BILL ANALYSIS Ó
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|SENATE RULES COMMITTEE | AB 161|
|Office of Senate Floor Analyses | |
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THIRD READING
Bill No: AB 161
Author: Chau (D), et al.
Amended: 3/17/15 in Assembly
Vote: 21
SENATE BUS, PROF. & ECON. DEV. COMMITTEE: 9-0, 6/8/15
AYES: Hill, Bates, Berryhill, Block, Galgiani, Hernandez,
Jackson, Mendoza, Wieckowski
ASSEMBLY FLOOR: 80-0, 4/20/15 (Consent) - See last page for
vote
SUBJECT: Athletic trainers
SOURCE: California Athletic Trainers Association
DIGEST: This bill establishes certification and training
requirements for athletic trainers and prohibits individuals
from calling themselves athletic trainers unless they meet those
requirements.
ANALYSIS: 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:
AB 161
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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. (BOC), 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
BOC, prior to January 1, 2004.
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".
Background
According to the author, this bill ensures 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 athletes with whom these
unqualified individuals work, and the employers who hire them,
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have no way of knowing that these individuals are not qualified
to be athletic trainers. The public has no 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.
Athletic Trainers. In compliance with the sunrise process, the
California Athletic Trainers' Association completed and
submitted an extensive "sunrise questionnaire" to the Senate
Committee on Business, Professions and Economic Development 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 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, 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,
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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.
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. 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 3,000 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 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 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.
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
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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
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.
FISCAL EFFECT: Appropriation: No Fiscal
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Com.:NoLocal: No
SUPPORT: (Verified6/9/15)
California Athletic Trainers' Association (source)
Advocates for Injured Athletes
American Medical Society for Sports Medicine
Association of Independent California Colleges and Universities
Board of Certification, Inc.
California College and University Police Chiefs Association
University of Southern California
2,500 individuals
OPPOSITION: (Verified6/9/15)
None received
ARGUMENTS IN SUPPORT: Supporters note that California is the
only state that does not regulate the profession and the
unregulated status of the athletic training profession is a
major public health concern because currently, uneducated and
unqualified individuals, including janitors and
shipping/receiving clerks, are posing as athletic trainers and
providing healthcare to a vulnerable population without the
proper education or training. Supporters also write that
certified athletic trainers are able to assess catastrophic
injuries and cite the example of San Diego County where there
have been two neck fractures in high school athletes that
resulted in lives saved thanks to the care from a certified
athletic trainer. Supporters note that currently, the California
public has no means of ensuring clinical competence in the
profession of athletic training and given the complexity of the
work involved, it is important that only those individuals who
use the Athletic Trainer title demonstrate the educational,
training and certification qualifications outlined in AB 161.
ASSEMBLY FLOOR: 80-0, 4/20/15
AB 161
Page 7
AYES: Achadjian, Alejo, Travis Allen, Baker, Bigelow, Bloom,
Bonilla, Bonta, Brough, Brown, Burke, Calderon, Campos, Chang,
Chau, Chávez, Chiu, Chu, Cooley, Cooper, Dababneh, Dahle,
Daly, Dodd, Eggman, Frazier, Beth Gaines, Gallagher, Cristina
Garcia, Eduardo Garcia, Gatto, Gipson, Gomez, Gonzalez,
Gordon, Gray, Grove, Hadley, Harper, Roger Hernández, Holden,
Irwin, Jones, Jones-Sawyer, Kim, Lackey, Levine, Linder,
Lopez, Low, Maienschein, Mathis, Mayes, McCarty, Medina,
Melendez, Mullin, Nazarian, Obernolte, O'Donnell, Olsen,
Patterson, Perea, Quirk, Rendon, Ridley-Thomas, Rodriguez,
Salas, Santiago, Steinorth, Mark Stone, Thurmond, Ting,
Wagner, Waldron, Weber, Wilk, Williams, Wood, Atkins
Prepared by:Sarah Mason / B., P. & E.D. / (916) 651-4104
6/10/15 9:26:55
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