BILL ANALYSIS Ó
SENATE COMMITTEE ON
BUSINESS, PROFESSIONS AND ECONOMIC DEVELOPMENT
Senator Jerry Hill, Chair
2015 - 2016 Regular
Bill No: AB 178 Hearing Date: June 29,
2015
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|Author: |Bonilla |
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|Version: |June 24, 2015 |
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|Urgency: |Yes |Fiscal: |Yes |
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|Consultant|Sarah Huchel |
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Subject: Board of Vocational Nursing and Psychiatric
Technicians of the State of California.
SUMMARY: Suspends the practical exam requirement for licensure as a
registered dental assistant (RDA) until July 1, 2017, during
which time the Dental Board of California (DBC) must evaluate
the exam; removes the requirement that the executive officer of
the Board of Vocational Nursing and Psychiatric Technicians of
the State of California (BVNPT) be a licensed vocational nurse,
registered nurse, or psychiatric technician; and requires the
appointment of an enforcement program monitor (EPM) to oversee
the BVNPT's disciplinary system.
Existing law:
1)Authorizes the DBC to license a person as a RDA who files an
application and submits written evidence, satisfactory to the
DBC, of one of the following eligibility requirements:
a) Graduation from an educational program in registered
dental assisting approved by the board, and satisfactory
performance on a written and practical examination
administered by the DBC.
b) For individuals applying prior to January 1, 2010,
evidence of completion of satisfactory work experience of
at least 12 months as a dental assistant (DA) in California
or another state and satisfactory performance on a written
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and practical examination administered by the DBC.
c) For individuals applying on or after January 1, 2010,
evidence of completion of satisfactory work experience of
at least 15 months as a DA in California or another state
and satisfactory performance on a written and practical
examination administered by the DBC. (Business and
Professions Code (BPC) § 1721.1 (a))
2)Provides for the licensure and regulation of vocational nurses
and psychiatric technicians by the BVNPT and extends the
operation of the BVNPT until January 1, 2016. (BPC §§
2840-2895.5)
3)Declares that protection of the public shall be the highest
priority for the BVNPT in exercising its licensing,
regulatory, and disciplinary functions. Whenever the
protection of the public is inconsistent with other interests
sought to be promoted, the protection of the public shall be
paramount. (BPC § 2841.1)
4)Requires the BVNPT to appoint an executive officer and
requires the executive officer to be a licensed vocational
nurse, registered nurse, or psychiatric technician. (BPC §
2847)
This bill:
1)Suspends the requirement of a practical exam for licensure as
a RDA and related provisions of law until July 1, 2017.
2)Requires the DBC to, in consultation with the Office of
Professional Examination Services, conduct a review to
determine whether a practical examination is necessary to
demonstrate competency of RDAs, and if so, how this
examination should be developed and administered. The DBC
shall submit its review and determination to the appropriate
policy committees of the Legislature on or before July 1,
2017.
3)Removes the requirement that the executive officer of the
AB 178 (Bonilla) Page 3
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BVNPT be a licensed vocational nurse, a licensed professional
nurse, or a licensed psychiatric technician.
4)Extends the sunset date on provisions related to the BVNPT
executive officer until January 1, 2018.
5)Requires the director of the Department of Consumer Affairs
(DCA) to appoint an EPM no later than October 1, 2015, and
authorizes the director to retain a person for this position
by a personal services contract.
6)Requires the director to supervise the EPM and authorizes him
or her terminate or dismiss the EPM from this position.
7)Requires the EPM to monitor and evaluate the BVNPT's
vocational nursing and psychiatric technician disciplinary
system and procedures, with specific concentration on
improving the overall efficiency and consistency of the
enforcement program. The director shall specify further
duties of the EPM.
8)Requires the monitoring duty to be on a continuing basis for a
period of no more than two years from the date of the
enforcement program monitor's appointment and shall include,
but not be limited to, all of the following areas:
a) Improving the quality and consistency of complaint
processing and investigation.
b) Ensuring consistency in the application of sanctions or
discipline imposed on licensees.
c) The accurate and consistent implementation of the laws
and rules affecting discipline, including adhering to
Consumer Protection Enforcement Initiative (CPEI) complaint
priority guidelines as described in the memorandum dated
August 31, 2009, by Brian J. Stinger titled "Complaint
Prioritization Guidelines for Health Care Agencies."
d) Staff concerns regarding disciplinary matters or
procedures.
e) Appropriate utilization of licensed professionals to
investigate complaints.
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f) BVNPT's cooperation with other governmental entities
charged with enforcing related laws and regulations
regarding vocational nurses and psychiatric technicians.
9)Prohibits the EPM from exercising authority over the BVNPT's
management or staff; however, the BVNPT and its staff shall
cooperate with him or her, and shall provide data,
information, and files as requested by the EPM to perform all
of his or her duties.
10)Requires the director to assist the EPM in the performance of
his or her duties, and the monitor shall have the same
investigative authority as the director.
11)Requires the EPM to submit to the DCA, the BVNPT, and the
Legislature an initial written report of his or her findings
and conclusions no later than April 1, 2016, and subsequent
written reports no later than October 1, 2016, and February 1,
2017, and be available to make oral reports to each if
requested to do so.
12)Authorizes the monitor to provide additional information to
either the DCA or the Legislature at his or her discretion or
at the request of either the DCA or the Legislature.
13)Requires the monitor to make his or her reports available to
the public or the media, and make every effort to provide the
BVNPT with an opportunity to reply to any facts, finding,
issues, or conclusions in his or her reports with which the
BVNPT may disagree.
14)Requires the EPM to issue a final report before August 1,
2017, which shall include final findings and conclusions on
the topics addressed in the initial report submitted by the
monitor.
15)Requires the BVNPT to pay for all of the costs associated
with the employment of the enforcement program monitor.
16)Sunsets provisions of law related to the EPM on October 1,
2017.
17)Requires DCA's internal audit unit to review the BVNPT's
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staffing resources needs and requirements, and requires the
director to provide to the Legislature a copy of the review,
no later than October 1, 2016. The director shall include with
this report an overview of how the director intends to ensure
that the BVNPT's staff are sufficiently qualified for purposes
of implementing the provisions existing law, and the estimated
costs of meeting staffing and other requirements, as
specified, based on findings of the review. The director shall
include a brief evaluation of whether the current fee
structure is appropriate to satisfy those staffing and other
requirements. Sunsets this provision on January 1, 2018.
18)Declares this bill to be an urgency statute necessary in
order for the BVNPT to meet urgent administrative needs.
FISCAL
EFFECT: This bill is keyed "fiscal" by the Legislative Counsel.
According to the Assembly Appropriations Committee analysis
dated May 4, 2015, this bill will have
costs of $350,000 to the Vocational Nursing and Psychiatric
Technicians Fund over two years for an enforcement program
monitor.
COMMENTS:
1.Purpose. This bill is sponsored by the Author . This is one
of several bills resulting from the Sunset Review process.
According to the Author's office:
"DBC. After the DBC recalibrated the practical examination
for RDAs last August [2014], there was an alarming decline in
passage rates. In addition to placing undue hardship on
examinees who are now unable to find work or have lost work
due to failing the exam, and the impact on our healthcare
workforce, the steep decline questions the validity of the
examination and its ability to accurately measure a licensee's
competency.
"BVNPT. Since the inception of the Sunset Review Oversight
process, there have been occasions when the operations of a
licensing entity are called into question and require
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additional scrutiny. This is typically in response to
information that is presented to the Legislature that warrants
further investigation. The Committee staff believes that this
is the case with the BVNPT Board."
2.RDA examination. Current law requires a candidate for
licensure as a RDA to demonstrate satisfactory performance on
a written and practical examination administered by the DBC.
The pass rates for the RDA Practical Exam averaged roughly 83%
over the past four fiscal years. However, in 2014, pass rates
dropped dramatically. Passage rates declined from an over 80%
average to a 38% pass rate in August 2014, 19% in November
2014, to 33% in February 2015. The sharp declines occurred
after the practical examinations were recalibrated, as
discussed above. In addition, recent examination scores from
the February 2015 examination indicate that these rates
continue to be very low.
Currently, the DBC is pursuing an occupational analysis (OA)
to validate the practical exam. The last OA was conducted in
2009. Licensure examinations with substantial validity
evidence are essential in preventing unqualified individuals
from obtaining a professional license. To that end, licensure
examinations must be developed following an examination
outline based on a current OA that is regularly evaluated and
updated when tasks performed or prerequisite knowledge in a
profession or on a job change, and to prevent overexposure of
test questions.
According to the DCA's policy, an occupational analysis and
examination outline should be updated at least every five
years to be considered current. Such an OA is projected to be
$60,000 and could take up to a year to complete. DBC staff
notes that the cost would be absorbable by the Dental
Assisting budget.
Based on the precipitous decline in examination scores, which
questions the validity of the examination and the ability of
the examination to truly measure competency, this bill would
eliminate the practical examination until the DBC is able to
conduct an OA, examine its validity, and determine whether an
examination is necessary to demonstrate competency.
Applicants for licensure would still need to meet all other
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existing requirements for licensure, including passing the
written examination.
3.EPM for BVNPT. The BVNPT underwent a Sunset Review in 2014.
The results of the review indicated that there were
significant, and possibly criminal, issues with its
enforcement program. The BVNPT was taking a very long time to
process cases, there were discrepancies in enforcement
statistics, and cases were not being handled appropriately.
As a result, this bill will enlist the support of the DCA's
Internal Audit Office and the Department of Investigations
(DOI) for immediate intervention, and will place an EPM within
the BVNPT to observe its activities for two years and report
to the DCA and Legislature on his or her findings.
4.Related Legislation. AB 179 (Bonilla and Hill) of 2015 extends
the operation of the DBC until January 1, 2020 and increases
statutory fee caps relating to dentists and dental assistants.
Extends the operation of the BVNPT until January 1, 2018, and
merges the Vocational Nursing fund and the Psychiatric
Technician funds, as specified. ( Status : This bill will be
heard in the Senate Committee on Business, Professions, and
Economic Development on July 6, 2015.)
SB 539 (Price), Chapter 338, Statutes of 2011, among other
things, extended the operation of the BVNPT until January 1,
2016, specified that the BVNPT would be subject to review by
the appropriate policy committees of the Legislature.
SB 540 (Price), Chapter 385, Statutes of 2011, among other
things, extended the operation of the DBC until January 1,
2016, and instead specified that the board would be subject to
review by the appropriate policy committees of the
Legislature. The bill changed the membership of the board to
include one additional public member, to be appointed by the
Governor. The bill also created a Dental Assisting Council of
the board, to be appointed by the board, to consider matters
relating to dental assistants and make recommendations to the
board and standing committees of the board, as specified.
5.Arguments in Support. The California Dental Assisting
Teachers Association , the California Dental Assistants
Association , and the Foundation for Allied Dental Education
states in support that, "Dental assisting is a promising
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healthcare career pathway, predominately for women, and often
for those who need to provide for their families.
Unfortunately, the practical examination now represents an
artificial hurdle for graduates of educational programs and
lacks credibility or professional relevance. It is now simply
a barrier that prevents over 80% of candidates who have spent
a year of their lives in educational programs, at great
expense in tuition and costly examination fees, including
application fees and repeated rental of practical examination
kits, from achieving their professional goals and obtaining
gainful employment - all due to an examination calibration and
grading process that was never made public or clear to the
candidates prior to its implementation.
"We support this temporary moratorium and its immediate
implementation while the DBC and the State fully execute an
Occupational Analysis, a feasibility study, and take proper
measures to ensure that this simulated examination is truly a
test of one's competence to become licensed as a Registered
Dental Assistant and serve the needs of the consumers of
California."
The DBC writes in support of this bill, stating, "Over the
last year, the psychometric validity of the Board's current
RDA practical examination has been questioned as the failure
rate of the examination has increased. The Board has begun
working with the Office of Professional Examination Services
on the occupational analysis and hopes to have findings
available during early 2016."
BVNPT writes, "Enactment of this important legislation will
ensure that the BVNPT can continue its vital work of
protecting the consumers of California from incompetent and/or
unethical licensed vocational nurses and psychiatric
technicians."
6.Arguments in Opposition. Numerous individuals express concern
that the lack of a practical exam will place patients in
harm's way for lack of competency. "Not having an unbiased
third party to evaluate the testing candidate is not in the
interest of public safety (you and myself included). To allow
a candidate the right to become an RDA without a practical
exam will prove to be harmful to the public and paying
consumer."
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SUPPORT AND OPPOSITION:
Support:
Board of Vocational Nursing and Psychiatric Technicians
California Dental Assistants Association
California Dental Assisting Teachers Association
Dental Board of California
Foundation for Allied Dental Education
Pasadena City College
Opposition:
Numerous individuals
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