BILL ANALYSIS
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|Hearing Date:June 21, 2010 |Bill No:AB |
| |2600 |
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SENATE COMMITTEE ON BUSINESS, PROFESSIONS
AND ECONOMIC DEVELOPMENT
Senator Gloria Negrete McLeod, Chair
Bill No: AB 2600Author:Ma
As Amended:March 25, 2010 Fiscal:Yes
SUBJECT: Medicine: licensing: continuing education requirements.
SUMMARY: Requires the Medical Board of California to consider
including a continuing medical education course in the diagnosis and
treatment of hepatitis to be taken by those whose practices may
require such knowledge.
Existing law:
1) Establishes the Medical Board of California (MBC) to license and
regulate physicians and surgeons.
2) Requires the MBC to adopt and administer standards for the
continuing medical education (CE) requirements for licensed
physicians and surgeons. Requires each licensed physician and
surgeon to demonstrate satisfaction of CE requirements at intervals
of not less than four nor more than six years. Further requires
that on and after July 1, 2006, all CE courses to contain
curriculum that includes cultural and linguistic competency in the
practice of medicine, as specified.
3) Provides that CE standards must meet any of the following criteria:
a) Have a scientific or clinical content with a direct
bearing on the quality or cost-effective provision of patient
care, community or public health, or preventive medicine.
b) Concern quality assurance or improvement, risk management,
health facility standards, or the legal aspects of clinical
medicine.
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c) Concern bioethics or professional ethics.
d) Are designed to improve the physician-patient
relationship.
4) Requires all physicians and surgeons to complete mandatory CE
courses in the subject of pain management and the treatment of
terminally ill and dying patients, except for physicians and
surgeons practicing in pathology or radiology specialty areas.
5) Allows the MBC to consider several courses in determining CE
requirements, including courses in human sexuality, nutrition,
child and elder abuse detection and treatment, acupuncture, and
early detection and treatment of substance abusing pregnant women
to be taken by physicians whose practices may require knowledge in
those areas.
6) Requires students in grades K-12 to obtain specified immunizations
prior to their first admission into an educational institution,
including immunization for hepatitis.
This bill requires the Medical Board of California to consider
including a continuing medical education course in the diagnosis and
treatment of hepatitis to be taken by those whose practices may
require such knowledge.
FISCAL EFFECT: According to the Assembly Appropriations Committee, no
direct fiscal impact to the MBC to consider adding hepatitis diagnosis
and treatment to educational curricula for physicians.
COMMENTS:
1.Purpose. According to the California Hepatitis Alliance (Alliance),
the Sponsor of this bill, this measure will allow physicians to stay
up-to-date on hepatitis prevention and treatment, improve their
ability to vaccinate and counsel at-risk patients, and improve
health outcomes for chronically infected patients in order to
prevent liver cancer and liver disease. The Alliance states that
liver cancer and liver diseases are leading causes of death in
California, with most of those cases directly related to chronic
infection with hepatitis B virus (HBV) and hepatitis C virus (HCV).
The Alliance states that screening, detection and treatments for
hepatitis B and hepatitis C are cost-effective approaches to
preventing liver cancer, liver disease and costly organ transplants,
but a critical first step is education of physicians and other
health and social service providers.
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2.Background.
a) CE requirements for physicians. California law requires all
licensed physicians to complete no less than 50 hours of approved
CE during each two-year period immediately preceding the
expiration date of the license as a condition of license renewal.
According to the MBC, certain educational activities that meet
the content standards for CE credit include programs accredited
by the California Medical Association, the American Medical
Association, the Accreditation Council for Continuing Medical
Education, programs which qualify for prescribed credit from the
American Academy of Family Physicians, and other programs offered
by other organizations and institutions acceptable to the MBC.
Additionally, the MBC is authorized to consider several courses
for CE, including courses in nutrition, human sexuality,
detection of elder child abuse, and acupuncture. This bill would
include in this list a course in the diagnosis and treatment of
hepatitis for physicians whose practice may require such
knowledge.
b) Hepatitis. According to the Centers for Disease Control and
Prevention (CDC), hepatitis is an inflammation of the liver and
also refers to a group of viral infections that affect the liver.
The most common types are Hepatitis A, Hepatitis B, and Hepatitis
C. Viral hepatitis is the leading cause of liver cancer and the
most common reason for liver transplantation. In the United
States, an estimated 1.2 million Americans are living with
chronic Hepatitis B, and 3.2 are living with chronic Hepatitis C;
and each year an estimated 25,000 persons become infected with
Hepatitis A, 43,000 with Hepatitis B, and 17,000 with Hepatitis C
Many do not know they are infected. According to an estimate,
from 2010 to 2030, the number of liver cancer cases in the U.S is
expected to rise 59%, with the highest increases expected among
Hispanics and Asian American and Pacific Islanders.
The CDC points out that the different types of hepatitis have
different modes of transmission and can affect the liver
differently. Hepatitis A is caused by the hepatitis A virus
(HAV), and the HAV infection produces a self-limited disease that
does not result in chronic infection or chronic liver disease.
HAV infection is primarily transmitted by the fecal-oral route,
by either person-to-person contact or through consumption of
contaminated food or water. Hepatitis A vaccination is the most
effective measure to prevent HAV infection and is recommended for
all children at age 1, certain international travelers, and
others at risk for HAV infection. Hepatitis B is caused by the
HBV, and infection can cause acute illness and lead to chronic or
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lifelong infection, cirrhosis (scarring) of the liver, liver
cancer, liver failure, and death. HBV is transmitted through
percutaneous (puncture through the skin) or mucosal contact with
infectious blood or body fluids. Hepatitis B vaccination is the
most effective measure to prevent HBV infection and its
consequences and is recommended for all infants and others at
risk for HBV infection. African American adults have the highest
rate of acute HBV infection in the United States and the highest
rates of acute HBV infection occur in the southern region.
People from Asia and the Pacific Islands comprise the largest
foreign-born population that is at risk for chronic HBV
infection. Hepatitis C is caused by the HCV that sometimes
results in an acute illness, but most often becomes a silent,
chronic infection that can lead to cirrhosis (scarring), liver
failure, liver cancer, and death. Chronic HCV infection develops
in a majority of HCV-infected persons, most of whom do not know
they are infected since they have no symptoms. HCV is spread by
contact with the blood of an infected person. There is no vaccine
for hepatitis C.
In 2010, the Institute of Medicine (IOM) published a report
entitled Hepatitis & Liver Cancer: A National Strategy for
Prevention and Control of Hepatitis B & C (Report). The IOM was
charged with establishing a committee to determine ways to reduce
new HBV and HCV infections and the morbidity and mortality
related to chronic viral hepatitis. To fulfill this function,
the IOM sought to assess current prevention and control
activities and identify priorities for research, policy and
action, and highlight issues that warrant further investigations
and opportunities for collaboration between private and public
sectors. The Report identified various findings and
recommendations. Specifically, the Report pointed out that there
are several factors that impeded the prevention and control of
HBV and HCV, including lack of knowledge and awareness about
chronic viral hepatitis on the part of healthcare and
social-service providers, about chronic viral hepatitis among
at-risk populations, members of the public, and policy-makers,
and insufficient understanding of the extent and seriousness of
this public health problem. Additionally, the Report offered
recommendations in four categories: surveillance, knowledge and
awareness, immunization and services for viral hepatitis.
Specifically, the recommendations identified the need for
comprehensive surveillance capabilities; develop education
programs for health care and social service providers, and the
need for increased immunization and screening.
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c) Hepatitis in California. The Center for Infectious Diseases
at the Department of Public Health, among other functions,
identifies, prevents and interrupts the transmission of
vaccine-preventable diseases, HIV/AIDS, viral hepatitis and other
diseases. Additionally, the Office of Adult Viral Hepatitis
Prevention works in partnership with local, state and national
health officials, community-based organizations, service
providers, and individuals to reduce the impact of viral
hepatitis among adults in California.
In 2008, the Office of Adult Viral Hepatitis Prevention began
working with various stakeholders to develop a viral hepatitis
strategic plan for adults in California, which was released
January 11, 2010. According to the report entitled California
Adult Viral Hepatitis Prevention Strategic Plan, 2010-2014
(report), while it is unclear exactly how many people are living
with viral hepatitis, in 2007 alone, HBV- and HCV-related
hospitalization costs in the state totaled $2 billion. The
report outlined three strategic visions: improving surveillance
capacity and data use; educating the public, providers, and
policy makers, and targeting and integrating services and
building infrastructure.
3.Arguments in Opposition. The Department of Consumer Affairs (DCA)
has taken an oppose position on this bill and states that this bill
is unnecessary. DCA states that licensed physicians complete
thorough training in their initial medical schooling and are
required by law to engage in ongoing CE as a condition of license
renewal. Because the scope of practice of each physician varies
widely from individual to individual, each physician should select
the continuing education training best suited for their practice.
If it is determined that there is a widespread lack of knowledge
among physicians regarding the diagnosis and treatment of any
medical condition, the MBC has the current authority to require
specific training through regulation.
The California Academy of Family Physicians states that it opposes
any disease specific mandates for continuing education. It points
out that there are many diseases and conditions that warrant
attention and continuing education, and mandating one above all
others is too broad of an approach that has no guarantee in
improving the health of a physician's specific patient population.
They also believe that this bill has the potential to divert scarce
time and resources from other important training that may more be
relevant to a physician and their medical practice.
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SUPPORT AND OPPOSITION:
Support:
California Hepatitis Alliance (CalHEP) (Sponsor)
Opposition:
California Academy of Family Physicians
Department of Consumer Affairs
Consultant: Rosielyn Pulmano