BILL ANALYSIS
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|Hearing Date:June 21, 2010 |Bill No:AB |
| |1647 |
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SENATE COMMITTEE ON BUSINESS, PROFESSIONS
AND ECONOMIC DEVELOPMENT
Senator Gloria Negrete McLeod, Chair
Bill No: AB 1647Author:Hayashi
As Amended:May 28, 2010 Fiscal: Yes
SUBJECT: Athletics.
SUMMARY: Establishes certification and training requirements for
athletic trainers; prohibits individuals from calling themselves
athletic trainers unless they meet those requirements; and, requires
the State Department of Education to adopt a heat-acclimatization
program.
.
Existing law:
1) Provides for the licensure and regulation of physical therapists
and physical therapy assistants by the Physical Therapy Board of
California (PTBC) within the Department of Consumer Affairs (DCA).
2) Defines the practice of physical therapy as the art and science of
physical or corrective rehabilitation or of physical or corrective
treatment of any bodily or mental condition of any person by the
use of the physical, chemical and other properties of heat, light,
water, electricity, sound, massage and active, passive and
resistive exercise, including physical therapy evaluation,
treatment planning, instruction and consultative services.
3) Requires the State Department of Education (Department) to adopt
rules and regulations that it deems necessary and proper to secure
the establishment of courses in physical education in elementary
and secondary schools. Requires the Department to exercise general
supervision over the courses of physical education in elementary
and secondary schools of the state; advise school officials, school
boards, and teachers in the development and improvement of their
physical education and activity programs; and investigate the work
in physical education in the public schools.
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4) Grants the Department certain authority over interscholastic
athletes, including the authority to state that the polices of
school districts, of associations or consortia of school districts,
and of the California Interscholastic Federation (CIF), concerning
interscholastic athletics, are in compliance with both state and
federal law.
5) Provides for 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.
This bill:
1) Makes it unlawful for any person to hold himself or herself out as
an athletic trainer unless he or she has been 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 requirements for certification by the Board of
Certification, Inc., prior to January 1, 2004.
1) Prohibits an athletic trainer from engaging in athletic training
activities unless pursuant to protocols developed by a physician
and surgeon for that athletic trainer.
2) Makes it an unfair business practice for any person to use the
title of "athletic trainer" or "certified athletic trainer" or any
other term, such as "licensed," "registered," or "ATC," that
implies or suggests that the person is certified as an athletic
trainer, if the person does not meet the requirements set forth in
this bill and engages in athletic trainer activities.
3) Requires the Department to adopt a heat-acclimatization program
established by the National Athletic Trainers' Association or other
similarly recognized organization, and to post this program on its
Internet Website.
FISCAL EFFECT: According to the Assembly Appropriations Committee
analysis dated April 26, 2010, this bill will result in General Fund
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administrative costs of approximately $125,000 to the Department to
adopt compliance and monitoring procedures to ensure schools comply
with the requirements of this measure related to the heat
acclimatization program.
COMMENTS:
1. Purpose. According to the Author, many individuals call themselves
"athletic trainers" in California, but California is in the
minority of states that do not regulate this profession. This bill
will provide title protection for this group of medical
professionals and ensure that only those properly trained and
certified may use that term and will help protect school athletes
from serious and catastrophic injury.
2. Background. According to information provided by the Author, it
has been estimated that more than 6 million high school students
participate in sports nationwide. Over 715,000 sports related
injuries occur annually and in just the last 2 years, over 125
middle and high school athletes died as a result of an injury.
California alone suffered 18 fatalities.
The Author further asserts that scientific studies have raised
concerns about the long-term impacts of head injuries in sports.
Their lasting effects are unknown and have recently been
highlighted by reports of professional football players who
sustained concussions during their playing years and are now
feeling the effects of memory loss and other memory related
diseases. For females, the leading cause of high school sports
concussion is soccer, and a 2009 American Journal of Sports
Medicine article shows that female athletes are suffering more
significant effects from multiple concussions than male athletes.
The San Jose Mercury News reported on a 2009 study that showed 41
percent of high school athletes who suffered a concussion return to
play prematurely.
Heat related illness in sports is a problem for young athletes as
well. Many high school sports begin practice during the summer
months when high temperatures are extreme. A recent USA Today
article reported 4 heatstroke related deaths at the high school
level in 2008.
The Sponsor of the bill, The California Athletic Association
(CATA), defines an athletic trainer as a person who specializes in
the prevention, diagnosis, assessment, treatment and rehabilitation
of muscle and bone industries and illnesses, and is educated in
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emergency care for catastrophic injuries such as spinal cord
injuries, sudden cardiac arrest, heat illness and concussions.
Working under the direction of a licensed physician, and in
cooperation with other health care providers, athletic trainers are
recognized as allied health professionals by the American Medical
Association (AMA) and must meet the qualifications set by a state
regulatory board and/or the Board of Certification, Inc. (BOC) as
well as have the following requirements:
a) Graduated from an accredited college or university athletic
training education program
b) Passed an examination administered by the Board of
Certification, Inc.
c) Meet the continuing education requirements defined by the
Board of Certification, Inc. including emergency cardiac care.
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 reaccredidation 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.
3. 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
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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 1647 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.
4. Attempts to Provide Title Act Protection and Require Certification
for a Similar Profession. In 2002 and 2003, then Assemblymember
Lowenthal introduced legislation on behalf of the California
Athletic Trainers Association (CATA) proposing licensure for
athletic trainers. AB 2789 (2001-02 Session) was amended to
require a study of the issue before being held on the Assembly
Appropriations Committee suspense file. AB 614 , (2003-04 Session)
was held in Senate Business and Professions Committee to allow the
Joint Committee on Boards, Commissions and Consumer Protection
(Joint Committee) to examine whether athletic trainers should be
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licensed as part of the "sunrise" process.
In compliance with the sunrise process, CATA completed and submitted
the extensive "sunrise questionnaire" in support of its proposal
for licensure. The athletic trainer sunrise proposal was heard by
the Joint Committee in January 2005. Following this hearing, the
Joint Committee voted unanimously, in April 2005, to reject full
licensure of athletic trainers, but suggested as part of this
recommendation that some form of recognition of athletic trainers,
such as title protection, may be appropriate.
In 2005, Senator Lowenthal introduced SB 1397 which would have enacted
the Athletic Trainers Certification Act, which prohibited 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. The bill would have regulated the practice of
athletic training by requiring all individuals who use the title
athletic trainer to meet specific education standards, pass a
certification exam, complete continuing education and register with
an athletic training organization. The measure also made it an
unfair business practice for a registered athletic trainer to
advertise or publicly represent he or she as "state certified" or
as "state registered" as an athletic trainer by the State of
California. Governor Schwarzenegger vetoed the measure claiming
"there is no evidence that the existing unregulated status of
athletic trainers poses any threat to public health and safety,"
and this measure would place unnecessary regulatory burdens on the
athletic training profession.
In the sunrise questionnaire, CATA indicated that there are about
2,200 certified athletic trainers in California. Only those
athletic trainers who have been certified by the Omaha-based Board
of Certification (an affiliate of the National Athletic Trainers
Association) are permitted to use the terms certified athletic
trainer" or "athletic trainer, certified." The Board of
Certification certifies athletic trainers who have met the
qualifications and passed a national written examination. To sit
for the exam, applicants for certification as an athletic trainer
must have completed a bachelor degree program in an athletic
training educational program accredited by the Commission on
Accreditation of Allied Health Education Programs. In 2005, there
were 12 accredited entry level athletic training education programs
in California, as well as one graduate level program and an
additional six entry-level programs in candidacy for accreditation.
Most of the accredited programs are in the California State
University system.
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The majority of certified athletic trainers in California are employed
in school settings, including four-year colleges and universities,
community colleges, high schools, professional sports teams,
clinics, hospitals, industrial settings or private health clubs
employ the rest.
5. Heat Acclimatization. The National Athletic Trainers' Association
(NATA) defines heat-acclimatization as "the initial 14 consecutive
days of preseason practice for all student athletes. The goal of
an acclimatization period is to increase exercise heat tolerance
and enhance the ability to exercise safely and effectively in warm
and hot conditions. This period should begin on the first day of
practice or conditioning, prior to the start of the regular season.
Any practices or conditioning conducted before this time should
not be considered as part of the heat acclimatization period."
Athletic trainer Douglas J. Casa, co-chair of NATA's
inter-association task force and Director of Athletic Training
education at the University of Connecticut stated, "When an athlete
undergoes a proper heat acclimatization program, the body response
to exercise and heat is improved, while athletes not following a
proper program face measurable risks for heat illness. A proper
plan in secondary school athletic programs is essential to minimize
these risks." In addition, NATA cites a presentation given by
Francis G. O'Connor, MD, MPH, president-elect of the American
Medical Society for Sports Medicine, associate professor at the
Uniformed Services University and medical director for the
Consortium on Health and Military Performance, "Exertional heat
stroke is the leading cause of preventable non-traumatic exertional
sudden death for young athletes in the U.S., and studies strongly
suggest that heat acclimatization appears to be one of the best
strategies for reducing the risk of heat illness."
NATA further asserts that all student athletes should follow the
14-day heat acclimatization plan, regardless of the conditioning
program and conditioning status leading up to the first formal
practice. According to NATA, "If athletes are not properly
acclimatized for play and treated properly, they can have chronic
if not fatal consequences. With the proliferation of deaths in
recent years from heat-related illnesses, this is believed to be
the first ever set of high school-specific guidelines published in
a scientific journal, and is critical education for student
athletes, parents, coaches, athletic trainers, medical
professionals and school staff on measures that can reduce the risk
of these illnesses." On June 18, 2009, NATA released a consensus
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statement, published in NATA's Journal of Athletic Training,
providing recommendations on heat-acclimatization guidelines for
secondary school athletic programs. The statement lists seven
specific recommendations for the 14-day heat acclimatization period
prior to full-scale athletic participation by secondary school
students.
6. Other States' Recent Efforts to Protect Students. Oregon's "Max's
Law," passed in 2009, requires school districts to ensure that
coaches receive annual training to recognize concussion symptoms
and assign appropriate medical treatment, and requires the State
Board of Education to establish related rules.
Texas' "Will's Bill," passed in 2007, requires every high school
coach to be trained in basic safety and emergency procedures, with
special emphasis on concussions and second-impact syndrome.
Washington State's "Zackery Lystedt Law" requires all athletes
under the age of 18 who are suspected of having a concussion to get
written consent from a licensed medical provider trained in
evaluating concussions before returning to play.
7. Arguments in Support. The California Athletic Trainers Association
argues, "Athletic trainers, along with parents, coaches and other
care providers help to ensure the safety of student athletes."
California State PTA writes in support, noting, "There is more
public awareness and concern about the incidence of heat stroke and
cardiac arrest in student athletes. Providing heat acclimatization
to schools is an important step in protecting our student athletes.
Each year, heat related illness and dehydration syndromes affect
thousands of athletes at all levels and continues to be among the
leading causes of preventable sports injury and death."
8. Arguments in Opposition. The California Chiropractic Association
(CCA) writes in opposition, citing support for the concept of the
bill and agreement that it is in the best interest of the public
for those calling themselves athletic trainers to meet minimum
standards. They are concerned about the lack of a specific,
outlined role for doctors of chiropractic. CCA has requested an
amendment to allow a doctor of chiropractic to be included as a
type of provider legally eligible to develop protocols when they
refer a patient to an athlete trainer. CCA also believes the bill
should be clear to ensure that there is a mechanism for a doctor of
chiropractic, medical doctor, or doctor of osteopathy to enter and
complete an athletic training certification program without again
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attending and graduating from a university or college.
The California Physical Therapy Assocation (CPTA) asserts that they
also share the original concerns leading to introduction of the
bill, regarding injuries and deaths associated with middle school
and high school athletes. CPTA believes that the current language
in the bill is unclear as to whether certain professionals, such as
emergency medical technicians and physical therapists, who provide
athletic training services to athletes, would also have to be
certified as athletic trainers to continue providing these
services. CPTA states that "it has not been demonstrated that
there is a compelling need to certify athletic trainers or that
this measure will create any benefit to the public or increase
safety."
The American Athletic Trainers Association and Certification Board
Inc. (AATA) states, "They, defended legal action to clarify that
NATA do not have sole use of the title "certified athletic
trainer." Therefore, under the terms of this court decision this
bill would violate a court order. That decision comes out of the
National Athletic Trainers Association, Inc. and the National
Athletic Trainers' Association Board of Certification (Plaintiffs)
v. American Athletic Trainers Association and Certification Board,
Inc. (Defendant) Case # 92-5560ER(Sx) Stipulated Order United
States District Court Central District of California." AATA
further asserts, "It would be a disservice to the struggling school
systems to limit who could perform athletic training in these
difficult economic times. We believe that our trainers are better
prepared to handle the emergent conditions that occur on athletic
fields. Trainers certified under NATA do not have appropriate
medical training to perform emergency diagnosis and care. Our
trainers must at least be certified as an EMT." Finally AATA
argues, "This rush to licensure is nothing more than a self
aggrandizement."
9. Policy Issues :
a) Who is responsible for enforcing this "athletic trainer" law?
This bill does not clarify who or what government entity is
responsible for enforcing the law and ensuring that all who
represent themselves as athletic trainers are in fact certified
and authorized to present themselves as one. Usually when a
particular profession is certified, the certifying body must
maintain some sort of documentation on its certified population
and have that information accessible for enforcement purposes.
For instance, in the case of a massage therapist, existing law
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requires the certifying organization to provide specified
information concerning a certificate holder, such as the current
status of the certificate, to any law enforcement agency or any
other representative of a local government agency with
responsibility for regulating, or administering a local ordinance
relating to massage or massage businesses. This bill does not
provide language to require BOC or any other certifying entity to
maintain or distribute specified information on its certificate
holders, and it does not specify what agency or individual would
receive that information for enforcement purposes. This is a
potential concern for consumers who may not be able to determine
whether someone is a certified athletic trainer or not.
b) Should this bill clarify that athletic trainers will not be
"state" certified? Requiring certification by a private
organization like BOC does not mean that the State of California
has certified anyone. Given that it will be BOC ensuring
individuals have met the necessary requirements for
certification, it should be made clear that the State of
California is not involved in either certification, registration
or licensing of athletic trainers.
The Committee may wish to consider adding language similar to what
is in the interior designer title act statute, which specifies
that it is an unfair business practice for any certified interior
designer to represent to the public that he or she is "state
certified" to practice interior design.
NOTE : Double-referral to Education Committee (second.)
SUPPORT AND OPPOSITION:
Support:
California Athletic Trainers' Association (CATA) (Sponsor)
American Red Cross, California Chapters
Association of California Neurologists (ACN)
California Association for Health, Physical Education, Recreation and
Dance (CAHPERD)
California Brain Injury Association (CALBIA)
California Community College Athletic Trainers' Association
California Medical Association
California State PTA
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Sudden Cardiac Arrest Association
One individual
Opposition:
American Athletic Trainers Association and Certification Board, Inc.
California Chiropractic Association (CCA)
California Physical Therapy Association (CPTA)
One Individual
Consultant:Antoinnae Comeaux