BILL ANALYSIS Ó SB 305 Page 1 Date of Hearing: June 25, 2013 ASSEMBLY COMMITTEE ON BUSINESS, PROFESSIONS AND CONSUMER PROTECTION Richard S. Gordon, Chair SB 305 (Price) - As Amended: June 19, 2013 SENATE VOTE : 37-0 SUBJECT : Healing arts: boards. SUMMARY : Extends until January 1, 2018 the sunset dates for the provisions establishing the Naturopathic Medicine Committee (NMC), the Speech-Language Pathology and Audiology and Hearing Aid Dispensers Board (SLPHADB), The Board of Occupational Therapy (BOT), the Physical Therapy Board of California (PTB), the Board of Optometry (OB), and the Respiratory Care Board of California (RCB) which are regulated by the Department of Consumer Affairs (DCA); extends the term of the executive officers of the PTB, SLPHADB, RCB, and the OB; specifies that any board, committee or bureau regulated by DCA is authorized to receive specified criminal records needed to complete an application for licensure; exempts certain individuals performing pulmonary tests in specified hospitals in Los Angeles County from certain licensure requirements; and subjects specified boards to review by the appropriate legislative policy committees, as specified. Specifically, this bill : 1)Specifies that any board under DCA is authorized to receive from a local or state agency certified records of all arrests and convictions, certified records regarding probation, and any and all other related documentation needed to complete an applicant or licensee investigation and further specifies that a local or state agency may provide those records upon request. 2)Requires that the powers and duties of the Board of Chiropractic Examiners (BCE) is subject to review by the appropriate policy committees of the Legislature, and further requires that the review of the BCE be performed as if the provisions of the BCE were scheduled to be repealed as of January 1, 2018. 3)Requires that the powers and duties of the Osteopathic Medical Board (OMB) be subject to review by the appropriate policy SB 305 Page 2 committees of the Legislature, and further requires that the review of the OMB be performed as if the provisions of the OMB were scheduled to be repealed as of January 1, 2018. 4)Extends until January 1, 2018, the provisions establishing the NMC. 5)Extends until January 1, 2018 the provisions establishing the SLPAHADB and subjects the SLPAHADB to review by the appropriate policy committees of the Legislature. 6)Extends until January 1, 2018 the authority of the SLPAHADB to appoint an executive officer. 7)Specifies that the SLPAHADB may refuse to issue, suspend, revoke, or impose terms and conditions upon the license of any licensee for the violation of a term or condition of a probationary order of a license issued by the SLPAHADB as specified. 8)Extends until January 1, 2018, the provisions establishing the BOT and subjects the BOT to review by the appropriate policy committees of the Legislature. 9)Extends until January 1, 2018, the provisions establishing the PTB. 10)Extends until January 1, 2018, the authority of the PTB to appoint an executive officer. 11)Extends until January 1, 2018 the provisions establishing the OB and subjects the OB to review by the appropriate policy committees of the Legislature. 12)Extends until January 1, 2018, the authority of the OB to appoint an executive officer. 13)Extends until January 1, 2018, the provisions establishing the RCB and subjects the RCB to review by the appropriate policy committees of the Legislature. 14)Allows the performance of pulmonary function testing by persons who are currently employed by Los Angeles County hospitals and have performed pulmonary function testing for at least 15 years to operate as respiratory care therapists SB 305 Page 3 without licensure, as specified. 15)Makes finding and declarations pertaining to the special law necessary to because of the unique circumstances relating to persons who are currently employed by Los Angeles County hospitals and have performed pulmonary function testing for at least 15 years. 16)Makes other technical and clarifying provisions. EXISTING LAW 1)Requires a board, bureau or program within DCA to require an applicant for licensure to furnish a full set of fingerprints in order to conduct a criminal history record check. (Business and Professions Code (BPC) Section 144) 2)Authorizes the BCE, as established, to license chiropractors. (BPC 1000 et seq.) 3)Provides for the licensure and regulation of osteopathic physicians and surgeons by the OMB. (BPC 2450) 4)Establishes the NMC within the OMB of California and repeals the provisions pertaining to the NMC on January 1, 2014. (BPC2450.3) 5)Specifies that the repeal of the NMC is subject to review by the appropriate policy committee of the Legislature. (BPC2450.3) 6)Establishes the SLPAHADB within DCA and provides the SLPAHADB with licensing, regulatory and disciplinary functions and repeals those provisions January 1, 2014. (BCP 2531) 7)Authorizes the SLPAHADB to employ an executive officer as specified, and repeals that authority on January 1, 2014. (BPC 2531.75) 8)Establishes the Occupational Therapy Practice Act and provides the BOT with licensing, regulatory and disciplinary functions as specified and repeals those provisions on January 1, 2014. (BPC 2570 et seq.) 9)Establishes the Physical Therapy Practice Act and provides the SB 305 Page 4 PTB with licensing, regulatory and disciplinary functions as specified and repeals those provisions on January 1, 2014. (BPC 2600 et seq.) 10)Authorizes the PTB to employ an executive officer as specified, and repeals that authority on January 1, 2014. (BPC 2607.5) 11)Establishes the Optometry Practice Act and provides the OB with licensure and regulation of optometrists as specified, and repeals those provisions on January 1, 2014. (BPC 3000 et seq.) 12)Authorizes the OB to employ an executive officer as specified, and repeals that authority on January 1, 2014. (BPC 2607.5) 13)Establishes the RCB and provides it with licensing, regulating and disciplinary functions as specified and repeals those provisions on January 1, 2014. (BPC 3710; 3710.1) 14)Authorizes the RCB to employ an executive officer as specified, and repeals that authority on January 1, 2014. (BPC 2607.5) 15)Specifies that activities not covered by the Respiratory Care Act are as follows: a) The performance of respiratory care that is an integral part of the program of study by students enrolled in approved respiratory therapy training programs; b) Self-care by the patient or the gratuitous care by a friend or member of the family who does not represent or hold himself or herself out to be a respiratory care practitioner licensed under the provisions of this chapter; c) The respiratory care practitioner performing advances in the art and techniques of respiratory care learned through formal or specialized training; d) The performance of respiratory care in an emergency situation by paramedical personnel who have been formally trained in these modalities and are duly licensed under the provisions of an act pertaining to their specialty; SB 305 Page 5 e) Respiratory care services in case of an emergency, which includes an epidemic or public disaster; f) Persons engaging in cardiopulmonary research; g) Formally trained licensees and staff of child day care facilities administering inhaled medication to a child as specified; or, h) The performance by a person employed by a home medical device retail facility or by a home health agency licensed by the State Department of Health Services of specific, limited, and basic respiratory care or respiratory care related services that have been authorized by the RCB. (BPC3765) FISCAL EFFECT : Unknown COMMENTS : 1)Purpose of this bill . This bill is one of four "sunset bills" to extend the operational authority of a variety of boards, bureaus and committees regulated by DCA. This bill extends the sunset date until January 1, 2018 for the continuing operation of the NMC, the RCB, the SLPAHADB, the PTB, the BOT, and the OB which are all scheduled to be repealed on January 1, 2014. In addition, this bill extends the terms of the executive officers of the RCB, the PTB, the SLPAHADB, and the BOT. This bill also requires the BCE and the OMB to be subject to a review by the appropriate policy committees of the Legislature in 2018. Finally, this bill provides a licensure exemption for certain individuals performing specified pulmonary function testing and clarifies the authority of the boards, bureaus, and committees regulated by DCA to obtain certain records from a local or state agency. This bill is author sponsored. 2)Author's statement . According to the author, "Unless legislation is carried this year to extend the sunset dates for the [NMC], the [RCB], the [BOT], the [PTB], the SLPAHADB and the [OB], they will be repealed on January 1, 2014. Because they were created via initiative act, the [OMB] and the [BCE] do not have a sunset date. This bill will specify SB 305 Page 6 that as of January 1, 2018, these two boards will be reviewed consistent with other healing arts boards under the DCA that are subject to a 4 year sunset review period. This bill will exempt certain employees from going through the laborious process of becoming certified respiratory therapists when they have been safely and reliably performing services for over 15 years. This bill specifies that any board under the [DCA] is authorized to receive certified records from a local or state agency of all arrests and convictions, certified records regarding probation, and any and all other related documentation needed to complete an applicant or licensee investigation. Also specifies that a local or state agency is authorized to provide those records to the board upon receipt of such a request." 3)Oversight Hearings and Sunset Review of Licensing Boards of DCA . In March 2013, the Assembly Business, Professions and Consumer Protection Committee and the Senate Business Professions, and Economic Development (BPED) Committee conducted a joint-oversight hearing to review 14 regulatory boards within DCA. The Committees began its review of these licensing agencies in March and conducted three days of hearings. This bill, like the accompanying sunset bills, is intended to implement legislative changes as recommended in the background reports authored by the Senate BPED Committee for all of the agencies reviewed by the Committees this year. 4)Sunset review process . The sunset review process provides a formal opportunity and mechanism for the DCA, the Legislature, the boards and bureaus, interested parties and stakeholders to discuss the performance of the boards, bureaus and committees and make recommendations for improvements. This is performed on a standard four-year cycle and was mandated by SB 2036 (McCorquodale, Chapter 908, Statutes of 1994). The legislation pertaining to this bill is based on specific issues raised and addressed in the reports released by the BPED committee. 5)Board of Chiropractic Examiners . The BCE is responsible for regulating the practice of licensed chiropractors in California. The BCE was created through an initiative measure approved on November 7, 1922. Through its enforcement program, the BCE disciplines licensees who violate the laws and regulations governing the practice of chiropractic. In FY SB 305 Page 7 2010/11, the BCE had a license base of 13,810 active and 1272 inactive licenses. The BCE also oversees 19 chiropractic schools and colleges located throughout the United States and Canada. Although there were several issues raised during the sunset review hearing regarding the BCE including, reciprocity for out-of-state licensees, complying with the Administrative Procedures Act (APA) and ensuring that BCE is tracking and maintaining accurate consumer satisfaction survey data, the only issue that could not be addressed administratively is the requirement that the BCE be reviewed by the appropriate policy committees of the Legislature in four years. This bill requires the BCE to be reviewed by the appropriate committee of the Legislature to ensure that BCE continues its mission to regulate licensed chiropractors and address any administrative issues that were raised during the sunset hearing that merit further review. 6)Osteopathic Medical Board . The OMB was established in 1922 when the Osteopathic Initiative Act (Act) was passed by electorate. In 1962, another initiative was passed providing the Legislature the authority to amend the Act. To date, the only restriction on the Legislature's power is that it may not fully repeal the Act unless the number of licensed osteopathic physicians (DOs) falls below 40. In 2002, the OMB volunteered to be included under the umbrella of the DCA. As one of the regulatory entities within the DCA, the OMB is charged with the licensing and regulation of DOs. The Board's statutes and regulations set forth the requirements for licensure and provide the OMB the authority to discipline a licensee. During the sunset review hearing, there were several issues raised by the Committees to be addressed by the OMB, including the OMB's operating without a Code of Ethics, licensure portability procedures for service members, posting meeting materials to the OMB's Web site, and other programmatic issues. The only issue that could not be addressed administratively is the requirement that the OMB be reviewed by the appropriate policy committee of the Legislature in four years. This bill requires the OMB to be reviewed by the appropriate committees of the Legislature to ensure the OMB continues its mission to regulate licensed DOs and address any administrative issues that were raised during the sunset hearing that merit further review. SB 305 Page 8 7)Naturopathic Medicine Committee . The Bureau of Naturopathic Medicine was established by the Legislature under DCA, and began licensing NDs in January 2005. The Bureau became the NMC under the OMB in October 2009. The NMC is designed as a resource for California consumers who choose NDs for their healthcare. Currently, there are approximately 437 active NDs licensed in California. During the sunset review hearing, there were several issues raised by the Committee to be addressed by the NMC including, the NMC's staffing issues, licensure portability procedures for service members, and posting meeting materials to the NMC's Web site. The only issue that could not be addressed administratively is the requirement that the NMC be reviewed by the appropriate policy committees of the Legislature again in four years, and extends the sunset date until January 1, 2018. This bill requires the NMC to be reviewed by the appropriate committees of the Legislature to ensure the NMC continues its mission to regulate NDs and address any administrative issues that were raised during the sunset hearing that merit further review. 8)The Speech-Language Pathology and Audiology and Hearing Aid Dispensers Board . The SLPAHADB regulates the professions of speech-language pathology, audiology, and hearing aid dispensing. Each profession is separate and distinct, and has its own scope of practice and licensing requirements. AB 1535 (Jones) (Chapter 309, Statues of 2009), merged the Hearing Aid Dispensers Bureau and the Speech-Language Pathology and Audiology Board into the current board. The current law which authorizes the SLPAHADB to license and regulate speech-language pathologists, audiologist, dispensing audiologists, hearing aid dispenser, speech-language pathology assistants, and speech-language pathology/audiology aides is set to expire on January 1, 2014. In order to maintain regulation of the professions currently operating under the jurisdiction of the SLPAHADB, this bill extends the provisions of law until January 1, 2018, and subjects it to review by the appropriate policy committees of the Legislature. In addition, this bill extends the SLPHADB's authority to appoint an executive officer until January 1, 2018. SB 305 Page 9 9)California Board of Occupational Therapy . The BOT was established by SB 1046 (Murray), (Chapter 697, Statutes of 2000). The BOT became operational in 2001 and remains responsible for the licensure and regulation of occupational therapists and occupational therapy assistants in California. The occupational therapy profession in California was regulated by a title act dating back to 1977 that prohibited individuals from using the professional titles "occupational therapist" and "occupational therapy assistant" without appropriate professional training. During the sunset review hearing, there were several issues raised to be addressed by the BOT, including publishing citations, licensure portability procedures for service members, and poor consumer satisfaction. The only issue that could not be addressed administratively is the requirement that the BOT be reviewed by the appropriate policy committees of the Legislature. In order to maintain regulation of the professions currently operating under the jurisdiction of the BOT, this bill extends the sunset date for the BOT until January 1, 2018, and subjects it to a review of the appropriate policy committees of the Legislature. 10)Physical Therapy Board of California . The Physical Therapy Practice Act was established in 1953. A "practice act" safeguards the public by regulating a defined scope of practice vs. a "title act" which merely restricts action to revoking a title with no restriction of practice. A PT may evaluate, plan treatment, instruct and consult, but may not diagnose. There are currently 26,000 licensed PTs in California. During the sunset review hearing, there were several issues raised by the Committee to be addressed by the PTBC. In order to effectively address the specific issues of the PTB raised during the sunset review process, SB 198 (Price) of 2013 was introduced to reorganize, revise, recast and update the Physical Therapy Practice Act. SB 198 will be heard by the Assembly, Business Professions and Consumer Protection. This bill specifically addresses the sunset of the PTB only. In order to maintain the current regulation of the Act, this bill extends the provisions of law pertaining to the operation of the PTB until January 1, 2018, and subjects it to a new review of the appropriate policy committees of the SB 305 Page 10 Legislature. In addition, this bill extends the provision allowing the PTBC to appoint an executive officer until January 1, 2018. 11)California State Board of Optometry . The OB is responsible for the regulatory oversight of approximately 9,000 optometrists, the largest population of optometrists in the United States. On March 20, 1903, California became the third state to pass a law recognizing the profession of optometry, and regulating its practice. In 1913, a new Optometry Practice Act was enacted creating the Board, defining its duties and powers, and prescribing a penalty for a violation of the Act. During the sunset review hearing, there were several issues raised by the Committees to be addressed by the OB, including license portability issues for service members. In order to maintain regulation of the OB, this bill extends the provisions of law pertaining to the operation of the OB until January 1, 2018, and subjects it to a new review of the appropriate policy committees of the Legislature. In addition, this bill extends the provision allowing the OB to appoint an executive officer until January 1, 2018. 12)Respiratory Care Board . The RCB was originally established as the Respiratory Care Examining Committee, which was created by the Legislature in 1982 to protect individuals from the unqualified practice of respiratory care. The RCB regulates a single category of health care workers - respiratory care practitioners (RCPs). RCPs are specialized health care workers who practice under the supervision of medical directors and are involved in the prevention, diagnosis, treatment, management, and rehabilitation of problems affecting the heart and lungs and other disorders, as well as providing diagnostic, educational, and rehabilitation services. RCPs provide treatment for patients who have breathing difficulties and care for those who are dependent upon life support and cannot breathe on their own. RCPs treat patients with acute and chronic diseases, including Chronic Obstructive Pulmonary Disease, trauma victims, and surgery patients. During the sunset review process, there were several important issues raised to address concerns pertaining to the RCB and its licensees, including the ability to obtain local agency SB 305 Page 11 records regarding criminal history reports, pulmonary function technologists and the extension of the laws pertaining to the RCB. This bill attempts to address those issues by allowing specified access to background information as consistent with other entities regulated by DCA, and further allows a certain group of pulmonary function technologists in Los Angeles County to be except from the licensure requirements of RCPs. 13)Exemption from licensure requirements for Pulmonary Function Technologists . When the RCB was instituted, several unlicensed individuals, including those who solely performed pulmonary function tests were grandfathered and issued a license as a RCP. However, the requirement to be grandfathered was not communicated to certain individuals performing pulmonary function testing who were employed at certain Los Angeles County safety-net hospitals. As a result, these employees continued to practice for several years without knowledge that their practice was illegal. In the late 1990's the RCB was made aware of the issue and it was reviewed during the 2002 sunset review of the RCB. At that time, the Joint Legislative and Sunset Review Committee asked the RCB to examine the issue of unlicensed professionals who were performing pulmonary function tests. The RCB attempted to seek legislation to exempt certain pulmonary function testing from being regulated. However, the RCB was unable to obtain the appropriate approval to pursue legislation. In an effort to find a solution that has been overlooked for a number of years, this bill would exempt these skilled professionals who have performed pulmonary function testing for over 15 years, and should have previously been a part of the grandfathering provisions, from the current licensure requirements of the RCB. In addition, the RCB agreed to continue examining the issue of regulating all unlicensed professionals in its 2013 strategic plan. This bill exempts those very specific individuals from licensure requirements in order to continue providing respiratory care services and pulmonary function testing by specified individuals who are currently employed at Los Angeles County Hospitals. The current law which authorizes the RCB to license and regulate RCPs is set to repeal on January 1, 2014. In order to maintain regulation of the professions currently operating under the jurisdiction of the RCB, this bill extends these provisions of law until January 1, 2018, RCB and subjects it SB 305 Page 12 to a new review of the appropriate policy committees of the Legislature. In addition, this bill extends the RCB's authority to appoint an executive officer until January 1, 2018. 14)Obtaining Local Agency Records . It is customary for most boards and bureaus to obtain complete arrest, conviction and other related documentation as part of an applicant's or licensee's disciplinary investigation. As such, boards rely on various authorities and local law enforcement agencies to provide documentation. There have been instances where some entities have been refused access to records due to clear lack of authority to obtain records without approval by the individual in question. This situation can cause delays in investigations and can even potentially prevent the appropriate disciplinary action. This bill provides additional clarity for such boards within DCA to obtain the appropriate records needed for licensure or disciplinary investigation. 15)Related legislation . SB 198 (Price) of 2013 reorganizes, revises, recasts and updates the Physical Therapy Practice Act. This bill is pending in the Assembly Business, Professions and Consumer Protection Committee. SB 304 (Price) of 2013 makes various changes to the Medical Practice Act and to the Medical Board of California. This bill is pending in the Assembly Business, Professions and Consumer Protection Committee. SB 306 (Price) of 2013 would have extended until January 1, 2018, the provisions establishing the State Board of Chiropractic Examiners, Speech Language Pathology and Audiology and Hearing Aid Dispensers Board the Physical Therapy Board of California and the California Board of Occupational Therapy and extends the terms of the executive officers of the Physical Therapy Board of California and the Speech Language Pathology and Audiology and Hearing Aid Dispensers Board. This bill was amended to address an unrelated topic and its provisions were added to this bill. SB 307 (Price) of 2013 extends, until January 1, 2018, the term of the Veterinary Medicine Board, which provides for the licensure and registration of veterinarians and registered veterinary technicians and the regulation of the practice of SB 305 Page 13 veterinary medicine by the Veterinary Medical Board. This bill was held on the Senate Floor. SB 308 (Price) 2013 extends, until January 1, 2018, the term of the Interior Design Law and specifies that a certified interior use a written contract when contracting to provide interior design services to a client. It also extends, until January 1, 2018, the State Board of Guide Dogs for the Blind and extends an arbitration procedure for the purpose of resolving disputes between a guide dog user and a licensed guide dog school. This bill extends until January 1, 2018, the State Board of Barbering and Cosmetology and requires a school to be approved by the board before it is approved by the Bureau for Private Postsecondary Education. Finally, this bill would also authorize the board to revoke, suspend, or deny its approval of a school on specified grounds. This bill is pending in the Assembly Business, Professions and Consumer Protection Committee. SB 309 (Price) of 2013 extends the term of the State Athletic Commission, which is responsible for licensing and regulating boxing, kickboxing, and martial arts matches and is required to appoint an executive officer until January 1, 2018. This bill is pending in the Assembly Arts, Entertainment, Sports, Tourism and Internet Media Committee. REGISTERED SUPPORT / OPPOSITION : Support California Naturopathic Doctors Association California Optometric Association California State Board of Optometry National Board of Examiners in Optometry Naturopathic Medicine Committee Osteopathic Physicians and Surgeons of California Physical Therapy Board of California SEIU California Opposition None on file. Analysis Prepared by : Elissa Silva / B.,P. & C.P. / (916) 319-3301 SB 305 Page 14