BILL ANALYSIS
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THIRD READING
Bill No: AB 2600
Author: Ma (D)
Amended: 3/25/10 in Assembly
Vote: 21
SENATE BUSINESS, PROF. & ECON. DEV. COMMITTEE : 5-0,
6/21/10
AYES: Negrete McLeod, Aanestad, Calderon, Florez, Yee
NO VOTE RECORDED: Wyland, Correa, Oropeza, Walters
SENATE APPROPRIATIONS COMMITTEE : Senate Rule 28.8
ASSEMBLY FLOOR : 56-17, 5/6/10 - See last page for vote
SUBJECT : Medicine: licensing: continuing education
requirements
SOURCE : California Hepatitis Alliance
DIGEST : 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.
ANALYSIS :
Existing law:
1. Establishes the Medical Board of California (MBC) to
CONTINUED
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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.
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
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immunizations prior to their first admission into an
educational institution, including immunization for
hepatitis.
This bill requires MBC 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.
Background
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 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 includes in this list a course
in the diagnosis and treatment of hepatitis for physicians
whose practice may require such knowledge.
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 United States is expected to rise 59
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percent, 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 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.
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
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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.
FISCAL EFFECT : Appropriation: No Fiscal Com.: Yes
Local: No
SUPPORT : (Verified 8/4/10)
California Hepatitis Alliance (source)
OPPOSITION : (Verified 8/4/10)
California Academy of Family Physicians
Department of Consumer Affairs
ARGUMENTS IN SUPPORT : According to the California
Hepatitis Alliance (Alliance), the bill's sponsor, this
bill 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 HBV and HCV.
The Alliance states that screening, detection and
treatments for hepatitis B and hepatitis C are
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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.
ARGUMENTS IN OPPOSITION : 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.
ASSEMBLY FLOOR :
AYES: Ammiano, Arambula, Beall, Blakeslee, Blumenfield,
Bradford, Brownley, Buchanan, Caballero, Charles
Calderon, Carter, Chesbro, Conway, Coto, Davis, De La
Torre, De Leon, Eng, Evans, Feuer, Fletcher, Fong,
Fuentes, Furutani, Galgiani, Garrick, Hall, Hayashi,
Hernandez, Hill, Huber, Huffman, Jones, Lieu, Bonnie
Lowenthal, Ma, Monning, Nava, Niello, Nielsen, V. Manuel
Perez, Portantino, Ruskin, Salas, Saldana, Skinner,
Solorio, Audra Strickland, Swanson, Torlakson, Torres,
Torrico, Tran, Villines, Yamada, John A. Perez
NOES: Adams, Anderson, Bill Berryhill, Tom Berryhill,
Cook, Emmerson, Fuller, Gaines, Harkey, Jeffries, Knight,
Logue, Miller, Nestande, Norby, Silva, Smyth
NO VOTE RECORDED: Bass, Block, DeVore, Gilmore, Hagman,
Mendoza, Vacancy
JJA:mw 8/4/10 Senate Floor Analyses
SUPPORT/OPPOSITION: SEE ABOVE
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