BILL ANALYSIS Ó
SENATE COMMITTEE ON LABOR AND INDUSTRIAL RELATIONS
Senator Tony Mendoza, Chair
2015 - 2016 Regular
Bill No: AB 1542 Hearing Date: August 24,
2015
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|Author: |Mathis |
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|Version: |April 23, 2015 |
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|Urgency: |Yes |Fiscal: |Yes |
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|Consultant:|Gideon Baum |
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Subject: Workers'compensation: neuropsychologists
KEY ISSUE
Should the Legislature permit the Division to appoint qualified
clinical neuropsychologists as Qualified Medical Examiners
(QMEs)?
ANALYSIS
Existing law establishes a workers' compensation system that
provides benefits to an employee who suffers from an injury or
illness that arises out of and in the course of employment,
irrespective of fault. This system requires all employers to
secure payment of benefits by either securing the consent of the
Department of Industrial Relations to self-insure or by securing
insurance against liability from an insurance company duly
authorized by the state.
Existing law requires that the administrative director (AD)
appoints qualified medical evaluators (QMEs) in each of the
respective specialties as required for the evaluation of
medical-legal issues. In order to be appointed as a QME, the
applicant must pass a written examination and meet additional
requirements specific to each specialty.
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For medical doctors or doctors of osteopathy, the applicant
must:
1) Be board certified in a specialty by a board recognized
by the AD and either the Medical Board of California or the
Osteopathic Medical Board of California; or
2) Have successfully completed a residency training program
accredited by the Accreditation Council for Graduate
Medical Education (ACGME) or the osteopathic equivalent.
For psychologists, the applicant must:
1) Be board certified in clinical psychology by a board
recognized by the AD; or
2) Hold a doctoral degree in psychology, or a doctoral
degree deemed equivalent for licensure by the Board of
Psychology from a university or professional school
recognized by the AD and has not less than five years'
postdoctoral experience in the diagnosis and treatment of
emotional and mental disorders; or
3) Has not less than five years' postdoctoral experience in
the diagnosis and treatment of emotional and mental
disorders, and has served as an agreed medical evaluator on
eight or more occasions prior to January 1, 1990.
(Labor Code §139.2)
This bill would:
1) Permit a medical doctor to be appointed as a QME if his
or her residency training program was certified by a
predecessor to the ACGME.
2) Permit the appointment of a clinical neuropsychologist
as a QME if:
a) The clinical neuropsychologist is by the American
Board of Clinical Neuropsychology, the American Board of
Professional Neuropsychology, or another organization
recognized by the AD, or was appointed as a qualified
medical evaluator in neuropsychology before January 1,
2015.
b) The clinical neuropsychologist is licensed to
practice psychology in this state who has a doctoral
degree in psychology from an accredited university or
college training program, has completed an internship or
its equivalent in a clinically relevant area of
professional psychology, and has at least two years of
AB 1542 (Mathis) Page 3
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experience and specialized training, at least one year of
which is at the post-doctoral level in the study and
practice of clinical neuropsychology and related
neurosciences under the supervision of a clinical
neuropsychologist.
1) Provide that the bill is an urgency measure, to take
effect immediately.
COMMENTS
1. QMEs and Medical-Legal Disputes:
As was noted above, Qualified Medical Examiners (QMEs) are
medical examiners who have taken an exam and met certain
specific requirements that are authorized to conduct an
evaluation of medical-legal issues. Medical-legal does NOT
refer to if an injured worker will or will not receive medical
treatment. Rather, medical-legal relates to the legal
consequences of medical conditions, frequently the extent to
which an injured employee's injuries or conditions are
disabling, or whether the injuries or conditions have become
permanent and stationary.
When there is a medical-legal dispute, a party can request
appointment of a QME. The requesting party specifies what
sort of expertise is needed to resolve the dispute, and the
DWC appoints a panel, from which a single QME is selected. If
both parties can agree to a single medical examiner, than the
agreed upon doctor, known as an Agreed Medical Evaluator
(AME), is used instead of the QME panel to resolve the
Medical-legal issues.
Until recently, Clinical Neuropsychologists were included as
being eligible for selection as QMEs. Generally, Clinical
Neuropsychologists were selected for their expertise in cases
involving head trauma. For reasons discussed below, that is no
longer the case. However, Clinical Neuropsychologists may
still be selected as AMEs.
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2. AB 1542 and Clinical Neuropsychologists as QMEs:
According to the American Neuropsychiatric Association (ANPA),
clinical neuropsychology is distinct from traditional
psychology due to the focus on understanding brain function.
The ANPA states:
"A clinical neuropsychologist usually holds an advanced degree
in clinical psychology (Ph.D., Psy.D.), and has completed a
clinical internship and specialized post-doctoral training in
clinical neuropsychology. What distinguishes a clinical
neuropsychologist from other clinical psychologists is
knowledge of the brain, including an understanding of areas
such as neuroanatomy and neurological disease?. They use
neuropsychological tests to assess cognitive deficits, and
they are involved in the management, treatment and
rehabilitation of cognitively impaired patients."
As noted above, the DWC may only certify a psychologist if the
psychologist is board certified by the Board of Psychology or
a board recognize by the DWC. Currently, Clinical
Neuropsychology is not a recognized specialty by the Board of
Psychology. Despite this, the DWC recognized Clinical
Neuropsychologists as QMEs until recent regulations removed
Clinical Neurologists from the list of potential QMEs. While
this decision brought the QME regulations in line with
statute, it was met with disappointment from some
stakeholders.
AB 1542 would return the QME process to the prior status quo,
allowing clinical neuropsychologists to be appointed as QMEs.
3. Proponent Arguments :
Proponents note that, until recently, clinical
neuropsychologists were eligible for appointment as QMEs.
Proponents further note that clinical neuropsychologists are
trained in understanding neuro-diseases and neuro-anatomy,
differentiating neuropsychologists from traditional
psychologists. Proponents argue that neuropsychologists are
needed to evaluate a number of serious head and brain injuries
including penetrating brain injuries, anoxia/Hypoxia, Diffuse
Axonal Injury, and Coup-contrecoup injuries. Proponents also
argue that denying injured workers access to
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neuropsychologists as QMEs will require traditional
psychologists serving as QMEs to contact clinical
neuropsychologists in order to adequately perform their duties
as a QME, creating unnecessary delay and cost for injured
workers and employers.
4. Opponent Arguments :
The Department of Industrial Relations (DIR) respectfully
opposes AB 1542. Specifically, DIR notes that it is the
Administrative Director's policy to recognize only specialty
boards that are recognized by one of the state's professional
licensing boards, such as the California Board of Psychology,
as licensing boards have the requisite professional background
and expertise to evaluate and identify subspecialties as
appropriate. DIR notes that the Administrative Director has
proposed regulations on QMEs enacting this policy so as to be
consistent across all disciplines. DIR also notes concern
because the California Board of Psychology does not recognize
neuropsychology as a subspecialty in psychology. As a result,
DIR argues that AB 1542 would contravene the Division's
proposal and would also undermine DWC's current policy of
applying uniform criteria for QME specialty certification that
meet professional standards accepted by the wider lay and
professional communities.
5. Prior Legislation :
SB 375 (Committee on Labor and Industrial Relations), Statutes
of 2013, Chapter 287, makes minor and technical changes to the
Qualified Medical Examiner (QME) appointment process.
SUPPORT
California Society of Industrial Medicine and Rehabilitation
(Sponsor)
Brain Injury Coalition of California
California Conference of Machinists
California Neurology Society
California Psychological Association
California Society of Physical Medicine and Rehabilitation
Californian Applicants' Attorney Association
Robert A. Rose, M.D.
Robert L. Weinmann, M.D. Qualified Medical Evaluator (QME)
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OPPOSITION
California Department of Industrial Relations
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