented a 
             temporary license renewal fee increase, of from $800 to $900, 
             effective in 2000 on a four-year basis (AB 1252, Wildman, Chapter 
             977, Statutes of 1999; extended by SB 724, Senate B&P Committee, 
             Chapter 728, Statutes of 2001).  The JLSRC recognized that the 
             demands on the BPM's operating fund suggested continuation of the 
             fee increase to maintain the BPM's licensing and enforcement 
             activities, and enable the BPM's fund condition to stabilize.  
             Since that time, the fee level was extended through 2005, and SB 
             1549 (Figueroa, Chapter 691, Statutes of 2004) removed the sunset 





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             date and the renewal fee has remained $900.  The fee level has 
             been supported by the California Podiatric Medical Association.

               Audits of Continuing Medical Education (CME).  Faced with 
             fiscal challenges, the BPM discontinued its contract with the 
             Medical Board to conduct random audits of CME.  The JLSRC 
             recommended that the BPM resume conducting random audits of CME 
             courses and providers to guarantee that licensees are receiving 
             CME courses of quality and relevance to the profession.  The BPM 
             resumed the annual Continuing Competence/CME random audit in 
             2004; however, the audits have been interrupted by staffing 
             limitations, furloughs, and budget constraints.  The annual 
             random audit is of one percent of licensees.  It verifies 
             self-certification under penalty of perjury in the current 
             renewal for compliance with the Continuing Competence and 50-hour 
             CME requirements.  The BPM has recently completed its 2011 random 
             compliance audit of 20 licensees and found a 95% compliance rate 
             with 19 providing documentation of CME (50 hours) and the 
             required Continuing Competence.  One licensee was granted a 
             one-time waiver by the BPM.

               Review of Complaints by Board Members.  In 2002, the JLSRC 
             emphasized that Board members should not review complaints and 
             the BPM should continue to contract with subject matter experts 
             to do so.  Board staff should conduct initial complaint review 
             and forward select complaints to a panel of experts when 
             technical expertise is needed.  The BPM agrees and complies with 
             this recommendation.

               Transition to a National Examination.  SB 1955 (Figueroa, 
             Chapter 1150, Statutes of 2002) amended BPC § 2486 to reflect a 
             transition from the state oral clinical licensing examination to 
             Part III of the National Board of Podiatric Medical Examiners 
             (NBPME) examination.

               Refine Continuing Competency Program.  The JLSRC recommended 
             that the BPM's continuing competency program should be refined to 
             provide additional pathways and ease compliance.  Accordingly, SB 
             1955 (Figueroa, Chapter 1150, Statutes of 2002) amended BPC §2496 
             to provide that upon renewing a license, the DPM may show 
             continued competency in practice by passing within the past 10 
             years Part III of the examination administered by the National 
             Board of Podiatric Medical Examiners.  The BPM deems this as 
             landmark legislation, to reinforce lifelong learning.  The BPM 
             believes that the complaint data over time showing a steady 
             50-percent decline reflects that patient harm is being prevented 





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             by these changes.
           
        1. Current Issues Identified.  The following are some of the major 
           issues pertaining to the BPM along with background information 
           concerning the particular issue and the BPM's response to the 
           issue.  Recommendations were made by Committee staff regarding the 
           particular issue areas which needed to be addressed. 

            a)   Issue  :  Ankle certification.  

            Background  :  The podiatric practice provisions of the Medical 
             Practice Act essentially provide for a two-tier license system, 
             depending on whether a DPM was ankle certified "on or after 
             January 1, 1984," the date that legislation took effect (Chapter 
             305, Statutes of 1983) to clarify that a podiatrist may treat the 
             ankle as part of the licensed scope of practice.  

           Joint Committee staff discussed in 1997 whether this two-tiered 
             system could be eliminated, upon receipt of BPM's first Sunset 
             Review report.  The BPM staff commented then that it was probably 
             premature.  In 1998, SB 1981 (Greene, Chapter 736, Statutes of 
             1998) repealed the requirement that licensed podiatrists obtain a 
             certificate from BPM in order to perform ankle surgery, and 
             instead, simply authorized a DPM certified by the BPM after 
             January 1, 1984 to perform ankle surgery.

           Now, a decade and a half later, and approaching three decades since 
             1984, the BPM states in its Report that it would support a single 
             scope of practice for DPMs.  The useful life of the 1984 two-tier 
             licensing has run its course, according to the BPM.  

           More than 80-percent of the BPM's licensees are "ankle licensed" 
             and this percentage continues to increase.  According to the BPM, 
             it is a small number of older licensees who do not perform ankle 
             surgery, amputations or surgical assisting to MD and DO surgeons 
             that the "ankle license" now allows. 

           According to the BPM, a single-scope licensure would simplify the 
             statute and its administration without harm to the public.

            Recommendation  :  Committee staff recommended that consideration 
             should be given to the to remove reference to "ankle 
             certification by the BPM on and after January 1, 1984" in BPC § 
             2472(d)(1) thereby confirming a single scope of licensure for 
             doctors of podiatric medicine. 






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            b)   Issue :  Status of BReEZe implementation by the BPM

            Background  :  The BreEZe Project will provide DCA boards, bureaus, 
             and committees with a new enterprise-wide enforcement and 
             licensing system.  BreEZe will replace the existing outdated 
             legacy systems and multiple "work around" systems with an 
             integrated solution based on updated technology.

           BreEZe will provide all DCA organizations with a solution for all 
             applicant tracking, licensing, renewal, enforcement, monitoring, 
             cashiering, and data management capabilities.  In addition to 
             meeting these core DCA business requirements, BreEZe will improve 
             DCA's service to the public and connect all license types for an 
             individual licensee.  BreEZe will be web-enabled, allowing 
             licensees to complete applications, renewals, and process 
             payments through the Internet.  The public will also be able to 
             file complaints, access complaint status, and check licensee 
             information.  The BreEZe solution will be maintained at a 
             three-tier State Data Center in alignment with current State IT 
             policy.

           BreEZe is an important opportunity to improve the BPM operations to 
             include electronic payments and expedite processing.  Staff from 
             numerous DCA boards and bureaus have actively participated with 
             the BreEZe Project.  Due to increased costs in the BreEZe 
             Project, last year SB 543 (Steinberg, Chapter 448, Statutes of 
             2011) was amended to authorize the Department of Finance (DOF) to 
             augment the budgets of BPMs, bureaus and other entities that 
             comprise DCA for expenditure of non-General Fund moneys to pay 
                   BreEZe project costs within the 2011-2012 Budget Year.

           The BPM indicated in its Report that in August 2011, DCA advised 
             the BPM that the BPM budget and fund will be charged assessments 
             of $4,000 in FY 2011/2012 followed in succeeding FYs by $11,000, 
             $9,000, $8,000, $9,000 and $9,000 consecutively through FY 
             2016/2017 for BreEZe SPR Funding.  The BPM is scheduled to begin 
             using BreEZe in the Summer of 2012.  

            Recommendation  :  Committee staff recommended the BPM should update 
             the Committee about the current status of its implementation of 
             BreEZe.  What have been the challenges to implementing this new 
             system?  What are the costs of implementing this system?  Is the 
             cost of BreEZe consistent with what the BPM was told the project 
             would cost?

        2. Responses regarding Issues Raised by the Committee.  The BPM 





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           responded to the issues raised by Committee staff on April 10, 
           2012.  In terms of removing the distinction regarding ankle 
           certification for DPMs, the BPM concurs with amending BPC Section 
           2472 to strike the reference to "January 1, 1984."  BPM states that 
           82% of its licensees are now "ankle licensed," and this percent 
           will continue increasing.

        With reference to the status of BreEZe computer project, BPM indicates 
           that it has met multiple times with the BreEZe team, and provided 
           all the program data requested.  BPM further states that it is 
           participating in configuration sessions to assess the new system 
           "hands on," and that implementation is scheduled for summer or fall 
           2012 (FY 2013).  The cost to BPM is $50,000 through FYs 2012-2017.  
           This is a $38,000-increase over the $12,000 previously budgeted for 
           i-Licensing.  Beginning in FY 2018, annual maintenance costs will 
           be about $1,000, according to BPM.

        3. This Bill Includes the Following Statutory Changes Related to the 
           BPM Identified by this Committee During the March 2012 Oversight 
           Hearings:

           a)   Extends the sunset date of the BPM.  The health, safety and 
             welfare of consumers are protected by a well-regulated medical 
             profession, including podiatric medicine.  DPMs make independent 
             medical judgments with patients including diagnosis, prescription 
             medication, and method of treatment.  The BPM continues to be an 
             effective mechanism for licensure and oversight of DPMs and 
             should be continued.  The BPM has shown over the years a strong 
             commitment to improve the BPM's overall efficiency and 
             effectiveness and has worked cooperatively with the Legislature 
             and this Committee to bring about necessary changes.  The BPM 
             should be continued under the jurisdiction of the MBC with a 
             four-year extension of its sunset date so that the Committee may 
             review once again if the issues and recommendations in this paper 
             and others of the Committee have been addressed.   This bill 
             extends the sunset dates for the BPM to January 1, 2017  .

           b)   Ankle Certification.  As noted above, nearly three decades 
             since the separate ankle certification was first established, the 
             useful life of the 1984 two-tier licensing has run its course, 
             according to BPM.  The BPM supports a single scope of practice 
             for DPMs.   This bill establishes a single scope of licensure for 
             DPMs by removing the reference to "ankle certification after 
             January 1, 1984."  .

           c)   Admitting History and Exam.  BPC Section 2472(f) provides that 





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             "A doctor of podiatric medicine shall not perform an admitting 
             history and physical examination of a patient in an acute care 
             hospital where doing so would violate the regulations governing 
             the Medicare program."  In 2010, a California Attorney General 
             Opinion No. 09-0504, regarding the effect of these provisions 
             regarding the ability of a doctor of podiatric medicine to 
             perform an admitting history and physical (H&P) at an acute care 
             hospital found that "not only is a podiatrist not precluded from 
             performing an admitting H&P by Business and Professions Code 
             Section 2472, but failing to do so may fall below the standard of 
             care expected of podiatrists generally." 

           In stating this opinion, the AG points out that the prohibition of 
             Section 2472 is for performing an H&P "where doing so would 
             violate the regulations governing the Medicare program" and was 
             placed in the statute in response to a former federal rule, which 
             imposed restrictions on federal reimbursements of podiatric 
             services under Medicare.  The federal restriction was superseded 
             by 42 C.F.R. Section 410.25 to provide that "Medicare Part B pays 
             for the services of a doctor of podiatric medicine acting within 
             the scope of his or her license, if the services would be covered 
             as physician's services when performed by a doctor of medicine or 
             osteopathy."  

           Therefore, the BPM points out, Medicare regulations no longer 
             restrict DPM history and physical examinations, thereby making 
             Section 2472(f) obsolete.  The BPM states that the provision is 
             confusing to the public and should be deleted from the Code.   The 
             bill repeals this obsolete provision prohibiting a DPM from 
             performing an admitting history and physical exam at an acute 
             care hospital  .

           d)   Eliminate 4-year limit for postgraduate training.  The law 
             provides that a graduate of an approved school of podiatric 
             medicine may apply for and obtain a resident's license from the 
             BPM, authorizing them to practice podiatric medicine, as 
             specified.  A resident's license may be renewed annually for up 
             to four years.  In its Sunset Report, the BPM proposed that the 
             four-year limitation of the resident's license be deleted, thus 
             ending the four-year cap on DPM postgraduate training.  According 
             to the BPM, few individuals may participate in residency and 
             fellowship training for more than four years, but the limit on 
             education is unnecessary.  The BPM argues that this limitation is 
             the only known statutory cap on education anywhere in this 
             country for any profession or group.  Ultimately, the BPM 
             believes that the four-year cap will interfere with advanced 





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             training of some leading practitioners.  The BPM states that it 
             is a principle of medical education that there is no such thing 
             as too much education and training.   This bill eliminates the 
             four year limit for postgraduate training  .

           e)   Corrective Shoes.  In its Report, the BPM proposed that BPC § 
             2477 be amended to clarify that a medical license is required in 
             order to diagnose and prescribe corrective shoes or appliances 
             (called orthotics) for the foot.  

           Orthotics typically refers to custom-made shoe inserts prescribed 
             by a licensed doctor of podiatric medicine, an osteopathic 
             doctor, or a medical doctor after a medical examination and 
             diagnosis.  Orthotics are designed to accommodate or correct an 
             abnormal or irregular walking pattern, and ultimately make 
             standing, walking, and running more comfortable and efficient by 
             altering the angles at which the foot strikes the ground.  
             Orthotics placed inside of an individual's shoes can absorb 
             shock, improve balance, and take pressure off sore spots.

           The BPM has recommended amending the law to clarify that anyone may 
             offer special shoes and inserts without a license to aid comfort 
             and athletic performance, but that a medical license is needed to 
             diagnose and prescribe for medical conditions.   This bill 
             clarifies that a medical license is needed to diagnose and 
             prescribe for medical conditions  .

           f)   Examination Score.  Following the BPM's 2001-2002 sunset 
             review, BPC §2484 was amended to reflect the two-year residency 
             requirement by AB 932 (Koretz, Chapter 88, Statutes of 2004).  
             That bill correspondingly amended BPC § 2493 to require "a 
             passing score one standard error of measurement higher than the 
             national passing scale score" on the American Podiatric Medical 
             Licensing Examination (APMLE) Part III, the national examination 
             administered by the National Board of Podiatric Medicine 
             Examiners (NBPME). 

           In the BPM's experience, the California score, one standard error 
             of measurement higher than the national scale passing score, 
             raises the passing score from 75 one or two points, e.g., to 77, 
             and slightly lowers the overall pass rate percentage.  
             Numerically, this means that for each bi-annual Part III exam, 
             one or two California candidates might achieve the national scale 
             passing score of 75, but fall just below California's one 
             standard error of measurement higher, and must retake the 
             examination.





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           The BPM's requirement by law for a higher score than the national 
             passing score confuses and disappoints applicants, and delays or 
             blocks their entering practice, sometimes losing job offers in 
             the process.  In the judgment of the BPM's professional staff, it 
             has a marginal if any effect on the quality of licensees and 
             patient care.   This bill removes the requirement that applicants 
             obtain a specific score on the licensing examination  .

           g)   Remove Two-Vote Requirement.  The BPM licenses DPMs under the 
             authority of the MBC.  The law creates the Health Quality 
             Enforcement Section within the Department of Justice with the 
             primary responsibility of prosecuting proceedings against 
             licensees and applicants within the jurisdiction of MBC and 
             various other boards, including the BPM.  Under these provisions, 
             a panel of administrative law judges, the Medical Quality Hearing 
             Panel (MQHP) within the Office of Administrative Hearings, 
             conducts disciplinary proceedings against a DPM.  BPC Section 
             2335 provides that all proposed decisions of the MQHP are 
             transferred to the executive officer of the BPM, and sent by 
             Board staff to each Board member within 10 days.  The BPM staff 
             then polls each member regarding his or her vote on the proposed 
             decision.  By majority vote, the BPM may do any of the following: 
              approve the decision, approve the decision with an altered 
             penalty, refer the case back to the administrative law judge in 
             order to take additional evidence, defer final decision pending 
             discussion of the case by Board as a whole, or non-adopt the 
             decision.

           The law provides that the votes of two members of the BPM are 
             required to defer a final decision pending discussion of the case 
             by the BPM as a whole.  If two or more members vote to defer the 
             final decision until after a discussion of the entire Board, then 
             the BPM must engage in that discussion before 100 calendar days 
             of the date the proposed decision is received by the BPM. 

           In its Report, the BPM stated that the requirement that, "The votes 
             of two members of the panel or board are required to defer a 
             final decision pending discussion of the case by the panel or 
             board as a whole," effectively prevents the BPM Board Members 
             from discussing a case in closed session as a jury even when one 
             member of the BPM identifies an issue and wishes to have 
             discussion with her or his colleagues prior to voting.  The BPM 
             has recommended deleting this provision as it relates to the BPM, 
             and believes that doing so, could empower the BPM as a jury in 
             disciplinary matters and make its role more meaningful.   This 





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             bill authorizes the vote of only one board member of the BPM to 
             defer a decision for consideration by the entire board  .

           h)   Increase Assessed Costs for Discipline.  As part of the 
             Medical Board, and utilizing MBC staff for enforcement, the BPM 
             has cost recovery authority through BPC § 2497.5.  The BPM's 
             Manual of Disciplinary Guidelines and Model Disciplinary Orders 
             provide that cost recovery is a standard condition for all cases. 
              According to the BPM, Administrative Law Judges (ALJs) are 
             inconsistent in the amount of cost recovery they propose from one 
             case to another.  In stipulated agreements, the BPM's staff and 
             the Attorney General always seek cost recovery as part of the 
             negotiation.  

           In its Report, the BPM recommended amending BPC § 2497.5(b) to give 
             the BPM discretion to increase cost recovery in disciplinary 
             cases when it non-adopts a proposed decision from an 
             administrative law judge "and in making its own decision finds 
             grounds for increasing the costs to be assessed."  The BPM 
             indicated that it is unusual to non-adopt an ALJ's proposed 
             decision and for the BPM to make its own decision.  However, the 
             BPM contends that it should not be prohibited from ordering 
             actual and reasonable cost recovery in such cases.   This bill 
             authorizes BPM to increase costs assessed when a proposed 
             decision is not adopted by the BPM and the BPM finds grounds for 
             increasing the assessed costs  .
           
           i)   Technical cleanup.   This bill makes several cleanup provisions 
             to clarify the law as recommended by the BPM and Committee staff  . 
              


       4.Background on the Physician Assistant Committee (PAC).  The PAC was 
          established in 1975.  At the time, the Legislature was concerned 
          about the existing shortage and geographic maldistribution of health 
          care services in the state.  The intent was in part to "create a 
          framework for the development of a new category of health manpower, 
          the physician assistant," and to encourage their utilization as a 
          way of serving California's health care consumers.  PAs are medical 
          practitioners who perform services under the supervision of 
          physicians.

       The PAC's primary role is the licensure of PAs.  The PAC exists within 
          the MBC but has limited ties to that board and acts independently on 
          many of its mandates.  The PAC continues to rely on MBC for 
          investigative and other services and generally has a cooperative 





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          working arrangement with the Board.

       The scope of practice of the PA is described in the Physician Assistant 
          Practice Act and in regulations promulgated by MBC.  Pursuant to 
          these laws, each PA may perform only those services he or she is 
          authorized to perform pursuant to a written delegation of authority 
          by the supervising physician.

       The PAC is comprised of nine members; 4 PAs, 4 public members and one 
          physician representative of MBC.  Four PA members are appointed by 
          the Governor.  Two public members are also appointed by the 
          Governor.  One public member is appointed by the Senate Committee on 
          Rules and one member is appointed by the Speaker of the Assembly.

       The PAC is a special fund agency, receiving its funding from the 
          licensing of PAs and biennial renewal fees of PAs.  Currently, the 
          license fee for PAs is $200 while the renewal fee is $300.  These 
          fees provided approximately 60% of the PAC's revenue therefore to 
          compensate for the loss of revenue from the supervising physician 
          fees, the PA application and renewal fees were increased.  The PAC 
          currently licenses 7,589 licensees.

       The total revenues anticipated by the PAC for FY 2011/2012, is 
          $2,002,000 and for FY 2012/2013, $1,948,000.  The total expenditures 
          anticipated for FY 2011/2012, is $1,371,000, and for FY 2012/2013, 
          1,469,000.  The PAC anticipates it would have approximately 5.2 
          months in reserve for FY 2011/2012, and 3.8 months in reserve for FY 
          2012/2013.  The PAC spends approximately 62 percent of its budget on 
          its enforcement program, 20 percent on its licensing program, 8 
          percent on its diversion program and 10 percent on administration.

       The PAC's staff is comprised of the Executive Officer and four 
          additional staff including two Associate Governmental Program 
          Analysts, one Staff Services Analyst, and a .5 Office Technician.

       5.Prior Review of the PAC.  The PAC was last reviewed by the former 
          JLSRC in 2005.  At that time, the JLSRC raised 13 issues regarding 
          PAC.  In November 2011, the PAC submitted its required Sunset Review 
          Report to the Committee.  Below are actions which the PAC and the 
          Legislature took over the past 6 years to address many of these 
          issues, as well as significant changes to the PAC's functions.

               Probation monitoring of PA licensees and associated costs.  
             The PAC assumed responsibility for monitoring its probationers in 
             2008 upon notification that the MBC would not be able to provide 
             this monitoring.  The PAC hired four retired annuitants with 





                                                                        SB 1236
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             investigator experience to provide necessary probation monitoring 
             for licensees.  The probation monitors began to conduct 
             background checks for petitioners who were petitioning the PAC 
             for reduction or modification of their probation or reinstatement 
             of licensure.  Prior to this, MBC provided these services; 
             however, this change resulted in the petitions being processed in 
             one to two months rather than four to six months.

           In its Sunset Report for 2005, the PAC noted that the cost of 
             monitoring PAs who have had their license disciplined and were 
             placed on probation was paid by the PAC through the enforcement 
             budget.  With that arrangement, all licensees would pay for the 
             actions of a limited number of licensees who are placed on 
             probation for violations of the laws and regulations.  In 2007, 
             the PAC amended its Disciplinary Guidelines to require that 
             probationers pay the costs of their probation.  Probationers are 
             now required to pay the costs for an investigation and 
             prosecution of the case, and if they fail to pay, their name is 
             then forwarded to the Franchise Tax Board for collection.  Prior 
             to 2007, probation monitoring costs were included in stipulated 
             settlements.

               Pocket licenses.  In 2005, the PAC requested authorization to 
             release funds to cover the costs of providing original and 
             renewal pocket plastic licenses to its licensees.  Paper 
             licenses, which were previously issued, were not durable, often 
             became illegible, and due to handling, often did not hold up for 
             the two-year license period.  As a result, many PAs had to order 
             a replacement pocket license.  Additionally, many hospitals and 
             clinics make copies of the licenses and the plastic licenses 
             contain security features not available on paper licenses and 
             also are not as alterable.  In 2008, the PAC secured a small 
             business contract using existing funds to provide plastic 
             licenses for all initial licenses and renewals.  The PAC began to 
             issue plastic credit card type pocket licenses in order to 
             prevent fraudulent tampering and to provide a more durable 
             license.

               Greater utilization of the profession.  The JLSRC raised the 
             issue of whether the PAC was "meeting its legislative mandate to 
             encourage utilization of physician assistants by physicians in 
             underserved areas of the state, and to allow for development of 
             programs for the education and training of physician assistants." 
              The passage of AB 3 in 2008 allowed supervising physicians the 
             authority to supervise four PAs at any one time instead of two.  
             Previously, supervising physicians could only supervise two PAs 





                                                                        SB 1236
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             at any one time unless they were practicing in underserved areas. 
              This change provided more opportunity for PAs to be utilized in 
             California and is essential to meet the growing demand for health 
             care.

           AB 3 also expanded the scope of practice for PAs to include 
             prescriptive authority to provide for more effective utilization 
             of PAs by physicians.  Prior to the bill's passage, PAs had to 
             obtain patient specific authority before prescribing class II-V 
             controlled substances but under the legislation, that requirement 
             was eliminated and PAs who complete an approved educational 
             course in controlled substances, and if delegated by the 
             supervising physician, can write the order.  The bill required a 
             PA and his or her supervising physician and surgeon to establish 
             written supervisory guidelines and specifies that this 
             requirement may be satisfied by the adoption of specified 
             protocols.  If a PA chooses not to take the educational course, 
             the requirements for patient-specific authority are still in 
             place.

           SB 1069 (Pavley, Chapter 512, Statutes of 2010) provided that a PA 
             acts as the agent of the supervising physician when performing 
             authorized activities, and authorized a PA to perform physical 
             examinations and other specified medical services, and sign and 
             attest to any document evidencing those examinations and other 
             services, as required pursuant to specified provisions of law.  
             The bill also clarified that a delegation of services agreement 
             may authorize PAs to order durable medical equipment and make 
             arrangements with regard to home health services or personal care 
             services.  Additionally, SB 1069 authorized PAs to perform a 
             physical examination that is required for participation in an 
             interscholastic athletic program.

           According to the PAC, it engages in outreach to encourage 
             utilization of PAs by: publishing informational articles during 
             each publication of the MBC's Newsletter, which is sent via email 
             to subscribers; providing information on its Website for 
             supervising physicians, potential PA students and consumers and; 
             participating at PA programs and conferences throughout the year.

               Use of a national practitioner database.  The PAC began to 
             request applicants to request a report on their licensing 
             background through the National Practitioner Data Bank if they 
             held a PA license in another state or held any previous health 
                                                                                   care licenses.  The purpose of the report is to receive 
             information about any previous disciplinary actions taken by 





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             another state or licensing agency.

               Continuing Education.  In 2010, the PAC updated its 
             regulations to require 50 hours of continuing medical education 
             (CME) or maintain certification by the National Commission on 
             Certification of Physician Assistants (NCCPA) for each renewal 
             period beginning with their license renewal on or after June 
             2012.

               Examination given on a continuing basis.  Senate Bill 819 
             (Yee, Chapter 308, Statutes of 2009) eliminated interim approval 
             from the application process to reflect that the Physician 
             Assistant National Certification Examination was previously only 
             given twice a year.  Prior to SB 819, interim approval was a 
             method to allow applicants who had completed a PA training 
             program to practice as a PA before they obtained licensure; 
             however, with the examination offered on a continuing basis, 
             applicants can only practice once they have taken and passed the 
             examination.  Additionally, exam scores are now being submitted 
             via a secure Website from the NCCPA to provide for timelier 
             transmittal to the PAC.

               Streamlining efforts.  Notices of deficient applications and 
             other license-related notices are now generated by the DCA's 
             Applicant Tracking System which results in consistent and 
             standardized correspondence and less staff time to prepare such 
             notices.  These notices are also issued to applicants via email, 
             if provided on an application, to allow for quicker receipt by 
             the applicant as well as cost savings to the PAC on supplies and 
             postage.  The PAC has also performed routine evaluations of its 
             application and eliminated questions and sections unrelated to 
             the licensure process.

        1. Current Issues Identified.  The following are some of the major 
           issues pertaining to the PAC along with background information 
           concerning the particular issue and the PAC's response to the 
           issue.  Recommendations were made by Committee staff regarding the 
           particular issue areas which needed to be addressed. 

            a)   Issue  :  Continued Enhancement of the Committee's Internet 
             Services and Implementation of BreEZe.  

            Background  :  One of the major changes since its last sunset review 
             has been its increased utilization of the Internet and computer 
             technology to provide services and information to the public and 
             its licensees on the PAC's Website.  These include: creating a 





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             career page with links and specific information regarding the PA 
             profession; adding a link for out of state licensure applicants 
             to order fingerprint cards online; adding a customer satisfaction 
             survey so that consumers, licensees and others may provide their 
             comments to the PAC regarding service they receive or 
             enhancements to the PAC program; adding licensing statistics for 
             counties throughout the state which are updated quarterly; adding 
             a quarterly Disciplinary Actions Report which allows consumers to 
             view disciplinary actions by date or by practitioner name; adding 
             a quarterly Enforcement Statistical Report which provides 
             information regarding complaints, investigations, disciplinary 
             actions, cost recovery, probationers and citation and fines; 
             adding an online change of address link for licensees and 
             applicants; developing and implementing a voluntary Website-based 
             self-test for PA laws and regulations which allows Website 
             visitors to test their current knowledge of PA laws and 
             regulations; adding all citations issued by the Committee to the 
             section of documents available to the public on the Website 
             (previously only disciplinary actions such as statements of 
             issue, accusations, decisions, probationary orders, surrenders, 
             defaults and revocations were available on the PAC Website) ; and 
             making the licensing application available on the Website.

           Despite these improvements, PA licensees are still not able to 
             renew licenses online or by using credit cards.  According to the 
             PAC , licensees and employers have been asking for several years 
             that the PAC enable them to renew on line and with credit cards.  
             As consumers, licensees are typically used to making electronic 
             payments often online for purchases and payments.  No doubt it 
             would be of great benefit to the licensing population and be more 
             efficient for the PAC to be able to make credit card payments for 
             fees online.  Providing this service of allowing online renewals 
             with a credit card will allow PAs to continue providing needed 
             health care and would decrease staff work.

           As previously indicated, DCA is in the process of establishing a 
             new integrated licensing and enforcement system, BreEZe, which 
             would also allow for licensure and renewal to be submitted via 
             the internet.  BreEZe will replace the existing outdated legacy 
             systems and multiple "work around" systems with an integrated 
             solution based on updated technology.  The goal is for BreEZe to 
             provide all the DCA organizations with a solution for all 
             applicant tracking, licensing, renewal, enforcement, monitoring, 
             cashiering, and data management capabilities. 

           BreEZe is an important opportunity to improve PAC operations to 





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             include electronic payments and expedite processing.  Staff from 
             numerous DCA boards and bureaus have actively participated with 
             the BreEZe Project and PAC staff continues to meet with BreEZe 
             consultants to develop Committee-specific components of the 
             system.

            Recommendation  :  The PAC should update the current status of its 
             efforts to fully implement electronic payments of fees and online 
             application and renewal processing, including anticipated 
             timelines, existing impediments and current status of BreEZe.  
             The PAC may wish to consider putting an interim plan in place to 
             ease the collection of license renewal fees.  The PAC should 
             continue to explore ways to enhance its Internet Services to 
             licensees and members of the public, including posting meeting 
             materials, policies, and legislative reports on the Internet and 
             webcasting meetings.

            b)   Issue  :  Continuing Education Audits.  

            Background  :  Assembly Bill 2482 (Maze & Bass, Chapter 76, Statutes 
             of 2008) authorized the PAC to require a licensee to complete CME 
             as a condition of license renewal.  This requirement may be met 
             by completing 50 hours of CME every two years or by obtaining 
             certification by the NCCPA, or other qualified certifying body as 
             determined by the PAC.  January 2011, PAC regulations became 
             effective to implement the provisions of AB 2482, including 
             establishing criteria for complying with the statute, provisions 
             for non-compliance, record-keeping requirements, approved course 
             providers, audit and sanction provisions for non-compliance, and 
             waiver provisions.  Additionally, the regulatory change 
             established an inactive status, allowing licensees to be exempt 
             from renewal or continuing medical education requirements.

           The PAC verifies completion of CME through a self-reporting 
             question on license renewal applications, allowing licensees to 
             verify whether they met the requirement or not by simply checking 
             a yes or no box.  According to the PAC, PAs are currently 
             required to meet the CME requirements; however, the 
             self-reporting certification will only start appearing on renewal 
             notices later this year.  While the PAC plans to conduct random 
             audits to verify compliance of those licensees who stated they 
             had completed their CME hours, it has not yet conducted any 
             audit.  The PAC may be lacking information about improper 
             compliance reporting, as licensees have yet to be required to 
             provide any certification or records of complying with the 
             continuing education requirement.  The only licensees whose 





                                                                        SB 1236
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             compliance can be verified directly are those PAs certified by 
             the NCCPA, as the PAC can obtain records directly from the 
             Commission.

            Recommendation  :  The PAC should explain the lack of self-reporting 
             audits and describe plans to implement audits.

           c)   I  ssue  :  Promoting and Understanding Workforce Development 
             Issues for Physician Assistants.

            Background  :  In establishing the PA profession in this state, the 
             Legislature intended to address "the growing shortage and 
             misdistribution of health care services in California" by 
             eliminating "existing legal constraints" that constitute "an 
             unnecessary hindrance to the more effective provision of health 
             care services."  PAs have effectively and safely fulfilled this 
             role and are widely recognized as an effective solution to access 
             to care problems in all settings.  A disproportionate number of 
             PAs provide services in medically underserved settings (e.g., 
             health manpower shortage areas) and settings where cost 
             containment is especially important, e.g., HMOs).  The PA 
             profession has an exemplary safety record, and there is no 
             evidence that PAs commit malpractice more frequently than 
             physicians or nurse practitioners.

           Recent federal health care reform efforts will result in a large 
             need for new health care providers to a growing population across 
             the nation and in California.  However, the state already faces a 
             shortage of primary care providers which can result in 
             potentially lower standards of care and longer wait times to 
             access care.  Recognizing the role that PAs can play in meeting 
             health care needs, the Patient Protection and Affordable Care 
             Act, the law, among other things, supported the educational 
             preparation of PAs who intend to provide primary care services in 
             rural and underserved communities and integrated PAs into newly 
             established models of coordinated care, such as the patient 
             centered primary care medical home and the independence at home 
             models of care.  The Act also funded a program to expand PA 
             training with the intention of increasing student enrollment in 
             PA programs.  Over a five-year period beginning in 2010, the 
             program will provide $32 million in funding for approximately 40 
             primary care PA training programs.  Funds go to PA student 
             stipends, educational expenses, reasonable living expenses and 
             indirect costs for a total of $22,000 per student, for a maximum 
             of two years per student, plus indirect costs.






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           According to the PAC, it monitors efforts by the California Academy 
             of Physician Assistants to promote the use of PAs in health care 
             settings.  The PAC states that it plans to continue to review the 
             relationship of PAs and Medical Assistants (MAs) in the health 
             care workplace setting, including a discussion of the supervision 
             of MAs by PAs, as several attempts have been made by the CAPA to 
             pass legislation regarding this issue which could allow further 
             use of PAs in delivery of health care in California and promote 
             workforce development.  The PAC has also encouraged California PA 
             training programs to work with the Office of Statewide Health 
             Planning and Development (OSHPD) for new graduates to apply for 
             grants to work in medically underserved areas.  OSHPD is also 
             currently collecting data on the use of PAs in health care 
             settings which could also allow better utilization of PAs, 
             particularly in underserved areas.  The PAC also states that it 
             works collaboratively with MBC to ensure that physicians are able 
             to utilize PAs effectively.

            Recommendation  :  The PAC should explain what additional efforts it 
             can take or models it can follow to increase the PA workforce and 
             ensure participation of its licensees in the state's health care 
             delivery system.  The PAC should look closely at the efforts and 
             the collection of data by the Registered Nursing Board in 
             determining workforce needs and in making future recommendations 
             to policymakers, the Legislature and the Governor.

        2. Responses regarding Issues Raised by the Committee.  The PAC 
           responded to the issues raised by Committee staff on April 16, 
           2012.  In terms of the implementation of the BreEZe project, the 
           PAC will begin using the database developed for BreEZe, and will 
           begin offering online renewal payments and payment for initial 
           licensing for both licensees and applicants.  Additionally, all 
           enforcement tracking activities will also migrate to BreEZe.  The 
           anticipated time for implementation to BreEZe is September 2012.

        The PAC further continues to enhance and improve information on the 
           PAC Website.  New enhancements to be made include the following:  
           update the PAC Career Page to ensure it is more informative to 
           perspective students interested in the PA profession.  
           Additionally, the PAC will develop a new brochure for Career 
           information.  The PAC will place regulatory rulemaking files on the 
           Website.  Currently, the Website contains the past three years' of 
           rulemaking files, but for historical purposes will include all 
           rulemaking files on the Website, or will make the files available 
           electronically.  The PAC currently posts meeting minutes on the 
           Website and will add all historical minutes on the Website for 





                                                                        SB 1236
                                                                         Page 24



           historical purposes, space permitting.

        In the area of webcasting, the PAC continues to webcast all public 
           meetings to allow members of the public and interested parties to 
           view meetings without being physically present.  The PAC began 
           webcasting in 2011 and has received positive comments from the 
           public and interested parties. 

        Enhanced public participation:  The PAC is exploring ways to enhance 
           public participation in their meetings by including, if possible, 
           the ability for the public to interact in real time at meetings by 
           telephone at a designated location or some other media system.  The 
           PAC will work with the Department of Consumer Affairs in this area 
           to determine how best to accomplish this task. 

        Regarding the lack of continuing education audits, the PAC indicates 
           that  AB 2482 (Maze, Chapter 76, Statutes of 2008) authorized the 
           PAC to require licensees to complete 50 hours of CME every two 
           years as a condition of license renewal.  Regulations implementing 
           the CME requirement became effective January 2011, and beginning 
           January 1, 2013, licensees who renew their license will 
           self-certify if they have satisfied the CME requirement.  

        Licensees are given a two year cycle in order to accrue the 50 hours 
           of CME required to renew the license.  Therefore, a PA who renews 
           his or her license on or after January 2013 will be required to 
           certify his or her compliance with the CME requirement by noting 
           that they are either nationally certified or have completed the 
           required CME if they are not nationally certified.  The CME 
           requirement is similar to the requirement for physicians licensed 
           by the MBC as well as other boards who require self-certification, 
           according to the PAC.
        Any audit of CME will occur after the January 2013 reporting 
           requirement date.  Prior to January 2013 renewal notices being 
           sent, we will modify the renewal form to include the new 
           certification requirements. 

        Regarding workforce development, the PAC states that it recognizes the 
           need for training, employing and retention of qualified, licensed 
           PAs in California, especially in light of the health care reforms 
           underway.  At the May 7, 2012 PAC meeting promotion of Workforce 
           Development will be considered, including forming a Subcommittee to 
           review this issue and retention and distribution of PAs in 
           California to support increased access to health care by consumers. 
            The PAC will also be working with the California Academy of 
           Physician Assistants on this issue.  Additionally, the PAC will 





                                                                        SB 1236
                                                                         Page 25



           work with the Department of Consumer Affairs to develop an 
           information bulletin and brochure for distribution to persons 
           interested in pursuing a career as a PA and work with them on 
           development of more reporting on employment statistics of PAs in 
           California.  As recommended by the Committee, the PAC supports the 
           suggestion that the Executive Officer meet with the Board of 
           Registered Nursing to discuss their data collection efforts 
           regarding workforce needs.

        3. This Bill Includes the Following Statutory Changes Related to the 
           PAC Identified by this Committee During the March 2012 Oversight 
           Hearings:

           a)   Extends the sunset date of the PAC and its executive officer.  
             The PAC has shown over the years a strong commitment to improve 
             its overall efficiency and effectiveness and has worked 
             cooperatively with the Legislature and this Committee to bring 
             about necessary changes.  The PAC should be continued with the 
             name change to the "Physician Assistant Board" with a four-year 
             extension of its sunset date so that this "Board" may once again 
             review if the issues and recommendations in this Background Paper 
             have been addressed.   This bill extends the sunset dates for the 
             PAC and its executive officer to January 1, 2017  

           b)   Changes the name of the Committee.  Over the years, the PAC 
             has continued its current status with ties to MBC and reliance on 
             the Board for investigative and administrative services.  At a 
             July 2010 meeting, the PAC agreed to move forward to seek 
             legislation to change its name from the "Physician Assistant 
             Committee" to the "Physician Assistant Board," a change that is 
             not intended to alter or do away with the current cooperative 
             working arrangement with MBC; as PAs will continue to work under 
             supervising physicians and that relationship is paramount to the 
             PA practice.  An example of the affiliation which the Committee 
             has with the MBC is that of the BPM.  This Board also relies on 
             the MBC to provide many of the services that the PAC receives.  
              This bill changes the name the "Committee" to "Board" and 
             correspondingly changes "board" to "Medical Board of California."
            
           c)   Composition of the Board.  There is a question as to whether 
             or not the PAC should still continue with a voting physician 
             member once it is considered as an independent "board."  It would 
             not appear necessary to continue with a physician as a member of 
             this board if the primary focus of this agency is on the practice 
             of PAs.  When the PAC, as well as other health boards (former 
             committees) were considered as part of the "allied health 





                                                                        SB 1236
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             professions," they were primarily under the jurisdiction of the 
             MBC and physicians were added to some of the former committees.  
             This is no longer the case, and now all other health boards have 
             independence from the MBC; even though this committee is still 
             unique in that it utilizes the services of the MBC.  There does 
             not appear to be any good reason to continue with a physician on 
             this committee, and it would seem more appropriate to replace the 
             physician with a PA.  It is recognized that the PAC maintains a 
             close relationship with the MBC and that the relationship would 
             continue, according to PAC, who states:  "Because physician 
             assistants may not practice independently and are required to 
             have a supervising physician, our interaction and current 
             relationship with the Medical Board is valued and important."  
              This bill changes composition of the "Board" to replace the 
             physician with a PA  .  

           d)   Employer Reporting.  Current law, the Business and Professions 
             Code Section 800 series provides several reporting mandates for 
             the MBC and several other health professions to assist licensing 
             boards in protecting consumers from licensees who have had action 
             taken against them by their employers, altering their workplace 
             privileges.  In its Sunset Report, the PAC maintained that the 
             current Physician Assistant Practice Act does not clarify whether 
             reports should be made to the PAC about certain actions against 
             its licensees.  The PAC encourages agencies to voluntarily 
             provide 800 series reports on PAs to the PAC for review and 
             processing and when a report is received, the PAC opens a 
             complaint and takes appropriate action.  However, under current 
             PA laws, it is not explicitly clear that health plans and health 
             care facilities are required to report certain actions taken by 
             these entities against a licensee's privileges.  The only 
             reporting mandate that applies to PAs requires that the district 
             attorney, city attorney, and prosecuting agencies to notify the 
             PAC immediately upon obtaining information of any filings 
             charging a felony against a PAC licensee.

           The PAC is interested in adding PAs to the 800 series, which it 
             believes would enhance consumer protection and allow the PAC to 
             receive critical information about its licensees.  Employers 
             would be required to report any actions taken against PAs by peer 
             review bodies for medical disciplinary cause or reason to the 
             PAC.   This bill clarifies that the reporting requirements in the 
             800 series apply to PAs  .

           e)   Fee Waiver for Military Status.  During the March oversight 
             hearings, the issue was raised regarding providing an exemption 





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             under the Physician Assistant Act for licensed PAs on active 
             military duty from the license renewal fee requirement.  In its 
             written response, the PAC states its support for such a fee 
             waiver for active duty military licensees.  The PAC staff has 
             received numerous requests from active duty military PAs asking 
             for a renewal fee waivers.  The PAC supports offering an 
             exemption as an appropriate way to honor licensees in active 
             military service.  This proposal is similar to the Medical 
             Board's exemption status for active military physicians.   This 
             bill establishes an exemption for active military from payment of 
             license renewals  . 

           f)   Retired license status.  The PAC has further recommended that 
             the PAC be granted a "retired" license status to accommodate 
             licensees who are no longer practicing to retain their license 
             without payment of renewal fees or completion of the CME.  This 
             license status is similar to other licensing boards within the 
             Department of Consumer Affairs.   This bill establishes a 
             "retired" license status for licensees no longer practicing to 
             retain their license without payment of renewal fees or 
             completion of continuing education  .

        4. Arguments in Support.  The  Board of Podiatric Medicine  states that 
           it strongly supports SB 1236, the sunset review bill extending the 
           BPM for an additional four years and updating the BPC sections 
           administered by the BPM as recommended in the Board's report.

        Although the  Physician Assistant Committee  has not had the opportunity 
           to meet to take a position on this bill, the Chairman of the PAC 
           Robert Sachs writes his support of SB 1236.  Chairman Sachs states: 
            "I support the recommendation to changing the name of the 
           Physician Assistant Committee to the Physician Assistant Board.  I 
           also believe that consumer protection will be further enhanced by 
           including physician assistants in the BPC §  800 series reporting 
           requirements.  Additionally, the proposed change of the composition 
           of the Physician Assistant Committee from four physician assistant 
           members to five members by replacing the Medical Board physician 
           member will further enhance the legislative mandate for consumer 
           protection." 

        "I believe that this bill will also benefit physician assistant 
           licensees by amending the Physician Assistant Practice Act to add 
           two new license status types; retired and military exemptions.  The 
           military status will address special requirements of those 
           licensees who serve in the military.  Licensees who wish to retire 
           from practice will have an opportunity to take advantage of the 





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           retire status."  SB 1236 will be considered by the members of the 
           PAC at the May 7, 2012 meeting.  At that time the PAC will take a 
           formal position on this bill.


        SUPPORT AND OPPOSITION:
        
         Support  :

        Board of Podiatric Medicine
        Robert Sachs, Chairman of the Physician Assistant Committee 

         Opposition  :  None received as of April 18, 2012

        Consultant:G. V. Ayers