BILL ANALYSIS Ó
SENATE TRANSPORTATION & HOUSING COMMITTEE BILL NO: ab 722
SENATOR MARK DESAULNIER, CHAIRMAN AUTHOR: lowenthal
VERSION: 5/28/13
Analysis by: Erin Riches FISCAL: no
Hearing date: June 4, 2013
SUBJECT:
Vehicles: driver's licenses: medical examinations
DESCRIPTION:
This bill makes chiropractors eligible to perform and report
medical examinations on individuals applying to drive a
schoolbus, school pupil activity bus, youth bus, general public
paratransit vehicle, or farm labor vehicle.
ANALYSIS:
Existing law:
Requires an individual operating a school bus, school pupil
activity bus, youth bus, general public paratransit vehicle,
or farm labor vehicle to have a valid driver's license for the
appropriate class of vehicle, as well as a special certificate
issued by the Department of Motor Vehicles (DMV) permitting
the operation of that vehicle.
Requires an individual applying for an original or renewal
certificate to drive a schoolbus, school pupil activity bus,
youth bus, general public paratransit vehicle, or farm labor
vehicle to submit a report of medical examination given not
more than two years prior to the application date.
Requires schoolbus drivers to undergo a medical examination
within the same month of reaching 65 years of age and each
12th month thereafter.
Provides that only a licensed physician, licensed physician
assistant, or licensed advance practice registered nurse may
perform the medical examination on individuals applying to
drive a schoolbus, school pupil activity bus, youth bus,
general public paratransit vehicle, or farm labor vehicle, and
AB 722 (LOWENTHAL) Page 2
on individuals 65 years or older who operate a schoolbus.
This bill adds licensed doctors of chiropractic who are listed
on the federal registry of medical examiners to the list of
providers qualified to perform the required medical examination
on individuals who are applying to drive a schoolbus, school
pupil activity bus, youth bus, general public paratransit
vehicle, or farm labor vehicle, as well as on schoolbus drivers
65 years or older.
COMMENTS:
1.Purpose . The author states that this bill makes physicals
more accessible to special certificate drivers because
chiropractors are often able to schedule an exam more quickly
and affordably than many other healthcare providers. The
author also states that because chiropractors have been
performing the identical exam on commercial truck drivers for
more than 20 years, it is appropriate to eliminate this gap in
the law.
2.Who currently performs physicals on special certificate
drivers ? For a long period of time, the federal government
authorized only doctors of medicine to perform physicals on
commercial drivers. In 1992, however, the Federal Highway
Administration amended its regulations to allow other
healthcare providers to perform these exams. Currently, the
Federal Motor Carrier Safety Administration (FMCSA) allows
doctors of medicine, doctors of osteopathy, physician
assistants, licensed advance practice registered nurses, and
chiropractors to perform examinations on commercial drivers.
California law, however, allows only a licensed physician,
licensed physician assistant, or licensed advance practice
registered nurse to perform the required physical exam and
report of a person who is applying to obtain a DMV certificate
to operate a school bus, school pupil activity bus, youth bus,
general public paratransit vehicle, or farm labor vehicle, as
well as on schoolbus drivers 65 years or older.
3.Is it appropriate for chiropractors to perform physicals on
special certificate drivers ? The DMV, which has not taken a
position on this bill, opposed a prior legislative attempt to
authorize chiropractors to perform these exams on the grounds
that the physicals were outside the chiropractic scope of
AB 722 (LOWENTHAL) Page 3
practice (see "Previous Legislation" below). The sponsors of
this bill assert that since 1922, the state has educated and
licensed chiropractors to serve as primary care providers.
They further state that chiropractors have long performed
physicals on truck drivers that are identical to the exams
required for special certificate drivers. Finally, they note
that statute requires chiropractors to refer a patient to
another healthcare provider if they detect a condition outside
their scope of practice.
4.Federal regulation change . In April 2012, FMCSA issued final
regulations establishing a National Registry of Certified
Medical Examiners. These regulations establish criteria,
including training and certification testing, that all medical
examiners must meet in order to conduct physicals on
commercial motor vehicle drivers. The regulations require all
motor carriers and drivers, effective May 21, 2014, to use
only medical examiners on this list. "Medical examiners"
include the same healthcare professionals as current
regulations - which, as noted above, includes chiropractors -
but these healthcare professionals will now have to be listed
on the registry in order to qualify to conduct the exams.
This bill would qualify any medical examiner listed on the
national registry to perform physicals on special certificate
drivers in California.
5.Previous legislation .
AB 1812 (Bermudez) of 2004 would have allowed licensed
advance practice registered nurses and chiropractors to
perform physicals on individuals applying to drive a
schoolbus, school pupil activity bus, youth bus, general
public paratransit vehicle, or farm labor vehicle. DMV
opposed the bill on the grounds that these providers
"simply do not have the training and experience to
recognize the symptoms of undisclosed conditions which may
affect the driver." Governor Schwarzenegger vetoed the
bill, arguing that it was unnecessary and would reduce the
current standard, but ordered DMV to conduct a study on the
issue. This study, completed in December 2005, stated that
California has traditionally set higher standards than
federal regulations, particularly in the case of school bus
drivers and other certificate holders who transport
children. It pointed out that the National Transportation
Safety Board had raised concerns about unqualified medical
personnel performing these exams. The report concluded
AB 722 (LOWENTHAL) Page 4
that "Until the Federal Motor Carrier Safety Administration
has resolved the issue of unqualified medical personnel
conducting these exams, California law should continue to
require that physicians conduct the medical exams for
special certificate drivers." FMCSA is now establishing a
national registry of healthcare providers and requiring
providers to meet certain training and certification
requirements in order to be listed on the registry.
AB 139 (Bass), Chapter 158, Statutes of 2007 allowed
licensed advance practice registered nurses qualified to
perform a medical examination and licensed physician
assistants to conduct physical examinations on individuals
applying to drive a schoolbus, school pupil activity bus,
youth bus, general public paratransit vehicle, or farm
labor vehicle. The California Academy of Physician
Assistants, sponsor of that bill, stated that the existing
law overburdened physicians with routine duties that should
be performed by clinically competent mid-level
practitioners.
Assembly Votes:
Floor: 77-0
Trans: 16-0
POSITIONS: (Communicated to the committee before noon on
Wednesday, May 29,
2013.)
SUPPORT: California Chiropractic Association (sponsor)
Southern California University of Health Sciences
(sponsor)
State Board of Chiropractic Examiners
OPPOSED: None received.