BILL ANALYSIS Ó
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|Hearing Date:April 29, 2013 |Bill No:SB |
| |307 |
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SENATE COMMITTEE ON BUSINESS, PROFESSIONS
AND ECONOMIC DEVELOPMENT
Senator Curren D. Price, Jr., Chair
Bill No: SB 307Author:Price
As Amended:April 24, 2013 Fiscal:Yes
SUBJECT: Healing arts: Veterinary Medical Board.
SUMMARY: Extends until January 1, 2016, the provisions establishing
the Veterinary Medical Board (VMB) and the term of the executive
officer of the VMB. Makes other changes regarding the inspection
authority of the VMB as it pertains to veterinary premises, the
membership and responsibility of the Multidisciplinary Committee of
the VMB, and the requirements for veterinary assistants regarding
access to controlled substances.
Existing law:
1)Provides for the licensing and regulation of approximately 9,800
veterinarians and 4,300 registered veterinary technicians by the
Veterinary Medical Board (VMB) within the Department of Consumer
Affairs (DCA). (Business and Professions Code (BPC) § 4800 et seq.)
2)Specifies that the VMB shall consist of 8 members, 4 of whom are
licensed veterinarians, 1 of whom is a registered veterinary
technician (RVT) and 3 of whom are public members, and that VMB
shall remain in effect until January 1, 2014, and that the VMB is
subject to review by the Legislature. (BPC § 4800)
3)Authorizes the VMB to appoint a person exempt from civil service who
shall be designated as an executive officer and who shall exercise
the powers and perform the duties delegated by the Board; provides
that this authority shall remain in effect only until January 1,
2014.
(BPC § 4804.5)
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4)Provides that the VMB may at any time inspect the premises in which
veterinary medicine, veterinary dentistry, veterinary surgery is
being practiced. (BPC § 4809.5)
5)Requires the VMB to establish a regular inspection program which
will provide for random, unannounced inspections. (BPC § 4809.7)
6)Provides that the VMB shall establish an advisory committee to
assist, advise, and make recommendations for the implementation of
rules and regulations necessary to ensure proper administration and
enforcement of the Veterinary Practice Act and to assist the VMB in
its examination, licensure, and registration programs. This
committee shall be known as the Veterinary Medicine
Multidisciplinary Advisory Committee (MDC). (BPC § 4809.8 (a))
7)Provides that members of the MDC shall be appointed by the VMB and
shall consist of
7 members; 4 licensed veterinarians, 2 RVTs, and 1 public member.
Members shall represent a sufficient cross section of the interests
in veterinary medicine in order to address the issues before it, as
determined by the VMB, including veterinarians, RVTs and members of
the public. (BPC § id.)
8)Provides for terms of the membership of the MDC. (BPC § 4809.8 (b))
9)Authorizes a RVT or a veterinary assistant to administer a drug,
including, but not limited to, a drug that is a controlled
substance, under the direct or indirect supervision of a licensed
veterinarian when done pursuant to the order, control, and full
professional responsibility of a licensed veterinarian. (BPC §
4836.1 (a))
10)Limits access to controlled substances to persons who have
undergone a background check and who, to the best of the licensee
manager's knowledge, do not have any drug or alcohol related felony
convictions. (BPC § 4836.1 (b))
This bill:
1) Extends the establishment of the VMB and the authorization for the
appointment of an executive officer to January 1, 2016.
2) Specifies that veterinary premises to be inspected by the VMB shall
not include nonprofit animal rescue or adoption centers.
3) Provides that the VMB shall make every effort to inspect at least
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20 percent of veterinary premises on an annual basis.
4) Changes the membership of the MDC so that it shall consist of 9
members:
4 licensed veterinarians, 2 RVTs, 1 public member, and a veterinarian
and RVT of the VMB.
Provides that board members shall serve concurrent with their term of
office.
5) States the intent of the Legislature that the MDC shall give
specific consideration to issues pertaining to the practice of
RVTs.
6) Requires a valid permit issued by the VMB to a veterinary assistant
before the veterinary assistant would be able to have access to
controlled substances on the veterinary premises.
7) Requires that as part of the application for a permit of the
veterinary assistant, the VMB shall require an applicant to furnish
a full set of fingerprints for purposes of conducting a criminal
history record check and that the fingerprints furnished shall be
submitted in an electronic format if readily available. Requires
the VMB to use the fingerprints furnished to obtain criminal
history information on the applicant from the Department of Justice
and the Federal Bureau of Investigation and for the VMB to obtain
any subsequent arrest information that is available.
8) Provides that the requirement for a permit is contingent on the VMB
receiving sufficient staffing and a fee to cover costs to implement
the permit requirement and that the requirement for the permit
shall become effective on January 1, 2015.
FISCAL EFFECT: Unknown. This bill has been keyed "fiscal" by
Legislative Counsel.
COMMENTS:
1.Purpose. This bill is one of six "sunset review bills" authored by
the Chair of this Committee. Unless legislation is carried this
year to extend the sunset dates for the VMB and its executive
director they will be repealed on January 1, 2014. This bill makes
a number of legislative changes recommended by the VMB as well as
recommendations made in the Committee's background paper.
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2.Oversight Hearings and Sunset Review of Licensing Boards and
Commission of DCA. In 2013, this Committee conducted oversight
hearings to review 14 regulatory boards within the DCA. The
Committee began its review of these licensing agencies in March and
conducted two days of hearings. This bill, and the accompanying
sunset bills, is intended to implement legislative changes as
recommended in the Committee's Background/Issue Papers for all of
the agencies reviewed by the Committee this year.
3.Review of the Veterinary Medical Board, Issues Identified and
Recommended Changes. The following are some of the major issues
pertaining to the VMB, or areas of concern reviewed and discussed by
the Committee during the review of the VMB, along with background
information concerning each particular issue. Recommendations were
made by Committee staff and members regarding the particular issues
or problem areas which needed to be addressed.
a) Issue : Delay and Lack of Addressing RVT Issues.
Background : According to those representing the RVT profession,
there have been several issues which either the MDC or the VMB
have not addressed or have delayed action in resolving. Examples
given were: (1) regulations to define the parameters for a
student exemption allowing them to perform restricted RVT job
tasks; (2) a regulation to clarify the VMB's authority over RVT
schools which took two and half years to go to public hearing
after approved by the VMB; (3) the transitioning from using the
state RVT examination to using a national RVT exam.
A little history regarding the RVT profession and RVT committees,
and RVT input on VMB matters may be appropriate at this point.
In 1975, the profession of Animal Health Technician (AHT) was
created by the Legislature in response to the desire by the
veterinary profession to have a well-trained and reliable work
force. The AHT Examining Committee (AHTEC) was created as an
independent committee with a separate budget to assist the VMB
with issues related to the new profession. In 1994, the title
"Animal Health Technician" was changed to RVT and the committee
was called the Registered Veterinary Technician Examining
Committee (RVTEC). In 1998, the original independent RVTEC was
to sunset, and a new committee of the VMB, the Registered
Veterinary Technicians Committee (RVTC), was created. The
Legislature gave the new committee the statutory authority to
advise the VMB on issues pertaining to the practice of RVTs,
assist the VMB with RVT examinations, CE and approval of RVT
schools. The Legislature also specifically stated in the law
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that its intent was that the VMB would give specific
consideration to the recommendations of the RVTC. In 2004, the
JLSRC was concerned that the RVTC had no independent authority
over issues within its jurisdiction, e.g., examinations,
eligibility categories, establishing criteria for and approving
RVT school programs. In 2006, the duties of the RVTC were
expanded to include assisting the VMB in developing regulations
to define procedures for citations and fines. In 2010, the
Legislature added an RVT to the VMB for the first time,
increasing the VMB composition to a total of 8 members: 4
veterinarians, 1 RVT and 3 public members. At the same time the
RVTC was allowed to sunset upon appointment of the RVT. The
newly created MDC also had the following make-up of members: 4
veterinarians, 2 RVTs and 1 public member.
The RVT committee has basically gone from an autonomous,
semi-autonomous to a non-existent committee. However, it appears
that both veterinarians and RVTs believed that both
representation on the VMB by an RVT and providing for RVTs on the
MDC would allow for issues regarding the RVT profession to be
adequately addressed. It appears, however, that this may not be
the case. The VMB seemed to realize this oversight at its
September 5, 2012 meeting as it discussed the role of its
committees and a structure for the committees that might be best
to address the issues of the VMB. It appears that one of the
problems may be that the VMB has no direct input during MDC
meetings or oversight of matters brought before the MDC, or has
not given clear direction to the MDC to address important issues
brought before the VMB or that must be resolved. The VMB has
also allowed RVT matters to be splintered between different
subcommittees. There is one RVT subcommittee of the VMB made up
of two board members and another subcommittee of the MDC made up
of one RVT and one veterinarian. Section 4809.8 of the Business
and Professions Code was clear that the role of the MDC was to
assist, advise and make recommendations for the implementation of
rules and regulations necessary for the proper administration and
enforcement of the Veterinary Medicine Practice Act and to assist
the VMB in its examination, licensure, and registration programs.
The MDC was intended to be inclusive of all issues regarding the
veterinarian profession, and the VMB must do the same.
Recommendation : Committee staff recommended that to assure the
VMB has direct input and oversight of matters related to the MDC,
there should be one veterinarian member of the VMB that sits on
the MDC, and the RVT member of the VMB should also sit on the
MDC. They would not act as a liaison to the MDC but rather as
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actual participants of the MDC. The VMB should eliminate its RVT
subcommittee and the MDC RVT subcommittee and deal with RVT
issues directly and not delay implementation of important RVT
matters. Section 4832(b) of the Business and Professions Code of
2005 should be reinstated and included within Section 4809.8 to
assure that the VMB will give specific consideration to the
recommendations of the MDC regarding RVT matters. [The current
language in this measure reflects these recommended changes.]
b) Issue : Slow Response to Issues and Recommendations of Joint
Committee.
Background : The Board has been slow to deal with the issues and
recommendations made by the previous Joint Legislative Sunset
Review Committee (JLSRC) during its sunset review in 2004, and
other issues which may have been brought before the VMB over the
past 8 years. The following are some examples:
Transitioning to the RVT National Examination.
Appropriate oversight of RVT schools.
Allowing students to perform limited RVT job tasks.
Providing information to consumers about the use (or
misuse) of specialty titles of veterinarians.
Making its Diversion Program self-supporting.
Only recently planning to increase the number of
inspections of veterinary premises.
Only recently putting forth regulations to increase
its fine authority.
Only recently updating its Disciplinary Guidelines.
Posting Disciplinary Actions taken by the Board on
its Website.
Only recently putting forth regulations to deal with
illegal animal dentistry.
Adoption of Uniform Substance Abuse Standards for
its Diversion Program.
Adoption of CPEI SB 1111 regulations similar to
other health related boards.
Lack of a consumer satisfaction survey.
Recommendation : During the review of the VMB, the Chairs of the
respective Committees were concerned about the issues which had
not been addressed by the VMB and also the problem of the VMB in
addressing RVT issues. To assure that the VMB will move ahead
more expeditiously to implement these necessary changes and
address RVT issues and provide continued oversight of the VMB, it
was recommended that this Board receive a two-year extension of
its sunset date rather than a four-year extension. It will not
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be necessary for the VMB to provide a detailed report in two
years, but rather provide the respective Committees with an
update on the progress it has made regarding these issues. [The
current language in this measure reflects this recommended
change.]
a) Issue : Prioritize Veterinary Premises and Facilities to be
Inspected.
Background : It came to the attention of the Committee that the
VMB may be inspecting non-veterinarian premises, including
501(c)(3) animal rescue groups, and providing an "inspection
report" and possibly issuing citations and fines. The Committee
was concerned that this may not be a reasonable use of resources
for the VMB especially in light of the problems it is having
maintaining its own inspection program over those facilities and
hospitals that provide direct veterinary services. There may
also be some confusion in the law regarding the VMB's
jurisdiction over these types of "premises" and that should be
clarified. There does not appear to be any need for the VMB to
be involved in inspecting nonprofit animal rescue or adoption
centers unless of course the VMB has probable cause to believe
that such facility is involved in unlicensed activity. However,
the VMB should only pursue action based on unlicensed activity,
not pursuant to its inspection authority. The scope of VMB
authority over humane society facilities needs to be clarified so
that resources are not being expended on low-priority activities
while higher priorities are suffering. Local jurisdictions,
either pursuant to health and safety violations or complaints
received, may be able to deal with these other entities more
directly.
Recommendation : Committee staff recommended that existing law
should be clarified so that the VMB is not inspecting these
non-veterinarian premises so that it can better target their use
of scarce enforcement (inspection) resources and staff. [The
current language in this measure reflects this recommended
change.]
b) Issue : Inspect More Veterinary Premises and Facilities.
Background : California Code of Regulations Section 2030 sets the
minimum standards for fixed veterinary premises where veterinary
medicine is practiced, as well as all instruments, apparatus, and
apparel used in connection with those practices. The method the
VMB has selected to enforce such standards is the inspection of
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veterinary premises. During the sunset review of the VMB in
2004, the VMB inspected an average of 300 registered veterinary
facilities that were selected from a master list, and an average
of 31 facilities in response to complaints it received. The vast
majority of these inspections were unannounced. From 1996 to
2003 the VMB had completed 2,616 inspections, including 211
complaint-related ones. The average rate for annual routine
hospital inspections during those years was 13 percent, with a
slight improvement during 2001/02 to 18 percent and 16 percent in
2002/03. In its report to the JLSRC at the time, the VMB
indicated that all new veterinary premises were inspected within
the first 6 to 12 months of operation and that its goal was to
have all premises inspected within a 5-year period.
The VMB further indicated to the JLSRC at the time that when it
"randomly" selects premises to inspect, it eliminates from
selection those premises with the most recent inspection dates.
Thus, it appears that once facilities are inspected, they enjoy
"safe harbors" from random inspections for an extended period of
time, perhaps as long as 6 or more years. To accomplish these
inspections, the VMB contracted with private veterinarians who
hold current California licenses and have at least 5 years of
clinical practice experience. However, the VMB was at the time
considering expanding the pool of prospective inspectors to
include RVTs as well.
The Committee did not receive any current information regarding
the VMB's inspection program of veterinary premises. The VMB
only indicated that it hired three new inspectors for the 2012/13
fiscal year to begin in September 2012, with a goal of increasing
the actual number of inspections each year to 500, or 16%. The
VMB also changed the method of hiring inspectors from the Request
for Proposal process to establishing a pool of qualified experts
and hiring via the streamlined contract process implemented by
DCA last year. This has greatly improved the pool of qualified
applicants.
Recommendation : The Committee requested that the VMB update the
Committee on its inspection program for the past 8 years and
indicate if it has adequate staff to increase the number of
actual inspections and what percentage of veterinary premises
does it believe it will be able to inspect on an annual basis. It
would appear, based on the past number of inspections conducted
by the VMB on an annual basis that the VMB should try to at least
conduct inspections of 20% of veterinary premises. [The current
language in this measure reflects this recommended change.]
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c) Issue : Veterinarian Assistants Access to Controlled
Substances.
Background : For many years the RVTs and veterinarian assistants
who assisted veterinarians in practice were allowed to administer
drugs under indirect supervision of a veterinarian, by the
veterinarian's order, control, and full professional
responsibility. However, in 2007, the VMB's legal counsel
questioned the language in existing law regarding who can
administer drugs to animals in a veterinary practice setting.
The California Veterinary Medical Association (CVMA) disagreed
with the VMB's interpretation of the law and subsequently sought
a Legislative Counsel (LC) opinion. The LC opinion confirmed
CVMA's position and it further validated current practice as it
pertains to federal drug laws.
Ultimately, however, the CVMA determined that temporary
regulations, designed to rectify the confusion in the law, could
only go so far, and that a statutory change would be necessary.
In 2007, CVMA carried SB 969 to make the statutory changes
necessary to clarify those persons who could provide controlled
substances in a veterinary office or clinic and under what level
of supervision. This measure was signed into law, but contained
a sunset provision. The purpose for the sunset provision was to
assure that there were no problems or complaints received by the
VMB regarding the access to controlled substances by veterinary
assistants. The sunset provision was extended to January 1,
2013, pursuant to SB 943 of 2011. During the interim, the DCA,
CVMA, the VMB and representatives from the RVT community met to
determine if other changes were necessary in the law to assure
that veterinary assistants who had access to controlled
substances had appropriate oversight and had no criminal history.
Discussions centered around the requirement for the
fingerprinting of veterinary assistants who would have access to
controlled substances within the veterinary facility. However,
the Department of Justice (DOJ) indicated that they would be
unable to provide criminal background information on veterinarian
assistants to the VMB unless they were under the authority of the
VMB. Therefore, the VMB would have to at least require
veterinary assistants to obtain a permit from the VMB to be
allowed access to controlled substances so that the VMB could
then request fingerprints of the veterinarian assistant that
would be provided to DOJ. The VMB could then be provided with
the criminal background information from DOJ before they granted
a permit.
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Recommendation : It was recommended that the VMB should establish
a permitting process for veterinary assistants who will have
access to controlled substances, both under direct and indirect
supervision of a veterinarian, so that the VMB can require
fingerprints of veterinarian assistants and obtain criminal
history information from DOJ. The requirement for a permit
should begin by 2015. However, the VMB should be provided
adequate staffing to implement this new program to be paid from
fees collected pursuant to the permit requirement. [The current
language in this measure reflects these recommended changes.]
5. Current Related Legislation. SB 304 (Price, 2013). Makes various
changes to the Medical Practice Act and to the Medical Board of
California. ( Note : This bill will also be heard before the BP&ED
Committee during today's hearing)
SB 305 (Price, 2013). Extends until January 1, 2018, the
provisions establishing the Naturopathic Medicine Committee and the
Respiratory Care Board of California, and extends the term of the
executive officers of the Respiratory Care Board of California and
the California State Board of Optometry. Specifies that the
Osteopathic Medical Board of California is subject to review by the
appropriate policy committees of the Legislature. Exempts
individuals who have performed pulmonary function tests in Los
Angeles County facilities for at least 15 years, from licensure as
a respiratory care therapist. Specifies that any board under the
Department of Consumer Affairs is authorized to receive certified
records from a local or state agency to complete an applicant or
licensee investigation and authorizes them to provide those records
to the board. ( Note : This bill will also be heard before the BP&ED
Committee during today's hearing)
SB 306 (Price, 2013). Extends 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 also subjects the boards to be
reviewed by the appropriate policy committees of the Legislature.
( Note : This bill will also be heard before the BP&ED Committee
during today's hearing)
SB 308 (Price, 2013). Extends, until January 1, 2018, the term of
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the Interior Design Law. Specifies that a certified interior
designer provides plans and documents that collaborates with other
design professionals. Requires a certified interior designer to
use a written contract when contracting to provide interior design
services to a client. 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. 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. The bill would also
authorize the board to revoke, suspend, or deny its approval of a
school on specified grounds.
( Note : This bill will also be heard before the BP&ED Committee
during today's hearing)
SB 309 (Price, 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. ( Note : This
bill will also be heard before the BP&ED Committee during today's
hearing)
SUPPORT AND OPPOSITION:
Support:
None on file as of April 24, 2013.
Opposition:
None on file as of April 24, 2013.
Consultant:Bill Gage