BILL ANALYSIS Ó
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|Hearing Date:June 23, 2014 |Bill No:AB |
| |2214 |
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SENATE COMMITTEE ON BUSINESS, PROFESSIONS
AND ECONOMIC DEVELOPMENT
Senator Ted W. Lieu, Chair
Bill No: AB 2214Author:Fox
As Amended:April 21, 2014Fiscal: Yes
SUBJECT: Emergency room physicians and surgeons: continuing medical
education: geriatric care.
SUMMARY: Enacts the Dolores H. Fox Act to require the Medical Board
of California to consider including a course in geriatric care for
emergency room physicians and surgeons as part of its continuing
education requirements.
Existing law:
1)Licenses and regulates physicians and surgeons under the Medical
Practice Act by the Medical Board of California (MBC) within the
Department of Consumer Affairs (DCA). (Business and Professions
Code (BPC) § 2000 et seq.)
2)Requires MBC to adopt and administer standards for the continuing
education of licensees, and requires each licensee to demonstrate
satisfaction of the requirements at regular intervals. (BPC § 2190)
3)Requires all general internists and family physicians, who have a
patient population of which over 25% are 65 years of age or older,
to complete at least 20% of all mandatory continuing education hours
in a course in the field of geriatric medicine or the care of older
patients. (BPC § 2190.3)
4)Requires all physicians and surgeons to complete a mandatory
continuing education course in the subjects of pain management and
the treatment of terminally ill and dying patients, as specified.
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(BPC § 2190.5)
5)Requires MBC to consider including a course in the following subjects
when determining its continuing education requirements: (BPC §
2191)
a) Human sexuality and nutrition;
b) Child abuse detection and treatment;
c) Acupuncture;
d) Nutrition;
e) Elder abuse detection and treatment;
f) Early detection and treatment of substance abusing pregnant
women;
g) Special care needs of drug addicted infants;
h) How to routinely screen for signs exhibited by abused women;
i) Special care needs of individuals and their families facing
end-of-life issues; and
j) Pain management.
This bill: Enacts the Dolores H. Fox Act to require the Medical Board
of California (MBC) to consider including a course in geriatric care
for emergency room physicians and surgeons as part of its continuing
education requirements.
FISCAL EFFECT: This measure has been keyed "fiscal" by Legislative
Counsel. The May 14, 2014 Assembly Committee on Appropriations
analysis cites minor and absorbable costs to MBC (Contingent Fund of
the MBC).
COMMENTS:
1.Purpose. This bill is sponsored by the Author in order to require
the Medical Board of California, in determining continuing education
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requirements, to consider including a course in geriatric care for
emergency room physicians and surgeons.
According to the Author, "California faces a critical shortage of
physicians with geriatric care expertise. For many elderly, the
emergency room is where the first signs of major health
complications are revealed, but often they are not recognized or
properly diagnosed. Elderly patients do not exhibit the same signs
or symptoms of illnesses as younger patients, often times causing
the elderly patients being misdiagnosed."
The Author believes that the lack of specific training in geriatric
care hinders emergency room physicians in their ability to provide
the best care to senior patients. The Author argues that current
continuing education training requirements for emergency room
physicians are insufficient to meet the needs of the elderly, and
states that this bill is necessary to ensure that emergency room
doctors have the knowledge and skills required to competently treat
elderly patients.
2.Background. A March 13, 2014 New York Times article titled
"Emergency Rooms Are No Place for the Elderly" states: "The number
of older people seeking health care is expected to increase
significantly over the next 40 years, doubling in the case of those
older than 65, potentially tripling among those over 85. In a
health care system already critically short of primary care
providers and geriatrics specialists, many of these older patients
will likely end up in emergency rooms." The article further
indicates that over the last five decades quality emergency care has
become synonymous with speed. Survival rates for patients suffering
stroke, heart attack or traumatic injury depend on the number of
minutes needed to triage, diagnose and treat. However, when it
comes to elderly patients, it is nearly impossible to work quickly.
Many are plagued with chronic diseases like diabetes, high blood
pressure and heart disease, and take numerous prescription drugs
which interact in complex and often times dangerous ways. The
elderly are also more likely to suffer dementia and cognitive
disorders that make answering even the simplest questions difficult.
The Times further notes that in recent years a growing number of
physicians and health facilities have begun to focus on the needs of
the growing elderly population as it interacts with the emergency
room. A number of changes have been suggested, including routine
screening for dementia and cognitive impairments, the use of
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non-slip flooring to decrease the risk of falls and training staff
to be more effectively tuned to the needs and circumstances of the
elderly. The Times writes that in recent years, "?about 50 medical
centers have incorporated such changes in their emergency rooms, a
notable improvement from a decade ago when none existed."
3.Geriatric Care. Geriatric medicine is medical specialty that
addresses the complex needs of older patients and emphasizes
maintaining functional independence even in the presence of chronic
disease. Geriatric medicine requires an interdisciplinary approach
between physicians, nurses, social workers, occupational therapists
and family members in order to provide comprehensive care for these
patients with multiple needs.
Geriatric medicine is its own specialty. After an internal medicine or
family practice residency, physicians can complete a one or two-year
fellowship training in the medical, social and psychological issues
that concern older adults to become certified in geriatric medicine.
This specialty is increasing in importance as the population ages
and that aging population lives longer. People over the age of 85
are the fastest growing segment of the population, and it is no
longer a rarity for people to live to be one hundred.
Geriatricians are primary care physicians who specialize in care for
people 65 and older and can also serve as consultants to other
physicians and to hospital programs that work with the elderly.
Geriatricians are typically board certified in Internal Medicine and
have additional training in areas pertaining to elder care. They
address issues such as memory loss, arthritis, osteoporosis,
mobility and Alzheimer's disease.
The Rand Corporation states that there is a shortage of geriatricians
in the United States, with fewer than four certified geriatricians
in the United States per 10,000 individuals 75 years of age or
older. Less than 1% of graduates from United States medical schools
choose geriatric medicine as a career.
With diminishing access to specialized care for older patients, an
inevitable consequence will be more older patients will seek
treatment in the emergency room. These facts underscore the need
for this bill.
4.Continuing Education Requirements. The MBC requires all physicians
to complete at least 50 hours of approved continuing education for
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each two-year period immediately preceding
the expiration date of the license. The MBC approves continuing
education providers and establishes criteria for acceptable courses.
The MBC requires all physicians to complete a mandatory continuing
education course in the subjects of pain management and the
treatment of terminally ill and dying patients. It also requires
all general internists and family physicians who have a patient
population of which over 25% are 65 years of age or older, to
complete at least 20% of all mandatory continuing education hours in
a course in the field of geriatric medicine or the care of older
patients.
The law further establishes a list of subjects that the MBC considers
when establishing continuing education requirements for physicians
and surgeons. This bill would require the MBC to add geriatric care
for emergency room physicians to that consideration list, but does
not mandate that the actual courses be required.
5.Related Legislation. AB 2198 (Levine) of 2014 requires a
psychologist, marriage and family therapist, educational
psychologist, professional clinical counselor and clinical social
worker, who began graduate study on or after January 1, 2016, to
complete a minimum of 15 hours of coursework on suicide prevention,
before being issued a license. Further requires, commencing January
1, 2016, a person licensed in these professions who began graduate
study prior to January 1, 2016, to take a six-hour continuing
education course on suicide prevention in order to renew a license.
( Status : This measure is also scheduled to be heard in this
Committee on June 23, 2014.)
AB 1820 (Wright, Chapter 440, Statutes of 2000) requires coursework and
training in geriatrics for general internists and family physicians.
AB 253 (Eng, Chapter 678, Statutes of 2007), sponsored by the MBC,
drastically changed the MBC's structure and membership. Previously,
MBC was made up of two Divisions, the Division of Licensing and the
Division of Medical Quality. The Division of Licensing handled all
policy decisions related to the MBC's licensing functions. The
Division of Medical Quality dealt with all enforcement policy
decisions. For the most part, each Division operated independently
from the other Division. The MBC realized that this was not the
best arrangement in order to meet its mission of consumer
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protection. AB 253 restructured the MBC to eliminate the two
divisions, resulting in a single, unified MBC. The bill also
reduced the membership from 21 Members, to 15 Members.
6.Arguments in Support. The California Commission on Aging (CCoA)
argues that, "California faces a critical shortage of medical
professionals with geriatric care expertise. For many elderly, the
emergency room is where the first signs of major health
complications are revealed, but often they are not recognized or
properly diagnosed. By recommending that geriatric care training be
made available in continuing education coursework, AB 2214 could
provide emergency room professionals access to important information
on the complex health issues that elders face."
California Long-Term Care Ombudsman Association (CLTCOA) states:
"Frequently, the lack of specific training in geriatric care hinders
emergency room physicians in their ability to provide the best
quality care for their senior patients. The current continuing
education training requirements for emergency room physicians are
insufficient to meet the needs of seniors, particularly those
seniors who live in long-term care facilities. AB 2214 is an
appropriate solution to this problem."
7.Suggested Conforming Amendments. This bill amends Section 2191 of
the Business and Professions Code which refers to the "Division of
Licensing" and "division" rather than to the "board." AB 253 (Eng,
Chapter 678, Statutes of 2007) restructured the MBC to eliminate the
Division of Licensing and the Division of Medical Quality, resulting
in a single, unified MBC. Staff recommends conforming amendments to
update this code section to appropriately refer to the "board."
SUPPORT AND OPPOSITION:
Support:
California Commission on Aging
California Long-Term Care Ombudsman Association
Opposition:
None received as of June 18, 2014
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Consultant:G. V. Ayers