BILL ANALYSIS                                                                                                                                                                                                    



                                                                  AB 864
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          Date of Hearing:   April 23, 2013

              ASSEMBLY COMMITTEE ON BUSINESS, PROFESSIONS AND CONSUMER  
                                     PROTECTION
                              Richard S. Gordon, Chair
                    AB 864 (Skinner) - As Amended:  April 1, 2013
           
          SUBJECT  :   Athletic trainers.

           SUMMARY  :   Establishes the Athletic Training Practice Act (Act)  
          to license and regulate athletic trainers (ATs) through the  
          creation of an Athletic Trainer Licensing Committee (Committee)  
          under the Physical Therapy Board of California (Board), to  
          commence on July 1, 2014 and expire on January 1, 2019.     
          Specifically,  this bill  :  

          1)Declares that the provisions enacted by this bill may be known  
            and cited as the Athletic Training Practice Act.

          2)Prohibits any individual from engaging in the practice of  
            athletic training unless duly licensed under the Act. 

          3)Prohibits a person from using the title "athletic trainer,"  
            "licensed athletic trainer," "certified athletic trainer,"  
            "athletic trainer certified," "a.t.," "a.t.l.," "c.a.t.,"  
            "a.t.c.," or any other variation of these terms, or any other  
            similar terms indicating that the person is an AT, unless that  
            person is duly licensed under the Act.

          4)Permits an individual who has practiced athletic training in  
            California for a period of 15 consecutive years prior to July  
            1, 2014, and is not eligible for an athletic training license,  
            to use the title "athletic trainer" without being licensed by  
            the Committee, upon registration with the Board; provided that  
            no person may use the title "athletic trainer" on or after  
            January 1, 2017 without being duly licensed under the Act.  

          5)Establishes the Committee within the Board, which shall  
            consist of seven members, organized in the following manner:

             a)   Four licensed athletic trainers, as specified;

             b)   One public member;

             c)   One physician and surgeon licensed by the Medical Board  








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               of California or one osteopathic physician and surgeon  
               licensed by the Osteopathic Medical Board of California;  
               and,

             d)   One physical therapist licensed by the Board.

          6)Provides that the Committee shall sunset on January 1, 2019,  
            unless it is deleted or extended beyond that date, and further  
            subjects the Committee to the authority of the Joint Sunset  
            Review Committee after its sunset date. 

          7)Provides that, subject to confirmation by the Senate, the  
            Governor shall appoint two of the licensed ATs, the public  
            member, and the physician and surgeon or osteopathic physician  
            and surgeon; the Senate Committee on Rules and the Speaker of  
            the Assembly shall each appoint a licensed athletic trainer;  
            and the Board shall appoint the licensed physical therapist.

          8)Provides that all appointments shall be for a term of four  
            years and shall expire on June 30 of the year in which the  
            term expires, with vacancies to be filled for any unexpired  
            term.

          9)Provides that, for initial appointments made on or after  
            January 1, 2014, the public member appointed by the Governor  
            shall serve a term of one year. The athletic trainers  
            appointed by the Senate Committee on Rules and the Speaker of  
            the Assembly shall serve terms of three years, and the  
            remaining members shall serve terms of four years.

          10)Provides that each member of the committee shall receive per  
            diem and expenses, as specified.

          11)Authorizes the Committee to adopt, repeal, and amend  
            regulations as may be necessary to enable it to carry into  
            effect the provisions of the Act. 

          12)Authorizes the Committee, in promulgating regulations, to  
            consult the professional standards issued by the National  
            Athletic Trainers' Association (NATA), the Board of  
            Certification, Inc. (BOC), the Commission on Accreditation of  
            Athletic Training Education (CAATE), or any other nationally  
            recognized professional organization.

          13)Requires the Committee to approve programs for the education  








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            and training of ATs.

          14)Requires the Committee to investigate each applicant before a  
            license is issued in order to determine whether the applicant  
            meets the qualifications required by the Act.

          15)Requires that protection of the public be the highest  
            priority for the Committee in exercising its licensing,  
            regulatory, and disciplinary functions, and that whenever the  
            protection of the public is inconsistent with other interests  
            sought to be promoted, the protection of the public shall be  
            paramount.

          16)Requires the Committee, except as otherwise provided, to  
            issue an athletic training license to an applicant who meets  
            all of the following requirements:

             a)   Has submitted an application demonstrating that the  
               applicant has graduated from an accredited and approved  
               professional degree program in athletic training at an  
               accredited and approved post-secondary institution or  
               institutions, as specified;
              
             b)   Has passed an athletic training certification  
               examination offered by BOC, its predecessors or successors,  
               or another nationally accredited athletic trainer  
               certification agency approved and recognized by the  
               Committee;

             c)   Possesses an emergency cardiac care certification from a  
               certification body approved by the Committee that adheres  
               to the most current international guidelines for  
               cardiopulmonary resuscitation (CPR) and emergency cardiac  
               care; and,

             d)   Has paid the application fee established by the  
               Committee.

          17)Requires the Committee to issue an athletic training license  
            to an applicant who did not graduate from an accredited  
            athletic training education program as described above, but  
            who received athletic training via an internship, if the  
            applicant meets all of the following requirements:

             a)   Furnishes satisfactory evidence of completion of a  








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               degree at an accredited post-secondary institution that  
               included instruction in basic sciences related to, and on  
               the practice of, athletic training;

             b)   Has passed an athletic training certification  
               examination offered by the BOC, its predecessors or  
               successors, or another nationally accredited AT  
               certification agency approved and recognized by the  
               Committee;

             c)   Completed at least 1500 hours of clinical experience  
               under an AT certified by the BOC;

             d)   Possesses an emergency cardiac care certification from a  
               certification body, approved by the committee, that adheres  
               to the most current international guidelines for CPR and  
               emergency cardiac care; and

             e)   Has paid the application fee established by the  
               Committee.

          18)Declares that a license issued by the Committee to be valid  
            for two years and thereafter shall be subject to renewal  
            requirements.

          19)Authorizes the Committee to establish license application and  
            renewal fees in an amount sufficient to cover the reasonable  
            regulatory costs of carrying out the Act.

          20)Authorizes the Committee to renew a license if an applicant  
            meets all of the following requirements:

             a)   Pays the renewal fee as established by the Committee;  
               and, 

             b)   Submits proof of all of the following:

               i)     Satisfactory completion of continuing education;

               ii)    Current athletic training certification from a  
                 certification body approved by the committee, including,  
                 but not limited to, the BOC, or its predecessors or  
                 successors; and,

               iii)   Current emergency cardiac care certification from a  








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                 certification body approved by the Committee that adheres  
                 to the most current international guidelines for CPR and  
                 emergency cardiac care.

          21)Authorizes the Committee to deny a license or the renewal of  
            a license for an applicant or licensee who is described by any  
            of the following:

             a)   Does not meet the requirements of the Act;

             b)   Has had an athletic training license, certification, or  
               registration revoked or suspended by an accredited  
               organization, state, or territory;

             c)   Has been convicted of a felony or any other crime that  
               substantially relates to the functions or duties of an AT;  
               or,

             d)   Has committed unprofessional conduct, as specified.

          22)Authorizes the Committee to order any of the following  
            actions relative to an athletic training license after a  
            hearing for unprofessional conduct, which includes, but is not  
            limited to, a violation of the Act, any regulation adopted by  
            the Committee pursuant to the Act, and revocation or  
            suspension of an athletic training license, certification, or  
            registration by an accredited organization, state, or  
            territory:

             a)   Issue a training license subject to terms and  
               conditions;

             b)   Suspend or revoke the athletic training license; and,

             c)   Impose probationary conditions upon the athletic  
               training license.

          23)Declares that the practice of athletic training includes all  
            of the following:

             a)   Risk management and injury or illness prevention;

             b)   The clinical evaluation and assessment of an injury or  
               an illness sustained or exacerbated while participating in  
               physical activity, or both;








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             c)   The immediate care and treatment of an injury or an  
               illness sustained or exacerbated while participating in  
               physical activity, or both; and,

             d)   The rehabilitation and reconditioning from an injury or  
               an illness sustained or exacerbated while participating in  
               physical activity, or both.

          24)Declares that the practice of athletic training does not  
            include the practice of physical therapy, the practice of  
            medicine, the practice of osteopathic medicine, the practice  
            of chiropractic medicine, the practice of nursing, or medical  
            diagnosis or treatment.

          25)Requires an AT to refer a patient to an appropriate licensed  
            health care provider when the treatment or management of the  
            injury, illness, or condition does not fall within the  
            practice of athletic training.

          26)Prohibits an AT from providing, offering to provide, or  
            representing that he or she is qualified to provide any  
            treatment that he or she is not qualified to perform by his or  
            her education, training, or experience, or that he or she is  
            otherwise prohibited by law from performing.

          27)Defines "injury" or "illness" means an injury or illness  
            sustained as a result of, or exacerbated by, participation in  
            athletics or physical activity for which the AT has had formal  
            training during his or her professional education program,  
            including nationally recognized educational competencies and  
            clinical proficiencies for the entry-level AT or advanced  
            post-professional study, and falls within the practice of  
            athletic training.

          28)Requires an AT to render treatment within his or her scope of  
            practice under the direction of a physician and surgeon  
            licensed by the Medical Board of California or an osteopathic  
            physician and surgeon licensed by the Osteopathic Medical  
            Board of California, with such direction provided by: 

             a)   Verbal order when the directing physician and surgeon or  
               osteopathic physician and surgeon is present; and, 

             b)   Written order or by athletic training treatment plans or  








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               protocols, to be established by the physician and surgeon  
               or osteopathic physician and surgeon, when the directing  
               physician and surgeon or osteopathic physician and surgeon  
               is not present.

          29)Authorizes the Committee, notwithstanding any other law and  
            consistent with the Act, to establish other alternative  
            mechanisms for the adequate direction of an AT.
             
          30)Exempts from the requirements of the Act the following  
            individuals:

             a)   An AT licensed, certified, or registered in another  
               state or country who is in California temporarily,  
               traveling with a team or organization, to engage in the  
               practice of athletic training for, among other things, an  
               athletic or sporting event;

             b)   An AT licensed, certified, or registered in another  
               state who is invited by a sponsoring organization, such as  
               the United States Olympic Committee, to temporarily provide  
               athletic training services under his or her state's scope  
               of practice for athletic training;

             c)   A student enrolled in an athletic training education  
               program, while participating in educational activities  
               during the course of his or her educational rotations under  
               the supervision and guidance of an athletic trainer  
               licensed under the Act chapter or other licensed health  
               care provider; or,

             d)   A member or employee of the United States Armed Forces,  
               licensed, certified, or registered in another state, as  
               part of his or her temporary federal deployment or  
               employment in California for a limited time.

          31)Declares that the Act does not limit, impair, or otherwise  
            apply to the practice of any person licensed and regulated as  
            a healing arts professional.

          32)Declares that the Act does not require new or additional  
            third party reimbursement for services rendered by an  
            individual licensed under the Act.

          33)Creates the Athletic Trainers' Account in the existing  








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            Physical Therapy Fund.

          34)Defines the terms "athletic trainer," "Board," and  
            "Commission". 

          35)Provides that the provisions of this bill related to title  
            protection, the structure of the Committee, the scope of  
            practice, and physician and surgeon direction of the AT shall  
            become operative on July 1, 2014, as specified.

          36)Makes findings and declarations relative to the need to  
            regulate the profession of athletic training.

           EXISTING LAW  provides for the regulation of various professions  
          and vocations, including those of an athlete agent.

           FISCAL EFFECT  :   Unknown 

           COMMENTS  :   

           1)Purpose of this bill  .  This bill would create the Athletic  
            Training Practice Act to license and regulate ATs through a  
            Committee created under the Physical Therapy Board.  The  
            Committee would have powers similar to other licensing boards  
            under the Department of Consumer Affairs to promulgate  
            regulations, approve training and educational programs,  
            investigate applicants and issue licenses, and order  
            disciplinary measures up to and including license suspension.   
            The Act would become operational on July 1, 2014 and sunset on  
            January 1, 2019 unless dissolved or extended before that date.  
             Opponents question the need for full licensure rather than  
            simple title protection, and also contend that the scope of  
            practice is overly broad and that the Committee should not be  
            located under the Board.  This bill is sponsored by the  
            California Athletic Trainers' Association (CATA). 

           2)Author's statement  .  According to the author: 

               "Athletic trainers and other individuals are currently  
               practicing athletic training - a health care profession -  
               in an unregulated manner.  Athletic training is recognized  
               by the American Medical Association as an allied health  
               care profession that is in the same category as physical  
               therapy and occupational therapy.  Currently 48 other  
               states regulate athletic training due to the inherent risk  








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               of individuals practicing healthcare without oversight.   
               Individuals have come to California from other  
               jurisdictions after losing their license or certification  
               and practice in the state.  In some cases, individuals who  
               have no training, instruction, or experience in athletic  
               training (or any other health or medical profession) are  
               practicing as athletic trainers.  They are employed by  
               schools, businesses and healthcare facilities.  In some  
               cases, individuals such as janitors, coaches, shipping and  
               receiving clerks and others have been given the title  
               Athletic Trainer and the responsibility for doing things  
               such as evaluating and managing concussions, spinal cord  
               injuries, shoulder dislocations, and knee injuries. This  
               lack of oversight has caused harm to the public in  
               California and in other states.

               "Furthermore, the lack of oversight of athletic trainers is  
               a consumer protection problem.  The athletes with whom  
               these unqualified individuals work, and the employers who  
               hire them, have no way of knowing that these individuals  
               are not qualified to be athletic trainers.  The public has  
               no way to determine if someone practicing athletic training  
               is qualified.  The public has no way to file a complaint,  
               or ask for a practitioner to be investigated and/or  
               sanctioned for incompetence, unethical practice, etc.  This  
               creates a huge regulatory gap in the healthcare system?.

               "Additionally, athletic trainers are typically the most  
               available, and also the most qualified, health care  
               providers to evaluate symptoms of a head injury suffered at  
               a school practice or competition to determine if the  
               athlete has a concussion.  However, current law bars  
               athletic trainers from managing concussions simply because  
               they are not licensed."

           3)The practice of athletic training  .  ATs are physical medicine  
            and rehabilitation specialists who generally work in  
            institutional settings under the direction of a physician.  In  
            practice, they are often the first healthcare providers on the  
            scene when injuries occur (particularly at sporting events),  
            and must be able to recognize, evaluate and assess injuries  
            and provide immediate care when needed.  ATs operate with  
            substantial independence and professional decision-making  
            authority, as a physician need not be onsite with the AT, or  
            even to individually know or work with the AT's clientele.  








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          The Act generally describes the practice of athletic training as  
            including the professional treatment of a patient for risk  
            management and injury or illness prevention, as well as the  
            clinical evaluation and assessment, immediate care and  
            treatment, organizational health and well-being, and  
            rehabilitation and reconditioning of a patient from an injury  
            or illness sustained or exacerbated while participating in  
            physical activity.

          ATs are considered "health care professionals" by the American  
            Medical Association, which states that "athletic training  
            encompasses the prevention, diagnosis and intervention of  
            emergency, acute, and chronic medical conditions involving  
            impairment, functional limitations, and disabilities."  ATs  
            are distinct from "personal trainers", who are generally  
            thought of as individuals who prescribe, monitor and modify  
            individual exercise programs in a fitness or sports setting.   
            Athletic training and physical therapy are also specific and  
            different professions, although there are some areas of  
            overlap. 

          ATs are usually employed by organizations such as professional  
            sports teams, colleges and universities, high schools,  
            outpatient rehabilitation clinics, hospitals,  
            industry/corporations, performing arts groups, physicians, the  
            military and health clubs.  Roughly 44% of certified ATs work  
            with athletes in educational or professional sports setting,  
            with nearly 19% working in health care facilities, and over  
            10% working in industry, public safety and the military.  The  
            sponsor reports that large employers use ATs in part because  
            of their utility in reducing employee injuries and worker's  
            compensation costs. 

           4)Current state of regulation for athletic trainers  .  The  
            educational system for athletic training has been standardized  
            and accredited by a national accreditation agency, CAATE.  
            According to the author, all 48 states currently regulating  
            athletic training utilize the BOC certification examination,  
            which is based on CAATE educational principles.  BOC is the  
            only entity that currently provides athletic training  
            certification, which means that it would be the sole provider  
            of the certification exam required by this bill.   
            Certification is not mandatory to practice athletic training  
            in California, and non-certified individuals are not subject  








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            to regulatory discipline.

            Despite its widespread adoption, BOC has a limited ability to  
            investigate complaints against certified ATs because they have  
            no subpoena power and limited staff with no authority in  
            California.  Its sole disciplinary power is the suspension or  
            revocation of the national certification which is not  
            recognized in California and thus poses no barrier to an  
            individual's continued practice. 

            According to the author, athletic trainers are already  
            licensed and regulated in the vast majority of states:  
            "?although 48 states in the nation license athletic trainers  
            and 30 of those states have sunset processes for their  
            licensure acts, no athletic training board has ever been  
                                                          discontinued, demonstrating that there is a continuing need  
            for licensing in those states because of the investigative and  
            regulatory oversight they provide."

            The sponsor notes that there are 47 states that regulate  
            athletic trainers, 39 of which provide licensure. The  
            remaining 8 states have elements of licensure, although  
            different terminology is used.  Only Alaska and Hawaii do not  
            regulate athletic trainers in any form, although they have  
            legislation pending. 

            There are 16 accredited athletic training programs in  
            California. In 2010, 182 Californians were became certified  
            ATs.

            Currently, there are approximately 2,500 certified ATs  
            practicing in California who would qualify for licensure as  
            ATs under the Act.  The sponsor of this bill, CATA, represents  
            approximately 2,300 ATs in California.  

           5)Evidence of substandard practice  .  One rationale for licensure  
            is that an oversight body like the Committee can remove bad  
            actors from practice by suspending or revoking the license  
            that may be a precondition for employment.  Licensure also  
            makes it difficult for unqualified individuals to hold  
            themselves out professionally as ATs.
           
            According to the author, "[a] survey of 760 certified athletic  
            trainers for the Sunrise report found more than 60 cases of  
            harm as the result of improper care provided by non-certified  








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            'athletic trainers.' According to the U.S. Department of Labor  
            Division of Practitioner Data Banks, a voluntary reporting  
            repository for sanctions made by state boards, there were 469  
            reports of sanctions to athletic trainers - both certified and  
            uncertified - from 2000 to 2010.  These sanctions were based  
            upon misconduct including incompetent practice/harm,  
            practicing beyond the scope of practice, and sexual  
            misconduct.  The BOC reported over 2,700 violations  
            [nationwide] of professional practice standards in five years  
            (2005-10) with nearly 300 violations in California, including  
            three sexual offenses.  In a 2011 case, a collegiate athlete  
            died because of negligence of a collegiate athletic trainer,  
            although no lawsuit has been filed to date. Two additional  
            athletic trainers were fired after being arrested on sexual  
            abuse charges."

            The sponsor reports that it is aware of at least 150  
            individuals practicing as athletic trainers without  
            certification in California high schools, and seven  
            individuals working in California community colleges who are  
            similarly unqualified.

            The standardized training required for licensure and the  
            disciplinary oversight provided by the Committee are intended  
            to address these problems.   

           6)Proposed California licensure requirements  .  In order to be  
            eligible for licensure, applicants must have a professional  
            degree from an accredited institution, pass the national  
            written certification exam, possess an emergency cardiac care  
            certification, and pay the application fee.  Individuals  
            without a professional degree would be required to complete at  
            least 1500 hours of clinical experience instead. Biannual  
            license renewal will be subject to continuing education  
            requirements, as determined by the Committee.  

          The Act requires ATs to refer a patient to the appropriate  
            health care provider when the treatment of an injury, illness  
            or condition falls outside of the AT's scope of practice. The  
            Act also requires ATs to render treatment only under the  
            written or verbal direction of a physician and surgeon.   
            Exemption from licensure will apply to ATs licensed in another  
            state or country operating temporarily in California due to a  
            sporting event, students participating in educational  
            activities under the supervision of a licensed AT, and active  








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            members of the military.  

           7)Questions for the Committee  .  This bill currently establishes  
            the Committee as the responsible regulatory entity for ATs,  
            and locates it within the existing Physical Therapy Board.   
            The location of the Committee may prove to be problematic,  
            given the apparent overlap between the professions and the  
            opposition from some quarters of the physical therapy  
            profession. According to the sponsor, the reason for  
            colocation is simply administrative convenience and avoidance  
            of the cost of creating a new board.  Nevertheless, the  
            Committee may wish to consider whether or not the licensing  
            body for ATs should be located under the board of a more  
            closely allied profession, such as the Medical Board of  
            California, or if its mission would be better served as an  
            independent board fully supported by licensing fees.    

          One critically important question is how the scope of practice  
            broadly set out in this bill compares with and overlaps other  
            professions.  The California Physical Therapy Association  
            (CPTA) argues that this bill effectively permits ATs to engage  
            in diagnosis (physical therapists require a physician's  
            diagnosis) and grants a broader scope of practice than  
            physical therapists enjoy, which may or may not be merited by  
            their differing educational requirements.  Given the  
            importance of consistency in setting scope of practice  
            relative to training and education, the Committee may wish to  
            inquire of the author and sponsor as to exactly how the scope  
            and educational requirements for ATs proposed by this bill  
            compare with those of related professions, such as physical  
            therapists, and whether or not the scope indicated by this  
            bill is clear, consistent and fair. 

          This bill also contains a confusing passage declaring that the  
            practice of athletic training does not include the "practice  
            of physical therapy, the practice of medicine, the practice of  
            osteopathic medicine, the practice of chiropractic medicine,  
            the practice of nursing, or medical diagnosis or treatment."  
            (BPC 2697.22(b))  Given the practical overlap that exists  
            between athletic training and physical therapy, for example,  
            this language read literally could be construed to restrict  
            athletic training only to those practices that do not fall  
            within the other cited professions - which presumably would be  
            minimal.  This suggests that the language was intended to  
            communicate the semantic point that the same practices may be  








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            described differently by different professions.  The Committee  
            may wish to inquire of the author as to the necessity of that  
            language.   

            One alternative to licensure that has been proposed in  
            previous legislation is certification and title protection,  
            where AT's continue with certification without a regulatory  
            board, but use of the title of "athletic trainer" is reserved  
            by law only for qualified individuals. While this approach  
            would be simpler, less expensive, and likely less  
            controversial, the sponsor argues that the overall level of  
            consumer protection would be lower as well because there would  
            be no mechanism for investigating or disciplining unqualified,  
            incompetent or unethical practitioners. The Committee may wish  
            to inquire of the author as to the relative merits of a title  
            act approach versus the practice act approach taken by this  
            bill. 

            Finally, the Committee may wish to consider whether or not a  
            cap on licensing fees should be made explicit in this bill, as  
            it is with many other regulated professions, which provides a  
            legislative check against excessive licensing fees.  

           8)Technical amendments  .  There are two technical corrections  
            that the author may wish to consider. 

            Section 2697.8(f) of the bill related to the sunset date of  
            the Committee contains a reference to the now-defunct Joint  
            Sunset Review Committee.  Given that the committee no longer  
            operates, and the sunset review process is now handled jointly  
            by the Senate Business, Professions and Economic Development  
            Committee and the Assembly Business, Professions and Consumer  
            Protection Committee, that reference should be deleted.

                 Page 4, lines 8-12: on line 8, strike the word "The";  
            strike lines 9-12, inclusive. 

            Section 2697.20(b)(2) contains a typographical error.

              Page 6, line 13: after a "certification body approved by",  
            delete "te" and insert "the" 

           9)Arguments in support  .  According to the sponsor, "Athletic  
            training is a profession that is regulated by 48 states,  
            recognized by multiple governmental and healthcare agencies as  








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            a specific healthcare profession and which has a single  
            nationally accredited education and certification process.  As  
            there is no defined scope of practice of athletic training in  
            the state, the status quo is an expansive scope of practice  
            and the ability of individuals to practice without any  
            preparation.  Further, the public has no ability to register  
            complaints nor can the state investigate and sanction unsafe  
            or unethical providers.  AB 864 will for the first time  
            provide a defined scope for this frontline medical profession  
            that is consistent with the extensive education, training and  
            certification of athletic trainers and ensure physician  
            oversight.  It will provide assurance of minimum standards of  
            competence of practitioners and will allow those that are  
            practicing illegally, unsafely or unethically to be  
            sanctioned."

          The American Medical Society for Sports Medicine (AMSSM) writes,  


               "AMSSM has long recognized the value and role of athletic  
               trainers within a Sports Medicine care team? Athletic  
               trainers play an essential role as the front line  
               healthcare professional for a well-functioning,  
               multi-disciplinary Sports Medicine care team.  Athletic  
               trainers interact on a daily basis with the athletes for  
               whom they are caring, are well trained in acute injury and  
               illness evaluation and management, facilitate care from  
               other clinicians when needed, and work closely with team  
               physicians to provide comprehensive care for athletes. 

               "[AB 864] will provide state-specific regulation to the  
               practice of athletic training.  This protects the public by  
               ensuring that those individuals who call themselves  
               "athletic trainers" have the proper educational credentials  
               and are adhering to accepted professional and ethical  
               practice standards.  AMSSM is concerned that a failure by  
               the state of California to license athletic trainers when  
               licensure exists in 48 other states will promote a  
               situation where 'athletic trainers' in California provide  
               substandard care for athletes.  For instance, athletic  
               trainers from other states who have lost their  
               certification or license may come to California to  
               practice.

               "[AB 864] is a cost-neutral bill that will provide a  








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               defined scope of practice to the profession of athletic  
               training in the state of California.  It will provide the  
               public with the certainty that athletic trainers who are  
               practicing in their communities have the requisite skills  
               and educational background to function safely, and it would  
               allow the people of California the means to report and  
               investigate athletic trainers who are practicing in an  
               unsafe manner."

           10)Arguments in opposition  .  According to the California Nurses  
            Association, "There are already qualified healing arts  
            practitioners currently licensed by the state who can perform  
            athletic training services, and thus there is no need to  
            create a new licensing category for athletic trainers.  These  
            existing practitioners, like nurses, physical therapists, and  
            others already retain the education, and clinical training and  
            experience to provide these services in a way that is safe for  
            athletes.  Further, we have very strong concerns with the  
            proposed scope of practice outlined in the bill which is very  
            broad and would endow athletic trainers with the practice  
            authority to treat, clinically evaluate, assess, rehabilitate,  
            and recondition 'patients'."

          CPTA opposes the bill on multiple grounds, namely: 1) there is  
            insufficient evidence of a problem caused by a lack of  
            regulations, and that title protection alone would be an  
            appropriate middle ground; 2) the scope of practice of  
            athletic trainers as defined in the bill is "overly broad,  
            unsafe and inconsistent with the education and training of  
            athletic trainers", particularly in comparison to physical  
            therapists who have more stringent educational requirements  
            yet a narrower scope of practice; 3) the bill unwisely  
            outsources the certification of ATs to a for-profit company  
            located in another state; 4) the Board is not an appropriate  
            place to house the Committee because the Board would lack  
            disciplinary authority over ATs while taking on unwanted  
            financial responsibilities; and 5) physical therapists should  
            be exempted from the licensure requirements because of the  
            higher level of required education and training.  

          According to CPTA, the Joint Legislative Sunset Review Committee  
            analyzed the issue of licensure for athletic trainers during  
            its 2005 sunset review hearings, and found that "At this time,  
            there appears to be insufficient justification to license  
            athletic trainers.  However, some sort of state recognition of  








                                                                  AB 864
                                                                  Page  17

            athletic trainers may be appropriate."  

          The California Federation of Teachers opposes the bill unless  
            amended to permit individuals who have been practicing as ATs  
            for more than 15 years to continue to use the title "athletic  
            trainer" indefinitely. 

           11)Previous legislation  .  

            SB 1273 (Lowenthal) of 2012 was very similar to AB 864.  SB  
            1273 failed passage in the Senate Business and Professions  
            Committee.

            AB 374 (Hayashi) of 2011 in its most recent version would have  
            extended title protection to ATs. AB 374 was amended in the  
            Assembly Appropriations Committee to address an unrelated  
            issue.    

            AB 1647 (Hayashi) of 2010 would have extended title protection  
            to ATs.  AB 1647 was vetoed by the Governor. 

            SB 284 (Lowenthal) of 2007 would have provided for  
            registration of ATs.  SB 284 was vetoed by the Governor.  

            SB 1397 (Lowenthal) of 2006 would have provided for  
            registration of ATs.  SB 1397 was vetoed by the Governor. 

            AB 614 (Lowenthal) of 2003 would have required the Department  
            of Consumer Affairs to review the need for licensing of ATs.   
            AB 614 was held in the Senate Business and Professions  
            Committee. 

            AB 2789 (Lowenthal) of 2002 would have required the Department  
            of Consumer Affairs to review the need for licensing of ATs  
            and undertake an occupational analysis.  AB 2789 was held on  
            the Assembly Appropriations Committee Suspense file.  

           REGISTERED SUPPORT / OPPOSITION  :   

           Support 
           
          California Athletic Trainers' Association (sponsor)
          American Medical Society for Sports Medicine
          Advocates for Injured Athletes
          California Community College Athletic Trainers' Association








                                                                  AB 864
                                                                  Page  18

          1378 private individuals

           Opposition 
           
          California Federation of Teachers
          California Nurses Association
          California Physical Therapy Association 
          Independent Physical Therapists of California
          Mount St. Mary's College
          Occupational Therapy Association of California
          398 private individuals
           
          Analysis Prepared by  :    Hank Dempsey / B.,P. & C.P. / (916)  
          319-3301