BILL ANALYSIS Ó
SENATE COMMITTEE ON
BUSINESS, PROFESSIONS AND ECONOMIC DEVELOPMENT
Senator Jerry Hill, Chair
2015 - 2016 Regular
Bill No: AB 161 Hearing Date: June 8,
2015
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|Author: |Chau |
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|Version: |March 17, 2015 |
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|Urgency: |No |Fiscal: |No |
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|Consultant|Sarah Mason |
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Subject: Athletic trainers.
SUMMARY: Establishes certification and training requirements for
athletic trainers and prohibits individuals from calling
themselves athletic trainers unless they meet those
requirements.
Existing law: Establishes the Unfair Practices Act which
defines unfair competition as any unlawful, unfair, or
fraudulent business act or practice and unfair, deceptive,
untrue or misleading advertising. (Business and Professions
(BPC) § 17000 et. seq.)
This bill:
1) Makes it unlawful for any person to hold himself or herself
out as an athletic trainer or a certified athletic trainer,
or use the term "AT", "ATC", or "CAT" to imply the person is
an athletic trainer unless he or she is certified by the
Board of Certification, Inc., and has done either of the
following:
a) Graduated from a college or university, after completing
an accredited athletic training education program, as
specified.
b) Completed eligibility requirements for certification by
the Board of Certification, Inc., prior to January 1, 2004.
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1) Makes it an unfair business practice for a person to use
the title "athletic trainer", "certified athletic trainer" or
any other term, such as "certified", "licensed",
"registered", "AT", "ATC", or "CAT" that implies or suggests
that the person is an athletic trainer, if the person does
not meet the requirements set forth in this bill.
2) Provides that a person who has worked as an athletic
trainer in California for a period of 20 consecutive years
prior to January 1, 2016, and who is not otherwise eligible
to use the title "athletic trainer", may use the title
"athletic trainer".
FISCAL
EFFECT: None. This bill is keyed "nonfiscal" by Legislative
Counsel.
COMMENTS:
1. Purpose. The California Athletic Trainers' Association
(CATA) is the Sponso r of this bill. According to the Author,
this bill would ensure that only people with the proper
education, training, and certification, may call themselves
an athletic trainer. The Author notes that "athletic trainers
and other individuals are currently practicing athletic
training - a health care profession - in an unregulated
manner." According to the Author, 49 states and the District
of Columbia regulate athletic trainers, but in California
anyone can label him or herself an athletic trainer without
the proper education, training, or certification. The Author
points out that in some cases, individuals such as janitors,
coaches, shipping and receiving clerks and others have been
given the title "Athletic Trainer" and the responsibility for
evaluating and managing concussions, spinal cord injuries,
shoulder dislocations, and knee injuries.
According to the Author, the lack of oversight of athletic
trainers is a consumer protection problem. The athletes with
whom these unqualified individuals work, and the employers
who hire them, have no way of knowing that these individuals
are not qualified to be athletic trainers. The public has no
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way to determine if someone practicing athletic training is
qualified. The public has no way to file a complaint, or ask
for a practitioner to be investigated and/or sanctioned for
incompetence, unethical practice, or other issues which
creates a huge regulatory gap in the healthcare system.
The Author states that AB 161 "would protect Californians by
ensuring that individuals calling themselves athletic
trainers have had the proper education and training and are
certified by a nationally accredited athletic training
certification agency."
2. Athletic Trainers. In compliance with the sunrise process,
CATA completed and submitted an extensive "sunrise
questionnaire" to this Committee in December 2011 in support
of its proposal for licensure (at the time, a bill proposing
licensure was moving through the Legislative process).
According to information contained in the sunrise
questionnaire, athletic trainers are allied healthcare
professionals recognized by the American Medical Association,
the American Medical Society of Sports Medicine and others.
Athletic trainers work in collaboration with a physician and
their education is predicated upon a formalized relationship
with a physician, working under established guidelines.
According to the sunrise questionnaire, athletic trainers
evaluate injuries and determine a patient's disposition,
respond to emergencies and make "split second decisions"
regarding the management of an injury as well as making
decisions regarding the course of rehabilitation. Athletic
trainers also make "immediate decisions regarding serious
conditions such as concussion, spinal cord injury, heat
illness and sudden cardiac arrest without the intervention or
advice of other health care professionals" in situations
where an incorrect decision could lead to a catastrophic or
fatal outcome.
An individual can become an athletic trainer by graduating
with a minimum of a bachelor's degree from an accredited
athletic training education program and by passing a national
certification examination offered by Board of Certification,
Inc. (BOC). According to the sunrise questionnaire, 70
percent of athletic trainers practicing today hold a master's
degree or higher. Athletic trainers, like other health care
professionals, take science based courses in anatomy,
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physiology, chemistry and physics and must understand all
systems of the body and their normal and pathological
functions, including biochemical functions. Athletic
training education also includes didactic instruction and
clinical training in risk management and injury prevention,
orthopedic clinical assessment and diagnosis, medical
conditions and disabilities, acute care of injuries and
illness, therapeutic modalities and conditioning and
rehabilitative exercise, psychosocial intervention and
referral, nutritional aspects of injuries and illness, health
care administration and professional development. Although
there are currently 16 accredited athletic training programs
in California, no person in California is required to obtain
a degree or to become certified to work as an athletic
trainer.
Currently, there are approximately 2,500 certified athletic
trainers practicing in California. Athletic trainers
specialize in the prevention, evaluation, immediate care,
treatment and rehabilitation of injuries and activity related
conditions in a wide range of people engaged in physical
activities from professional and amateur athletes to
industrial workers and entertainers. Athletic trainers are
employed by professional sports teams, colleges and
universities, high schools, outpatient rehabilitation
clinics, hospitals, industry/corporations, performing arts
groups, physicians, the military and other institutions.
Nearly 40 percent of athletic trainers in California work
with non-athletes from a variety of backgrounds because they
may reduce employee injuries and subsequent worker's
compensation costs. Information provided in the sunset
questionnaire highlighted cost savings of around $7 million
annually by a large manufacturing firm with over 3000
employees as a result of the firm hiring five athletic
trainers to work in an injury preventive role.
Information provided in the sunrise questionnaire found more
than 60 cases of harm as the result of improper care provided
by non-certified "athletic trainers." Of 760 respondents who
took part in a CATA survey for the sunrise questionnaire, 400
reported instances of harm as the result of improper care due
to certified and non-certified athletic trainers. According
to the U.S. Department of Labor Division of Practitioner Data
Banks, a voluntary reporting repository for sanctions made by
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state boards, there were 469 reports of sanctions to athletic
trainers - both certified and uncertified - from 2000 to
2010. These sanctions were based upon misconduct including
incompetent practice/harm, practicing beyond the scope of
practice, and sexual misconduct. BOC reported over 2,700
violations of professional practice standards in five years
(2005-10) with nearly 300 violations in California, including
three sexual offenses, and in some cases included those
practicing without a valid certification or practice by those
who had lost their licensure in other states.
CATA asserts that there are "currently no other unregulated
professions that are providing services similar to those of
athletic trainers."
3. Board of Certification, Inc. According to their Website, BOC
was incorporated in 1989 to provide a certification program
for entry-level athletic trainers. BOC establishes and
regularly reviews both the standards for the practice of
athletic training and the continuing education requirements
for BOC certified athletic trainers. BOC asserts that is has
the only accredited certification program for athletic
trainers in the U.S. Additionally, BOC cites accreditation
by the National Commission for Certifying Agencies (NCCA) and
requirements that it undergo review and re-accreditation
every five years through the NCCA. NCCA is the accreditation
body of Institute for Credentialing Excellence, a non-profit
organization that provides educational, networking, and
advocacy resources to the credentialing community, and is
charged with evaluating certification organization for
compliance with the NCCA Standards for the Accreditation of
Certification Programs.
BOC's Website further asserts that they have been responsible
for the certification of athletic trainers since 1969. BOC
was the certification arm of the professional membership
organization of the National Athletic Trainers' Association
until 1989 when BOC became an independent non-profit
organization. Athletic trainers currently have the option
for certification through BOC. For BOC certification,
athletic trainers must have received a minimum of a
bachelor's degree from a National Athletic Training
Association (NATA) accredited institution and pass a
comprehensive exam. All states currently regulating athletic
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trainers utilize the BOC examination which is based on the
Commission on Accreditation of Athletic Training Education
(CAATE). To retain certification, credential holders must
continue taking medical-related courses and adhere to the BOC
standards of practice.
4. Title Act vs. Practice Act Protection. It is important to
note the distinction between "title act" and certification or
registration regulation versus "practice act" and licensing
regulation. A practice act along with licensure confers the
exclusive right to practice a given profession on
practitioners who meet specified criteria related to
education, experience, and examination, and often is embodied
in a statutory licensing act (i.e., those who are not
licensed cannot lawfully practice the profession). A
practice act is the highest and most restrictive form of
professional regulation, and is intended to avert severe harm
to the public health, safety or welfare that could be caused
by unlicensed practitioners.
A title act and a certification or registration program, on the
other hand, reserves the use of a particular professional
(named) designation to practitioners who have demonstrated
specified education, experience or other criteria such as
certification by another organization. A title act typically
does not restrict the practice of a profession or occupation
and allows others to practice within that profession; it
merely differentiates between practitioners who meet the
specified criteria, and are authorized by law to represent
themselves accordingly (usually by a specified title) and
those who do not. Some title acts also include a state
certification or registration program, or reliance on a
national certification or registration program, so that those
who use the specified title, and hold themselves out to the
public, have been certified or registered by a state created
or national entity as having met the specified requirements.
This entity may also regulate to some extent the activities
of the particular profession by setting standards for the
profession to follow, and to also provide oversight of the
practice of the profession by reporting unfair business
practices or violations of the law and either denying or
revoking a certification or registration if necessary.
AB 161 does not establish a licensing practice act, but instead
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provides for a title act. It restricts the use of the title
"athletic trainer" to only those who have met certain
education or certification requirements. There is no state
program created to provide oversight of this profession;
there is, instead, reliance on whether the person meets the
education requirements or if they have been certified by a
specific corporation and provides awareness to the public
that the person has met these qualifications.
5. Related Legislation. AB 1890 (Chau) of 2014 was identical to
this bill. ( Status: The bill was vetoed by Governor Brown
who wrote in his veto message that the conditions set forth
in the bill "impose unnecessary burdens on athletic trainers
without sufficient evidence that they are really needed.")
AB 864 (Skinner) of 2013 would have established the licensure
and regulation of athletic trainers through the creation of
an Athletic Trainer Licensing Committee under the Physical
Therapy Board of California. ( Status: The bill was held
under submission in the Assembly Committee on
Appropriations.)
SB 1273 (Lowenthal) of 2012 was very similar to AB 864.
( Status: The bill failed passage in this Committee.)
AB 374 (Hayashi) of 2011 would have established the Athletic
Trainer Licensing Committee within the Medical Board of
California to license and regulate athletic trainers
commencing January 1, 2013, with a sunset date of January 1,
2018. The bill was later amended to provide title protection
for athletic trainers. ( Status: The bill was later amended
to become a bill by Assemblymember Hill that dealt with
funeral embalmers and signed by the Governor.)
AB 1647 (Hayashi) of 2010 would have established
certification and training requirements for athletic trainers
and prohibited individuals from calling themselves athletic
trainers unless they meet those requirements. ( Status : The
bill was vetoed by Governor Schwarzenegger.)
SB 284 (Lowenthal) of 2007 would have enacted the Athletic
Trainers Registration Act prohibiting a person from
representing himself or herself as a "certified athletic
trainer," unless he or she is registered by an athletic
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training organization. ( Status: The bill was vetoed by
Governor Schwarzenegger.)
SB 1397 (Lowenthal) of 2006 would have enacted the Athletic
Trainers Certification Act, prohibiting a person from
representing him or herself as an athletic trainer unless he
or she is certified as an athletic trainer by an athletic
training organization, as defined. ( Status: The bill was
vetoed by Governor Schwarzenegger.)
AB 614 (Lowenthal) of 2003 would have required the DCA to
submit a recommendation to the Legislature as to whether the
state should license and regulate athletic trainers by
January 1, 2006, if the DCA is provided with an occupational
analysis of persons providing athletic trainer services by
July 1, 2005. ( Status: This bill was held in this Committee
to allow JCBCCP to examine whether athletic trainers should
be licensed as part of the "sunrise" process.)
AB 2789 (Lowenthal) of 2002 would have required the
Department of Consumer Affairs to review the need for
licensing of athletic trainers and undertake an occupational
analysis. ( Status : This bill was held under submission in
the Assembly Committee on Appropriations.)
6. Arguments in Support. The California Athletic Trainers
Association (CATA) writes in support of this bill, noting
that California is the only state that does not regulate the
profession. CATA states that "The unregulated status of the
athletic training profession is a major public health
concern. Currently, uneducated and unqualified individuals
including janitors and shipping/receiving clerks are posing
as athletic trainers and providing healthcare to our
vulnerable population without the proper education or
training. Individuals who have lost their national
certification or license in other states are practicing in
California and calling themselves athletic trainers with
absolute impunity."
Advocates for Injured Athletes also supports this bill,
writing that "certified athletic trainers are able to assess
catastrophic injuries. In San Diego County, there have been
2 neck fractures in high school athletes that have resulted
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in lives saved thanks to the care from a certified athletic
trainer." The organization states that athletic trainers
deserve title protection.
The American Medical Society for Sports Medicine writes in
support, noting that "in the current environment, literally
anyone can call themselves an athletic trainer, allowing many
individuals to act as athletic trainers in the state of
California who are not properly trained as athletic trainers.
Currently, the California public has no means of ensuring
clinical competence in the profession of athletic training."
According to Board of Certification, Inc ., "It is unfortunate
that California is a safe haven for those who have never gone
through the educational and training rigors of athletic
training or, perhaps worse, lost their athletic training
license in another state or lost their BOC certification."
BOC writes that an athletic trainer may lose their BOC
certification and their license to practice in Arizona for
example and there is nothing stopping the uncertified,
unlicensed individual from moving to California and
continuing to practice athletic training - thereby putting
patients at risk.
The University of California Southern California also
supports this bill, writing that "given the complexity of the
work involved, USC believes it's important that only those
individuals who use the Athletic Trainer title demonstrate
the educational, training and certification qualifications
outlined in AB 161."
SUPPORT AND OPPOSITION:
Support:
California Athletic Trainers' Association (CATA) (Sponsor)
Advocates for Injured Athletes
Association of Independent California Colleges and Universities
(AICCU)
American Medical Society for Sports Medicine
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Board of Certification, Inc. (BOC)
California College and University Police Chiefs
University of California Southern California (USC)
2,500 individuals
Opposition:
None on file as of June 2, 2015.
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