BILL ANALYSIS Ó
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|Hearing Date:April 22, 2013 |Bill No:SB |
| |218 |
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SENATE COMMITTEE ON BUSINESS, PROFESSIONS
AND ECONOMIC DEVELOPMENT
Senator Curren D. Price, Jr., Chair
Bill No: SB 218Author:Yee
As Amended:April 9, 2013 Fiscal: Yes
SUBJECT: Healing arts.
SUMMARY: Establishes the California Traditional Chinese Medicine
Traumatology Committee under the California Acupuncture Board and
requires the California Acupuncture Board to issue a certificate to
practice as a Traditional Chinese Medicine Traumatologist to
applicants who meet certain education, training and clinical
experience requirements and pay a specified fee.
Existing law:
1)Establishes the California Acupuncture Board (Board) within the
Department of Consumer Affairs (DCA), which licenses and regulates
the acupuncture profession pursuant to the Acupuncture Licensure
Act. (Business and Profession Code (BPC) § 4925)
2)Defines an acupuncturist as an individual who has been licensed to
practice acupuncture pursuant to the Acupuncture Licensure Act.
Defines acupuncture as the stimulation of a certain point or points
on or near the surface of the body by the insertion of needles to
prevent or modify the perception of pain or to normalize
physiological functions, including pain control, for the treatment
of certain diseases or dysfunctions of the body and includes the
techniques of electroacupuncture, cupping and moxibustion. (BPC §
4927)
3)States that a licensed acupuncturist is authorized to do the
following:
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a) To engage in the practice of acupuncture.
b) To perform or prescribe the use of Asian massage, acupressure,
breathing techniques, exercise, heat, cold, magnets, nutrition,
diet, herbs, plant, animal, mineral products, and dietary
supplements to promote, maintain, and restore health. Nothing in
this section prohibits any person who does not possess an
acupuncturist's license or another license as a healing arts
practitioner from performing or prescribing the use of any of
these modalities, as specified. (BPC § 4937)
4)Provides for certification of massage practitioners and massage
therapists, as defined, by a Massage Therapy Organization (MTO) and
specifies that the MTO is a nonprofit organization meeting specified
requirements, and imposes certain duties on the MTO. (BPC §§ 4600
(e), 4600.5 (a) and (b)(2))
5)Provides that the MTO is to be governed by a board of directors
selected from various related groups, organizations and entities,
including law enforcement, involved with both the business and
practice of massage therapy. (BPC § 4600.5 (b)(1))
6)Requires the MTO to issue either a "massage practitioner"
certificate or a "massage therapist" certificate to an applicant,
who submits a written application and provides satisfactory evidence
that he or she meets all of the specified education, experience or
examination requirements, or has a current valid license from a
local jurisdiction and meets other education and/or experience
requirements. (BPC § 4601 (b))
7)Provides for various grounds for discipline against a certificate
holder or for denial of a certificate to an applicant, including:
unprofessional conduct; procurement of certificate by fraud;
misrepresentation or mistake; conviction of a felony or misdemeanor
substantially related to their qualifications, functions or duties,
or committing any fraudulent, dishonest, or corrupt act that is
substantially related; and, committing any act punishable as a
sexually related crime. (BPC § 4603)
8)Provides that it is an unfair business practice for any person to
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state or advertise or put out any sign or card or other device, or
to represent to the public through any print or electronic media,
that he or she is certified, registered, or licensed by a
governmental agency as a massage therapist or practitioner. (BPC §
4605)
9)Provides that it is an unfair business practice for any person to
use the title of "certified massage therapist" or certified massage
practitioner" or any other term, such as "licensed," "registered,"
or "CMT," that implies or suggest that the person is certified as a
massage therapist or practitioner without meeting the requirements
as specified. (BCP § 4606)
10)Establishes the State Board of Chiropractic Examiners which
licenses and regulates the chiropractic profession pursuant to the
Chiropractic Act. (Chiropractic Initiative Act, § 1, adopted by the
electors November 7, 1922)
11)Makes the unlawful practice of medicine a public offense with both
misdemeanor or felony penalty provisions which would apply. (BPC §
2052)
This bill:
1)Defines "Traditional Chinese Medicine Traumatology." (TCMT)
2)Defines a "Certified Traditional Chinese Medicine Traumatologist."
(CTCMT)
3)Makes it a misdemeanor, for any individual who does not hold a valid
certificate, to hold oneself out as or to fraudulently buy, sell, or
obtain a certificate as a "Certified Traditional Chinese Medicine
Traumatologist."
4)Makes it a misdemeanor for any individual to fraudulently buy, sell,
or obtain a certificate as a "Certified Traditional Chinese Medicine
Traumatologist."
5)Establishes the TCMT Committee within the California Acupuncture
Board.
6)Specifies the composition and membership of the TCMT Committee.
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7)Requires an applicant to furnish satisfactory evidence of education,
training and clinical experience that meets one of the following
standards:
a) Passed an examination and received a certificate in
traditional Chinese medicine traumatology for completing a
curriculum in the subject. The curriculum for all applicants
shall provide for adequate instruction in the following subjects:
i) Human anatomy and physiology
ii) Pathology
iii) Western diagnosis on traumatological injury
iv) Clinical management and medical ethics
v) Basic theory of traditional Chinese medicine
vi) Comparison of traditional Chinese medicine and western
medicine
vii) Meridian and acu-points
viii) Basic traditional Chinese medicine diagnosis
ix) Basic theory of traditional Chinese medicine traumatology
x) Traditional Chinese medicine diagnosis on traumatology
xi) Hands on Skills of Traditional Chinese Medicine
Traumatology I
xii) Hands on Skills of Traditional Chinese Medicine
Traumatology II
xiii) Chinese herbs and formulas for traumatology
xiv) Traditional Chinese medicine traumatology case study
xv) Completes one thousand hours in a clinical internship on
traditional Chinese medicine traumatology
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b) The applicant has been apprenticed as a traditional Chinese
medicine traumatologist for 10 years prior to January 1, 2014.
c) Applicants who completed education and training outside of the
United States or Canada must furnish evidence of their education
and at least 10 years of clinical experience.
8)Authorizes the TCMT Committee to review the applicant's
qualifications for certification.
9)Defines unprofessional conduct and provides the California
Acupuncture Board the ability to deny, suspend or revoke or impose
probationary conditions upon the license of any CTCMT if he or she
is guilty of unprofessional conduct or fraudulent act.
10)Defines fraudulent activity and provides the California Acupuncture
Board the ability to deny, suspend or revoke or impose probationary
conditions upon the license of any CTCMT if he or she is guilty of a
fraudulent act.
11)Provides the California Acupuncture Board the ability to deny,
suspend or revoke or impose probationary conditions upon the license
of any CTCMT if he or she is guilty of committing:
a) Gross negligence
b) Repeated negligent acts
c) Incompetence
12)Specifies the California Acupuncture Board's authority regarding
CTCMT's who have been convicted of a crime.
13)Includes specifications regarding where a certificate holder should
post their license and a timeline for notifying the California
Acupuncture Board when a certificate holder changes the location of
their practice.
14)Specifies the expiration timeframe for certificates and renewal
requirements.
FISCAL EFFECT: Unknown. This bill has been keyed "fiscal" by
Legislative Counsel.
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COMMENTS:
1.Purpose. This bill is sponsored by the American Traditional Chinese
Medicine Traumatology Association . According to the Author,
existing law neither oversees nor regulates the practice of
traumatology. Currently, anyone can obtain a business license and
call themselves a traumatologist. SB 218 would place the profession
under state oversight to ensure the proper use of the title
"Certified Traditional Chinese Medicine Traumatologist."
2.Background.
a) Traditional Chinese Medicine. In ancient China, Traditional
Chinese Medicine (TCM) was taught via family or
master-apprenticeship education meaning these practitioners
learned from a master through hands-on training. During the Tang
Dynasty (618-907 A.D.), there was a TCM school to train imperial
physicians called "Taiyishu;" the earliest medical school run
and managed by the government. After the foundation of the
People's Republic of China in the 1950's, a series of policies
and measures for promoting TCM education were instituted. In
1956, China set up the first group of TCM colleges, including
Beijing College of TCM, Shanghai College of TCM, Guangzhou
College of TCM and Chengdu College of TCM.
To date, approximately 100,000 students have been trained in TCM.
Presently, there are 33 TCM colleges and universities in China
with approximately 30 thousand students. Among the 33 colleges
and universities, 15 offer bachelor's degrees, 22 offer masters
degrees and 10 offer doctorate degrees. Three other universities
have post-doctoral programs. Over one third of TCM colleges and
universities admit foreign students and about 2000 foreign
students have graduated to date. Generally, each college or
university of TCM has two to three affiliated hospitals. The
affiliated hospitals are the schools' clinical training base.
After completing their TCM bachelor degrees, students may elect
to spend an additional two years specializing in a variety of
tracks including acupuncture and traumatology.
b) Traditional Chinese Medicine Traumatology. Traumatology is
one of the modalities that constitute TCM. Traumatology is
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defined as a range of treatments that address both acute and
chronic musculoskeletal conditions through stimulation of
rolling, pressing, rubbing, pushing, holding and lifting the
areas between each of the joints to open the body's defensive chi
and stimulate the energy movement in four meridians. Currently,
there are approximately 80-100 individuals practicing
traumatology in California. Although highly skilled, it is
extremely difficult for these practitioners to obtain proof of
their training to qualify for licensure as an acupuncturist. As
such, the practice of traumatology remains unregulated in
California.
(Note: The term "traumatology" is also defined as the study of
wounds and injuries caused by accidents or violence to a person,
and the surgical therapy and repair of the damage, and is
considered as a branch of medicine. It is often considered a
subset of surgery, and in countries with the specialty of trauma
surgery it is most often a sub-specialty to orthopedic surgery.
Traumatology may also be known as accident surgery.)
3. Arguments in Support. The American Traditional Chinese Medicine
Traumatology Association (Sponsor) believes that the measure would
provide a pathway for skilled traumatologists to achieve California
certification and thereby provide Californians with basic health
and safety assurances when receiving services from a California
Certified Traumatologist.
The Chinese Consolidated Benevolent Association states, "TCM
Traumatology takes a holistic approach to the body with a complete
theoretical system that has provided cures to individuals for
centuries."
Andrew University argues that traumatology has been practiced in
California since the first Chinese immigrants built the railroads
in the mid to late 1800's. "A group of such practitioners exist in
the state of California and have been providing highly skilled and
affordable care to the public. In many cases, these practitioners
provide these needed services in some of the most disadvantaged and
low-income communities."
Alhambra Medical University supports the bill "because it will be
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beneficial to the health of the people in California."
The National Guild of Acupuncture and Oriental Medicine, California
Chapter believes that the bill would provide a legal mechanism for
practitioners of traumatology to become state certified and subject
to DCA oversight through the Acupuncture Board.
The American Chinese Cultural Exchange & Trading Association
believes that the bill would bring about a public recognition of
the profession, establish high standards and training for the
certification process and continue to enhance the public's access
to high quality care at very affordable prices.
4. Arguments in Opposition. The California Acupuncture Coalition
opposes SB 218. In their letter they note, "This bill will impose
significant new burdens and regulatory complexities on a licensing
board that is already struggling?it will create consumer confusion
and endanger the reputation of existing California licensed
acupuncturists. The funds collected from licensure fees will not
be sufficient to cover the development and administration of an
examination; adequate regulatory oversight and administrative
support; and enforcement and other consumer protection mechanisms."
The California State Oriental Medical Association also opposes the
bill. They have concerns that the proposed educational
requirements are "substandard," and they point out that no
continuing education would be required.
The United California Practitioners of Chinese Medicine indicates
in their letter, "The bill is unnecessary because practitioners of
TCM are currently eligible for certification by the California
Massage Therapy Council."
The California Certified Acupuncturists Association opposes the
bill. They argue, "This bill appears to mainly satisfy the needs
of?a small interest group?that is unable or unwilling to obtain
licensing or certification through existing means." They also
note, "The creation of a TCM Traumatology Committee with the
coexistence of the California Acupuncture Board may undermine the
integrity of the existing licensed acupuncture profession. Also,
the introduction of a new certificate title will likely cause
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confusion among consumers."
The Academy of Chinese Medicine believes that the bill would
jeopardize public safety. They state, "Given the absence of clear
educational and certification standards for TCM traumatology as a
stand-alone medical field in California, this bill does not define
who administers the education program and how many hours are
required. In addition, there is no standard examination given
through the Acupuncture Board in this bill. [There] is no doubt
that such a bill will post a tremendous risk for the general
public."
5. Related Legislation. SB 1488 (Yee, 2012) would have established
the California Traditional Chinese Medicine Traumatology Council as
a non-profit organization to provide for the certification and
regulation of the practice of California traditional Chinese
Medicine traumatologists. The bill would have required the
council to develop and report to the Legislature by January 1,
2015, its standards for approving education programs, and
evaluating the education, training and clinical experience of
applicants and would have repealed the provisions on January 1,
2017. ( Note : This measure passed out of this Committee by a vote
of 5 to 2 on April 26, 2012. It failed passage in Assembly
Business, Professions and Consumer Protection on June 26, 2012. It
was granted reconsideration but was not set for another hearing.)
SB 628 (Yee, 2011) would have changed the name of the California
Acupuncture Board to the "Traditional Chinese Medicine Board,"
retitled the Acupuncture Licensure Act into the "Traditional
Chinese Medicine Licensure Act" and changed the designation of a
licensed acupuncturist into a licensed "Traditional Chinese
Medicine Practitioner." Would have provided for the certification
of traumatologists and included traumatology in the authorized
activities of a licensed acupuncturist. ( Note : This measure passed
out of this Committee by a vote of 5 to 2 on May 5, 2011. It
failed passage in Assembly Business, Professions and Consumer
Protection on July 5, 2011. It was granted reconsideration but was
not set for another hearing.)
SUPPORT AND OPPOSITION:
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Support:
Chinese Consolidated Benevolent Association
Andrew University
Alhambra Medical University
American Traditional Chinese Medical Traumatology Association
California Traditional Chinese Medicine University Alumni Association
Hoy Sun Wing Yung Benevolent Association in America
Wong Family Benevolent Association Incorporated
Tom Family Benevolent Association
Chinese Medicine Society of America
California Acupuncture Oriental Medicine Association
United Acupuncture Association
American Association of Acupuncture and Traditional Chinese Medicine
Vietnamese Acupuncture and Oriental Medicine Association Institute
Chinese Athletic Association of San Francisco
Yau Kung Moon Kung-Fu Association of USA
Far East Café
Citizens for Better Community
National Guild of Acupuncture and Oriental Medicine
American Chinese Cultural Exchange & Trading Association
North American Oriental and Western Medicine Academy
American Chinese Traumatology Association
Over 200 individuals
Opposition:
California Acupuncture Coalition
California State Oriental Medical Association
United California Practitioners of Chinese Medicine
California Certified Acupuncturists Association
Academy of Chinese Medicine
Citizens for Better Community
EGA International
Pacific College of Oriental Medicine
Southern California University of Health Sciences
Association of World Traditional Medicine
CFM Educational Services
Over 100 licensed acupuncturists
Over 1000 acupuncture patients
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Consultant:Le Ondra Clark, Ph.D.