BILL ANALYSIS
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|Hearing Date:June 14, 2010 |Bill No:AB |
| |2386 |
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SENATE COMMITTEE ON BUSINESS, PROFESSIONS
AND ECONOMIC DEVELOPMENT
Senator Gloria Negrete McLeod, Chair
Bill No: AB 2386Author:Gilmore
As Amended:May 28, 2010 Fiscal: Yes
SUBJECT: Armed Forces: medical personnel.
SUMMARY: Authorizes a hospital to enter into an agreement with the
Armed Forces of the United States to authorize a physician and
surgeon, physician assistant, or a registered nurse to provide medical
care in the hospital under specified conditions.
Existing Federal law:
1) States that a person under the jurisdiction of the Secretary of a
military department may not provide health care independently as a
health-care professional unless the person has a current license to
provide such care. Provides that in the case of a physician, the
physician may not provide health care as a physician unless the
current license is an unrestricted license that is not subject to
limitation on the scope of practice, as specified. Allows the
Secretary of Defense to waive these provisions in unusual
circumstances, as specified.
2) Allows a health care professional who has a current license to
practice medicine, osteopathic medicine, dentistry, or another
health profession, and who is performing authorized duties of the
Department of Defense, to practice the health profession or
professions of the healthcare professional in any State, the
District of Columbia, or a Commonwealth, territory, or possession
of the United States, regardless of whether the practice occurs in
a health care facility of the Department of Defense, a civilian
facility affiliated with the Department of Defense, or any other
location authorized by the Secretary of Defense.
3) Defines a health care professional for purposes of item #1) above
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as a physician, dentist, clinical psychologist, marriage and family
therapist certified as such by a certification recognized by the
Secretary of Defense, or nurse and any other person providing
direct patient care as may be designated by the Secretary of
Defense in regulations.
Existing State law:
1)Establishes the Department of Consumer Affairs (DCA), comprised of
more than 40 boards, bureaus, committees, commissions, and other
programs that set minimum standards of competence, education, and
skills for various professions and vocations.
2)Establishes the Medical Board of California (MBC) to license and
regulate physicians and surgeons.
3)Establishes the Physician Assistant Committee within the MBC to
license and regulate physician assistants.
4)Establishes the Board of Registered Nursing to license and regulate
nurses.
5)States that it is the policy of the state that, consistent with high
quality health care services, persons with skills, knowledge and
experience obtained in the armed services of the United States
should be permitted to apply such learning and contribute to the
health manpower needs of the state at the maximum level of
responsibility and skill for which they are qualified.
6)States that the rules and regulations of boards within DCA shall
provide for methods of evaluating education, training, and
experience obtained in military service if such training is
applicable to the requirements of that profession.
7)Prohibits, unless otherwise required by federal law or regulations,
a board within the DCA which licenses dentists, physicians and
surgeons, podiatrists, or nurses, from requiring a person to obtain
or maintain any license to practice a profession or render services
in California if one of the following applies:
a) The person practicing a profession or rendering services does
so exclusively as an employee of a department, bureau, office,
division, or similarly constituted agency of the federal
government, and provides medical services exclusively on a
federal reservation or at any facility wholly supported by and
maintained by the United States government.
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b) The person practicing a profession or rendering services does
so solely pursuant to a contract with the federal government on a
federal reservation or at any facility wholly supported and
maintained by the United States government.
c) The person practicing a profession or rendering services does
so pursuant to, or as a part of a program or project conducted or
administered by a department, bureau, office, division, or
similarly constituted agency of the federal government which by
federal statute expressly exempts persons practicing a profession
or rendering services as part of the program or project from
state laws requiring licensure.
8)Allows a board to deny issuance of a license to an applicant or take
disciplinary action against the holder of a California license for
acts or omissions committed by the applicant or licensee in the
course of professional practice or rendering services described in
item #7) above if both of the following apply:
a) The acts or omissions committed by the applicant or licensee
constituted grounds for denial or discipline pursuant to the laws
of this state governing licensees or applicants for licensure for
the profession or vocation in question.
b) The acts or omissions constituting the basis for denial or
discipline by the agency were not authorized, exempted or
rendered inconsistent by federal statute.
9)States that a physician and surgeon who is not licensed in this
state but who is a commissioned officer on active duty in the
medical corps of any branch of the armed forces of the United States
may engage in the practice of medicine as part of a residency,
fellowship, or clinical training program if all the following
conditions are met:
a) The residency, fellowship, or clinical training program is
conducted by a branch of the armed forces of the United States at
a health facility on a federal reservation and limited in
enrollment to military physicians on active duty in the medical
corps of a branch of the armed forces of the United States.
b) The residency, fellowship, or clinical training program, as
part of its program, contracts with or affiliates with a similar
program in or at a health facility not on a federal reservation
to offer specific courses or training not available at the
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facility located on the federal reservation.
c) The officers enrolled in the residency, fellowship, or
clinical training program restrict their practice only to
patients who are seen as part of their duties in the program.
d) The compensation received by the officers enrolled in the
residency, fellowship, or clinical training program is limited to
their regular pay and allowances as commissioned officers.
e) The officers enrolled in the training programs or portions of
training programs not conducted on a federal reservation shall
register with the Division of Licensing of the Medical Board of
California on a specified form.
This bill:
1)Authorizes a hospital to enter into an agreement with the Armed
Forces of the United States to authorize a physician and surgeon,
physician assistant, or registered nurse to provide medical care in
the hospital if all of the following apply:
a) The physician and surgeon, physician assistant, or registered
nurse holds a valid license in good standing to provide medical
care in the District of Columbia or any state or territory of the
United States.
b) The medical care is provided as part of a training or
educational program designed to promote the combat readiness of
the physician and surgeon, physician assistant, or registered
nurse.
c) The agreement complies with federal law and any regulations or
guidelines adopted pursuant to this bill.
2)Requires a physician and surgeon, physician assistant, or registered
nurse who is authorized to practice pursuant to item #1) above to
disclose, while working, on a name tag in at least
18-point type, his or her name and license status, his or her state of
licensure, and a statement that he or she is a member of the Armed
Forces of the United States.
3)States that if an agreement is entered into pursuant to item #1)
above, no board under this division that licenses physicians and
surgeons, physician assistants, or registered nurses may require
such person to obtain or maintain any license to practice his or her
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profession or render services in the State of California.
4)Requires a physician and surgeon, physician assistant, or registered
nurse who enters into an agreement with a hospital pursuant to item
#1) above, to register with the board that licenses his or her
respective health care profession in this state on a form provided
by that board.
5)Sunsets the provisions of this bill on January 1, 2016.
FISCAL EFFECT: Unknown. This bill has been keyed fiscal by
Legislative Counsel with the most recent amendments.
COMMENTS:
1. Purpose. According to the Author who is the sponsor of this
measure, this bill would provide the statutory framework to allow
military health care professionals to improve their skills prior to
being deployed to war. The Author states that a similar successful
model was achieved in Nevada in 2009, in which a program was
created at the UMC Trauma Center near Nellis Air Force Base. The
program was very popular and mutually beneficial to the hospital
because the Air Force was able to provide fully-trained and
certified physicians free of charge.
1) Background. Current law allows physician and surgeons,
podiatrists, nurses, or dentists who are licensed in other states
to practice their professions in California without obtaining state
licensure as long as they are practicing or rendering services as
an employee of, or pursuant to a contract with the federal
government, and provides health care services at facilities
supported or maintained by the United States government. However,
current law does not permit these health care practitioners, who
may also be military personnel, to be afforded an opportunity to
receive their training or education in California hospitals. This
bill would allow, pursuant to an agreement between a hospital and
the Armed Forces of the United States, physicians and surgeons,
physician assistants, or nurses licensed in other states to provide
medical care at California hospitals as part of a training or
educational program designed to promote the combat readiness of
these heath care practitioners.
1. Other States. According to the Author, in 2009, the Nevada State
Legislature passed Senate Bill 302, which is substantially similar
to the provisions of this bill. Senate Bill 302 authorized a
hospital to enter into an agreement with the Armed Forces to allow
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a medical officer to provide medical care in the hospital under
specified conditions. In testimony before the Nevada State
Assembly Committee on Health and Human Services, the sponsors of
the bill, the United States Air Force, stated that this bill would
greatly benefit the military by giving its physicians, many of whom
are new, the volume and diversity of medical calls and patient care
that just do not exist on the base and the opportunity to hone
their skills. Additionally, the Air Force stated that the bill
would benefit the county hospitals by adding additional licensed
physicians in the emergency rooms.
2. Arguments in Support. The California Academy of Physician
Assistants states that this bill would improve access to
appropriately trained health care providers.
SUPPORT AND OPPOSITION:
Support: California Academy of Physician Assistants
Opposition: None on file as of June 8, 2010
Consultant: Rosielyn Pulmano