BILL ANALYSIS                                                                                                                                                                                                    Ó



                                                                  SB 218
                                                                  Page  1

          Date of Hearing:   August 6, 2013

              ASSEMBLY COMMITTEE ON BUSINESS, PROFESSIONS AND CONSUMER  
                                     PROTECTION
                               Susan A. Bonilla, Chair
                      SB 218 (Yee) - As Amended:  August 5, 2013

           SENATE VOTE  :   23-6
           
          SUBJECT  :   Healing arts. 

           SUMMARY  :   Authorizes the creation of a non-profit California  
          Traditional Chinese Medicine Traumatology Council (Council),  
          requires the Council to develop standards for the education and  
          training of applicants, and authorizes the Council to issue  
          certificates to qualified applicants to practice as a California  
          certified traditional Chinese medicine traumatologist (CCTCMT),  
          and to discipline certificate holders for specified violations.   
           Specifically,  this bill  :   

           1) Defines "California traditional Chinese medicine  
             traumatology" (TCMT) as including a range of treatments to  
             address both acute and chronic musculoskeletal conditions  
             through stimulation of acupressure points. Techniques  
             include, but are not limited to, brushing, kneading, 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 the meridians.

           2) Defines a "California certified traditional Chinese medicine  
             traumatologist" as "a person who has been certified by the  
             Council to perform California traditional Chinese medicine  
             traumatology."

           3) Requires the establishment of the Council, which shall be a  
             non-profit organization exempt from taxation as specified,  
             for the purpose of developing standards for, and certifying  
             the practice of, TCMT. 

           4) Authorizes the Council to commence activities after  
             submitting a request to the Internal Revenue Service seeking  
             the exemption. 

           5) Specifies that the Council shall consist of five members,  
             each of whom shall serve four year terms:








                                                                  SB 218
                                                                  Page  2


             a)   Two representatives from the clinical settings of  
               traumatology;

             b)   One representative from the Medical Board of California;  
               and,

             c)   Two representatives from the California Medical  
               Association.

           6) Requires that the representatives from the clinical settings  
             of traumatology be selected by professional societies,  
             associations, or other entities, whose memberships are  
             comprised solely of practitioners of TCMT.

           7) Clarifies that the selecting professional society,  
             association, or entity must have a dues-paying membership in  
             California of at least 30 individuals for the last three  
             years and shall have bylaws that require its members to  
             comply with a code of ethics.

           8) Requires the meetings and deliberations of the Council to be  
             subject to the provisions of the Bagley-Keene Open Meeting  
             Act, and all hearings shall be subject to the provisions of  
             the Ralph M. Brown Act.

           9) Requires the Council to issue the title and certificate for  
             CCTCMT to any applicant who applies on a form developed by  
             the Council and meets all of the following requirements:

             a)   Is at least 18 years of age;

             b)   Is not subject to denial for reasons related to the  
               making of false statements, conviction of a crime, acts  
               involving dishonesty or deceit, acts that would otherwise  
               constitute grounds for suspension or revocation of a  
               license under the Business and Professions Code, and a lack  
               of good moral character, as specified; 

             c)   Passes a written examination developed and administered  
               by the Council that tests the applicant's ability,  
               competency, and knowledge in the practice of TCMT; and, 

             d)   Completes and furnishes:









                                                                  SB 218
                                                                  Page  3

               i)     For an applicant who has completed education and  
                 training outside of the United States or Canada,  
                 documented evidence of education and training, and at  
                 least eight years of clinical experience in TCMT that  
                 meets the standards established by the Council; or, 

               ii)    For an applicant who has completed education and  
                 training inside the United States or Canada, a  
                 certificate in TCMT upon completion of a curriculum in  
                 the subject, which provided  adequate instruction in  
                 thirteen specified subjects, as well as 1,000 hours in a  
                 clinical internship in TCMT. 

          10)                                          States that  
            documentation of education and training may include degrees,  
            certificates, transcripts, and proof of academic or clinical  
            residency.

           11)Requires the Council to investigate all of the documentation  
             provided by the applicant and verify its authenticity to  
             evaluate whether an applicant meets the certification  
             standards, including the level of experience and training to  
             sufficiently qualify for the traumatology certification.

          12)                                          Requires the  
            certificate holder to renew his or her certificate every two  
            years.

          13)                                          Requires the  
            Council to develop and report to the Legislature by January 1,  
            2016, all of the following:

             a)   The standards for approval of educational and clinical  
               training programs;

             b)   The standards for evaluating the education, training,  
               and clinical experience of an applicant;

             c)   The written examination; and, 

             d)   A continuing education program.

          14)                                          Prohibits a CCTCMT  
            from practicing medicine, or practice within the scope of  
            activities regulated by the State Board of Chiropractic  








                                                                 SB 218
                                                                  Page  4

            Examiners.

          15)                                          Requires an  
            applicant for certification to file an application with the  
            Council. 

          16)                                          Prohibits an  
            individual who is not qualified to receive the title and  
            certificate from holding himself or herself out as a CCTCMT. 

          17)                                          Requires  
            certificate holders to notify the Council of his or her home  
            address and any business address where he or she regularly  
            practices, whether as an employee or as an independent  
            contractor, and further requires the certificate holder to  
            notify the Council of any change of address within 30 days of  
            the change.

          18)                                          Requires the  
            certificate holder to include the name under which he or she  
            is certified and his or her certificate number in all  
            advertising, and to display his or her original certificate at  
            his or her place of business. 

          19)                                          Requires the  
            certificate holder, upon request at the location where he or  
            she practices, to provide the name under which he or she is  
            certified and the certificate number to a member of the  
            public, the Council, or a member of law enforcement or a local  
            government agency.

           20)Requires applicants to pay an application fee and a renewal  
             fee, to be set by the Council in an amount not to exceed the  
             amount required to cover the reasonable cost of administering  
             the program.

           21)Requires that moneys received by the Council be utilized by  
             the Council to pay for the costs associated with  
             administering these provisions. 

           22)Requires the Council to provide a breakdown of costs  
             associated with administering these provisions on an Internet  
             Web site. 

           23)Declares that it is an unfair business practice for any  








                                                                  SB 218
                                                                  Page  5

             person to hold himself or herself out as a CCTCMT or to use  
             the title of "California certified traditional Chinese  
             medicine traumatologist" without meeting the specified  
             requirements.

           24)Declares that it is a violation of these provisions for the  
             certificate holder to commit, and the Council may deny an  
             application for a certificate or suspend or revoke a  
             certificate for, any of the following, as specified:

             a)   Unprofessional conduct, as specified;

             b)   Procuring a certificate by fraud, misrepresentation, or  
               mistake;
              
             c)   Violating or attempting to violate, directly or  
               indirectly, or assisting in or abetting the violation of,  
               or conspiring to violate, any of these provisions, or any  
               rule or bylaw adopted by the Council; 

             d)   Conviction of any felony, or conviction of a misdemeanor  
               that is substantially related to the qualification or  
               duties of a certificate holder;

             e)   Impersonating an applicant or acting as a proxy for an  
               applicant;

             f)   Impersonating a CCTCMT, or allowing an uncertified  
               person to use a certificate;

             g)   Committing any fraudulent, dishonest, or corrupt act  
               that is substantially related to the qualifications or  
               duties of a certificate holder; or,

             h)   Committing any act punishable as a sexually related  
               crime.

          25)                                          Requires the  
            Council to investigate within 30 days any consumer complaints  
            against a certificate holder, and further requires the Council  
            to establish an Internet Web site where consumers may file  
            complaints, including a web-based complaint form.

          26)                                          Prohibits the  
            Council from disciplining or denying a certificate to a  








                                                                  SB 218
                                                                  Page  6

            certificate holder or applicant except according to these  
            provisions.

          27)                                          Requires the  
            Council to act in good faith and in a fair and reasonable  
            manner in denying an application or disciplining a certificate  
            holder, and further deems certain procedures to be "fair and  
            reasonable," as specified, although a court may also find  
            other procedures to be fair and reasonable when the full  
            circumstances or considered.                 

          28)Deems disciplinary procedures to be fair and reasonable if  
            specifically authorized by statute or if all of the following  
            apply:

             a)   The procedures has been set forth in the articles or  
               bylaws of the Council, and such provisions are provided  
               annually to all members;

             b)   The procedures provide for 15 days' prior notice of the  
               discipline to the certificate holder and the reasons  
               therefor;

             c)   The procedures provide an opportunity for the accused to  
               be heard, orally or in writing, not less than five days  
               before the effective date of the discipline by the  
               decision-making body;

          29)Requires notice of discipline to be given by a method  
            reasonably calculated to provide actual notice, as specified. 

          30)Authorizes the Council to discipline a certificate holder by  
            probation, suspension for a period not to exceed one year,  
            revocation, suspension, or other authorized action, as  
            specified.

          31)Authorizes the Council to issue an initial certificate on  
            probation, with specific terms and conditions. 

          32)Requires the Council to take all of the following actions if  
            it receives notice that a certificate holder has been arrested  
            and charges alleging specified offenses have been filed,:

             a)   Immediately suspend the certificate on an interim basis;









                                                                  SB 218
                                                                  Page  7

             b)   Notify the certificate holder within 10 business days of  
               the suspension and the reasons therefor; and,

             c)   Notify the employer, if known, of the certificate  
               holder, within 10 business days of the suspension.  

          33)Requires the suspended certificate, upon notice of a  
            conviction, to be permanently revoked; and further requires  
            the Council to provide notice to the certificate holder of the  
            existence of that evidence within 10 business days, and that  
            the certificate will be revoked within 15 business days unless  
            countervailing evidence is provided by the certificate holder.  


          34)Requires that any action challenging discipline or denial,  
            including claims of defective notice, to be commenced within  
            one year after the date of the certificate denial or  
            discipline; and further authorizes a court to grant relief,  
            including reinstatement, if it finds that relief to be  
            equitable under the circumstances. 

          35)Declares that denial or discipline based on substantive  
            grounds that violates contractual or other rights, or is  
            otherwise unlawful, is not made valid by compliance with these  
            provisions. 

          36)Requires the Council, upon notice to the Council that the  
            charges resulted in an acquittal, to immediately reinstate a  
            suspended certificate and provide notice of the reinstatement  
            within 10 business days to any business that previously  
            received a notice of suspension.

          37)Requires the Council, notwithstanding any other law and if it  
            receives clear and convincing evidence that a certificate  
            holder has committed an act punishable as a sexually related  
            crime or felony that is substantially related to the  
            qualification, functions or duties of a certificate holder, to  
            immediately suspend the certificate; further requires the  
            Council to consider any available mitigating evidence, except  
            as specified.  

          38)Requires the Council, if it suspends a certificate for a  
            sexually related crime or felony substantially related to the  
            qualification, to take the following additional actions:









                                                                  SB 218
                                                                  Page  8

             a)   Notify the certificate holder within 10 business days of  
               the suspension, the reason therefor, and the holder's right  
               to request a hearing;

             b)   Notify any employer or contractor, and the appropriate  
               local government permitting authority, within 10 business  
               days of the suspension; and,

             c)   Hold a hearing within 30 business days, if the holder of  
               the suspended certificate so requests in writing, to  
               challenge the factual basis for the suspension.  

           EXISTING LAW:  

          1)Establishes the California Massage Therapy Council (CAMTC) and  
            defines the responsibilities and duties of the CAMTC.   
            (Business and Professions Code (BPC) Section 4600.5)

          2)Requires the CAMTC to issue a "massage therapist" or  
            "massage practitioner" 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.  (BCP  
            4601)

          3)Makes the unlawful practice of medicine a public offense  
            that may be punishable as either a misdemeanor or felony.  
             (BPC 2052)

          4)Regulates and licenses the practice of acupuncture by the  
            Board. (BPC 4928)

          5)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)

          6)Requires the California Acupuncture Board to issue a  
            license to practice acupuncture to any person who makes  
            an application, pays specified fees, and meets specified  
            requirements.  (BPC 4938)








                                                                  SB 218
                                                                  Page  9


          7)Makes the unlawful practice of acupuncture a public offense  
            that may be punishable as a misdemeanor, with a fine of not  
            less than $100 and not more than $2,500, or imprisonment in a  
            county jail for a period not exceeding one year, or both.   
            (BPC 4935)

          8)Requires the Board to establish standards for the  
            approval of schools and colleges offering education and  
            training in the practice of an acupuncturist, as  
            specified, and requires training programs to include  
            3,000 hours of study in curricula pertaining to the  
            practice of acupuncture. (BPC 4939)

          9)Requires each acupuncturist to complete 50 hours of  
            continuing education every two years as a condition of  
            renewal of his or her license. (BPC 4945)

           FISCAL EFFECT  :   Unknown

           COMMENTS  :   

           1)Purpose of this bill  . This bill would provide certification  
            and title protection for the practice of "traumatology" - a  
            branch of traditional Chinese medicine - to be overseen by a  
            non-profit Council authorized in statute.  Underlying concerns  
            with the bill include questions as to its necessity, whether  
            its provisions will ultimately inform or potentially confuse  
            consumers, and whether or not the statute contains sufficient  
            consumer protections and legislative oversight. This bill is  
            sponsored by the American Traditional Chinese Medicine  
            Traumatology Association (ATCMTA).  

           2)Author's statement  . According to the author, "Traumatology is  
            an unregulated practice in the State of California. No  
            government body oversees Traumatology's level of education,  
            training and experience. SB 218 (Yee) will place this practice  
            under a non-profit's oversight and assure the public in a  
            standard level of experience, training and care."

           3)Understanding traumatology and "Traditional Chinese Medicine"  .  
             As defined by this bill, "California traditional Chinese  
            medicine traumatology" includes "a range of treatments to  
            address both acute and chronic musculoskeletal conditions  
            through stimulation of acupressure points. Techniques include,  








                                                                  SB 218
                                                                  Page  10

            but are not limited to, brushing, kneading, 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 the meridians." 

          It should be stressed that the bill's own provisions appear to  
            restrict the scope of practice of CCTCMTs to acupressure  
            alone, which is one of a larger number of modalities  
            traditionally associated with traumatology. The bill  
            explicitly excludes the practice of medicine and chiropractic,  
            and the practice of acupuncture or physical therapy without a  
            license is prohibited by existing law. 

          Traumatology is considered a subset of traditional Chinese  
            medicine, and, according to the author, has been practiced in  
            an unlicensed fashion in California for roughly 150 years.  
            Western medicine also uses the term "traumatology" to describe  
            the unrelated study of wounds and injuries caused by accidents  
            or violence and the repair of those wounds and injuries, and  
            should not be confused with the practices of TCM.  

          According to the National Center for Complementary and  
            Alternative Medicine (NCCAM) within the National Institutes of  
            Health, the broader category of TCM originated in ancient  
            China and has evolved over thousands of years. "TCM  
            practitioners use herbs, acupuncture   and other methods to  
            treat a wide range of conditions?The TCM view of how the human  
            body works, what causes illness, and how to treat illness is  
            different from Western medicine   concepts?The human body is  
            regarded as an organic entity in which the various organs,  
            tissues, and other parts have distinct functions but are all  
            interdependent. In this view, health and disease relate to  
            balance of the functions."



            NCCAM also notes the breadth of its use: "Today, TCM is  
            practiced side by side with Western medicine in many of  
            China's hospitals and clinics. TCM is widely used in the  
            United States. Although the exact number of people who use  
            TCM in the United States is unknown, it was estimated in  
            1997 that some 10,000 TCM practitioners served more than 1  
            million patients each year. 

            However, NCCAM also strikes a note of caution: "Although TCM  








                                                                  SB 218
                                                                  Page  11

            is used by the American public, scientific evidence of its  
            effectiveness is, for the most part, limited. Acupuncture  
            has the largest body of evidence and is considered safe if  
            practiced correctly. Some Chinese herbal remedies may be  
            safe, but others may not be."



            As of 2012, there were approximately 60 accredited TCM  
            educational institutes nationwide, with 20 located in  
            California.  There are no known national standards for  
            traumatologists. Currently, traumatology courses are offered  
            in accredited schools for acupuncture, but there is no known  
            school in California that teaches traumatology exclusively.   


           4)Understanding the non-profit "massage therapy" model of  
            professional certification  . The non-profit Council proposed to  
            be created by this bill was modeled after the non-profit  
            California Massage Therapy Council (CAMTC) currently  
            overseeing the certification and discipline of massage  
            practitioners. 


            CAMTC was enacted in 2008 (SB 731 (Oropeza), Chapter 384) to  
            create a standardized system of voluntary statewide  
            certification of massage professionals. Current law makes it  
            an unfair business practice for anyone not certified by CAMTC  
            to use certain massage-related titles.  Applicants for  
            certification must complete a specified number of educational  
            hours and pass an examination which is administered by the  
            National Certification Board for Therapeutic Massage and  
            Bodywork (NCBTMB).  The statutes related to regulation of  
            massage therapy and CAMTC will sunset on January 1, 2015  
            unless extended by legislative action.  
                                               
            CAMTC is led by a volunteer board of directors comprised of  
            professionals from California's massage community, including  
            massage associations, schools, and businesses.  While CAMTC  
            does not accredit or approve schools, it does have the  
            responsibility to determine if the curriculum of schools meets  
            the legal requirements for applicants to obtain certification.  
             Schools must either be nationally accredited or approved by  
            the California Bureau for Private Postsecondary Education or a  
            California community college.  CAMTC regulates approximately  








                                                                  SB 218
                                                                  Page  12

            38,000 certified massage professionals.

            If a certificate holder violates the terms of certification,  
            CAMTC is authorized to suspend or revoke the holder's  
            certification, but CAMTC has no cite and fine authority.   
            CAMTC may deny, discipline or revoke certification for a  
            variety of reasons including: failure to obtain a clear  
            fingerprint check; reports of unprofessional conduct in  
            another state; any attempt to obtain a certificate through  
            misrepresentation or fraud; or committing any act punishable  
            as a sexually-related crime.  All of the relative disciplinary  
            procedures are carried out by an employee of CAMTC.  Since  
            2010, there have been approximately 130 certificate  
            suspensions or revocations.

           5)Arguments in support  .  According to the American Association  
            of Acupuncture & Traditional Chinese Medicine, "SB 218  
            (Yee)?would provide a pathway for skilled traumatologists,  
            trained in this unique branch of [TCM] to achieve  
            certification from the State of California. The establishment  
            of high educational standards and oversight would provide  
            Californians with basic assurances of safety when receiving  
            services from a [CCTCMT].

            "?Some acupuncture organizations have made the argument that  
            the establishment of a traumatology certification would  
            endanger public safety. This assumption is absolutely  
            misguided.  Traumatology, unlike acupuncture, is an  
            unregulated profession in California. How can an unregulated  
            practice be more dangerous than one that is under state  
            jurisdiction? SB 218 will increase public safety by regulating  
            this profession.

            "Second, a few acupuncture organizations contend that the  
            education provisions of SB 218 are inadequate.  The opposition  
            bases their claims on the practice of traumatology in China.  
            Chinese traumatologists have clinical duties within hospitals,  
            and may even diagnose and practice medicine. Obviously, the  
            practice of traumatology in California is very limited  
            compared with China. A California certified traumatologist  
            will not have the same duties and responsibilities of as a  
            traumatologist in China, and, therefore, will not require an  
            equivalent level of education?.

            "SB 218 would simply bring about a public recognition of this  








                                                                  SB 218
                                                                  Page  13

            unique branch of TCM. This bill would provide the legal means  
            for traumatologists to obtain certification, resulting in  
            increased mainstream acceptance and the implementation of  
            oversight to safeguard the public."

           6)Arguments in opposition  . According to the California  
            Acupuncture Coalition, which has taken an Oppose Unless  
            Amended position, states that "SB 218 will confuse and  
            endanger consumers.  The proposed certification title utilizes  
            the terms "Chinese medicine" and "traditional Chinese  
            medicine." Both terms are essentially synonymous with  
            fullscope, fulltraining acupuncture and Asian medicine  
            professionals. These terms are internationally recognized by  
            entities such as the World Health Organization and the  
            National Institutes of Health .... Use of these terms in  
            conjunction with a substandard7) certification will confuse  
            consumers, potentially misleading consumers into believing  
            that certificants possess significantly deeper and broader  
            levels of training than would be required under this bill." 

          CAC also contends that the use of the term "Chinese medicine" in  
            the title authorized by this bill conflicts with the intent of  
            the Acupuncture Act because of its prohibition on representing  
            oneself as trained, experienced or an expert in Chinese  
            medicine without an acupuncture license.  "Accordingly, the  
            CAC remains strongly opposed to SB 218 unless it is amended to  
            remove from the certificate title the term Chinese medicine or  
            any other term likely to cause the consumer public to confuse  
            certificants with fullscope, fulltraining licensed  
            acupunctur8)ists."
            
          9)This bill in practice  .  The practical effect of this bill  
            would be to create a non-profit Council funded by user fees or  
            other donations that would set its own educational, training  
            and testing standards, allowing individuals to advertise  
            themselves as "California certified" traumatologists.  Those  
            without certificates could continue to provide traumatology  
            services that are otherwise legal, as long as the  
            practitioners do not claim to be certified. The traumatology  
            practices covered by this bill would be limited to  
            acupressure.  Discipline by the Council would be limited to  
            action against the certificate, ranging from minor  
            restrictions to complete revocation.  
                
           10)Questions for the Committee.  The most recent version of this  








                                                                  SB 218
                                                                  Page  14

            bill presents a number of outstanding questions and issues  
            that the Committee may wish to consider:

              a)   Is this bill necessary  ? The California Acupuncture Board  
               has estimated that there are 150 practitioners of  
               traumatology in this state, although it is unknown how many  
               of these practitioners would seek a certification, or if  
               applicants might come from other states or countries.  The  
               number of potential applicants is difficult to forecast  
               since the qualifications for the certificate are left  
               largely to the discretion of the Council. The Committee may  
               wish to consider at the threshold whether or not this bill  
               is necessary in light of the small number of potential  
               applicants. 

             Furthermore, given that the Council and its work would need  
               to be supported exclusively by fees - and cannot even start  
               issuing certificates until it has completed its design of  
               education, training and testing standards - it is not clear  
               how the Council could be created and operated over the long  
               term with such a low number of expected applicants.  

             The Senate Appropriations Committee analysis of a prior  
               version of this bill noted that it expected a similar  
               program situated under the California Acupuncture Board,  
               proposed by a previous version of this bill, to have  
               start-up costs of $80,000 and ongoing costs between  
               $150,000 and $200,000 per year. While fiscal matters are  
               outside the purview of this Committee, the question remains  
               whether there are enough potential applicants to justify  
               and support the creation of a third party certificating  
               body for title rights alone. 

             The Committee may also wish to inquire of the author as to  
               the evidence of consumer confusion in the market for  
               traumatology services that cannot be addressed by existing  
               law and therefore make title protection necessary.  

              b)   Will this bill decrease, or increase, consumer  
               confusion  ?  As noted above, this bill only authorizes  
               certain individuals to use the term "California certified"  
               in advertising traumatology services (which may only  
               include acupressure). It does not stop uncertified  
               individuals from claiming to offer traumatology services.  









                                                                  SB 218
                                                                  Page  15

             There is also some confusion as to the boundary between  
               traumatology as defined by this bill and the practice of  
               acupuncture. The Acupuncture Licensure Act prohibits  
               individuals without an acupuncture license from  
               "representing that he or she is trained, experienced, or an  
               expert in the field of acupuncture, Asian medicine or  
               Chinese medicine."  As a result, the title provided by this  
               bill - which contains the words "Chinese medicine" - may  
               actually confuse consumers as to what kind of treatments a  
               particular practitioner is licensed to provide. 

             More importantly, it allows an individual to advertise him or  
               herself as 'California certified', but the state would have  
               very little role in the setting of standards for the  
               educational, training and testing requirements. The Council  
               would have that responsibility and others, including the  
               investigation of applicants' qualifications and deciding  
               matters of discipline. As a result, consumers may get the  
               mistaken impression that the state has created - and  
               investigates and enforces - standards for the proper  
               practice of traumatology when the regulation is actually  
               performed by a private party.

             There is also a possibility of confusion based on the scope  
               of practice provided for in this bill. By its own terms,  
               this bill appears to be limited to acupressure, but the  
               curriculum described in the qualifications section includes  
               "Chinese herbs and formulas" (which is part of what is  
               generally thought of as traumatology). As such, consumers  
               may be confused as to what kinds of services are really  
               being "certified", and even applicants or certificate  
               holders may not be clear on which practices fall under the  
               scope of the certificate and which do not. 

             As such, the Committee may wish to consider whether or not  
               the title protection offered by this bill would actually  
               better inform consumers about the nature and quality of  
               traumatology services, and help them make a more useful  
               distinction between certificated and uncertificated  
               providers.
              
              c)   Does the state have sufficient oversight capability to  
               ensure consumer protection  ? As noted above, the state would  
               have little control over the standards set or the decisions  
               made by the Council. And while this model of  








                                                                  SB 218
                                                                  Page  16

               self-regulation does have some precedent in the industries  
               of massage therapy, interior design and tax preparation,  
               those professions generally do not purport to exist for the  
               treatment of health conditions. This bill describes  
               traumatology as offering "a range of treatments to address  
               both acute and chronic musculoskeletal conditions." As  
               such, the Committee may wish to consider whether or not it  
               is appropriate for a profession that views itself as a  
               health care treatment provider should be entirely  
               self-regulating while operating under the aegis of the  
               state.  

             Further, this bill does not include basic consumer  
               protections found under the CAMTC model, such as  
               fingerprinting, background checks, or a standard "sunset  
               date" for its authority.  There are also outstanding  
               technical issues, not the least of which is the lack of any  
               designated authority to select the two representatives to  
               the Council from the traumatology industry.  

             It should also be made explicit that it is unprofessional  
               conduct to fail to comply with the Health Freedom Act (BPC  
               2053.5 & 2053.6), which requires specified disclosures to  
               patients when providing certain alternative or  
               complementary medicine treatments, such as the use of  
               herbal remedies, which do not constitute the practice of  
               medicine. 

               The Committee may wish to consider whether or not this bill  
               contains sufficient consumer protection safeguards to  
               justify the granting of a title that includes the words  
               "California certified."

           11)Prior legislation  . SB 1488 (Yee) of 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, as  
            well as report to the Legislature on standards for approving  
            education programs, and evaluating the education, training and  
            clinical experience of applicants.  That bill failed passage  
            in the Assembly Business, Professions and Consumer Protection  
            Committee.  

            SB 628 (Yee) of 2011 would have changed the name of the  








                                                                  SB 218
                                                                  Page  17

            California Acupuncture Board to the "Traditional Chinese  
            Medicine Board," redesignated licensed acupuncturists as  
            licensed "Traditional Chinese Medicine Practitioners," and  
            would have included traumatology in the authorized activities  
            of a licensed acupuncturist. That bill failed passage in the  
            Assembly Business, Professions and Consumer Protection  
            Committee.

            SB 731 (Oropeza) (Chapter 384, Statutes of 2008), established  
            the voluntary statewide certification of massage therapists by  
            the Massage Therapy Organization (MTO), which was renamed the  
            CAMTC in 2011.  The goal of the CAMTC is to standardize the  
            process of certification throughout the state.  The  
            certification allows for massage professionals to work in  
            multiple California locations without the need for multiple  
            permits or fees.

          REGISTERED SUPPORT / OPPOSITION  :


           Support 
           
           ------------------------------------------ 
          |American Traditional Chinese Medical      |
          |Traumatologist Association (sponsor)      |
          |Alhambra Medical University               |
          |------------------------------------------|
          |American Association of Chu Pui Kok Chong |
          |Tong                                      |
          |------------------------------------------|
          |American Association of Acupuncture &     |
          |Traditional Chinese Medicine              |
          |------------------------------------------|
          |American Chinese Cultural Exchange &      |
          |Trading Association                       |
          |------------------------------------------|
          |Andrew University Berkeley                |
          |------------------------------------------|
          |Association of Traditional Medical        |
          |Doctors                                   |
          |------------------------------------------|
          |California Acupuncture Medical            |
          |Association                               |
          |------------------------------------------|
          |California Acupuncture Oriental Medicine  |








                                                                  SB 218
                                                                  Page  18

          |Association                               |
          |------------------------------------------|
          |California Chinese Quangxi Association    |
          |------------------------------------------|
          |California Chiropractic Association       |
          |------------------------------------------|
          |Cantonese Association of Oakland          |
          |------------------------------------------|
          |Chee Kung Tong Association                |
          |------------------------------------------|
          |Chin Ying Chong Association               |
          |------------------------------------------|
          |Chinese American Association of Commerce  |
          |------------------------------------------|
          |Chinese Athletic Association of San       |
          |Francisco                                 |
          |------------------------------------------|
          |Chinese Consolidated Benevolent           |
          |Association                               |
          |------------------------------------------|
          |Chinese Medicine Society of America       |
          |------------------------------------------|
          |Council of Acupuncture & Oriental         |
          |Medicine Associations                     |
          |------------------------------------------|
          |Guangxi Chinling Association Oakland of   |
          |U.S.A.                                    |
          |------------------------------------------|
          |Hip Sing Association                      |
          |------------------------------------------|
          |Hop Sing Association                      |
          |------------------------------------------|
          |Hop Wo Benevolent Association             |
          |------------------------------------------|
          |Hoy-Sun Ning Yung Benevolent Association  |
          |in America                                |
          |------------------------------------------|
          |Kong Chow Benevolent Association          |
          |------------------------------------------|
          |Kwok Shing Hong Company                   |
          |------------------------------------------|
          |Mar's Family Association                  |
          |------------------------------------------|
          |Ng Family Benevolent Association          |
          |------------------------------------------|








                                                                  SB 218
                                                                  Page  19

          |Sam Yick Benevolent Association of        |
          |Western U.S.A.                            |
          |------------------------------------------|
          |Sam Yup Benevolent Association            |
          |------------------------------------------|
          |San Francisco Lodge Chinese American      |
          |Citizens Alliance                         |
          |------------------------------------------|
          |Soo Yuen Benevolent Association           |
          |------------------------------------------|
          |Sue Hing Benevolent Association           |
          |------------------------------------------|
          |Suey Sing Association                     |
          |------------------------------------------|
          |Tom Family Benevolent Association         |
          |------------------------------------------|
          |Unified Association                       |
          |------------------------------------------|
          |United Acupuncture Association            |
          |------------------------------------------|
          |Vietnam Chinese Mutual Aid and Friendship |
          |Association of Oakland                    |
          |------------------------------------------|
          |Vietnam Chinese United Association of     |
          |U.S.A.                                    |
          |------------------------------------------|
          |Vietnamese Acupuncture & Oriental         |
          |Medicine Association Institute            |
          |------------------------------------------|
          |Vietnam Chinese Mutual Aid and Community  |
          |Center                                    |
          |------------------------------------------|
          |Wong Family Benevolent Association        |
          |------------------------------------------|
          |World Federation of Chinese Organizations |
          |From Vietnam                              |
          |------------------------------------------|
          |Wu Yi Friendship Association              |
          |------------------------------------------|
          |Yeong Wo Benevolent Association           |
          |------------------------------------------|
          |Ying On Association                       |
           ------------------------------------------ 
          898 small businesses & private individuals
           








                                                                 SB 218
                                                                  Page  20

            Opposition 
           
          Academy of Chinese Medicine
          Association of Korean Asian Medicine & Acupuncture of California
          California Acupuncture Board
          California Acupuncture Coalition
          California Certified Acupuncturists Association
          California Chamber for History of Chinese Medicine
          California State Oriental Medical Association
          Japanese Acupuncture Association of California
          New England School of Acupuncture
          Research Institute of Chinese Medicine
          United California Practitioners of Chinese Medicine
          2160 small businesses & private individuals

           Analysis Prepared by  :    Hank Dempsey / B.,P. & C.P. / (916)  
          319-3301