BILL ANALYSIS
SENATE JUDICIARY COMMITTEE
Senator Ellen M. Corbett, Chair
2009-2010 Regular Session
SB 1069 (Pavley)
As Amended April 12, 2010
Hearing Date: April 20, 2010
Fiscal: Yes
Urgency: No
TW:jd
SUBJECT
Physician Assistants
DESCRIPTION
This bill, sponsored by the California Academy of Physician
Assistants, would authorize physician assistants to perform and
certify physical examinations and other specified medical
services, as defined. This bill authorizes state and local
government agencies to rely on certificates executed by
physician assistants, as specified. This bill also establishes
statute of limitations regulations for claims brought against
physician assistants.
BACKGROUND
Primary care physicians are in short supply in California.
Recently published reports predict a shortfall of roughly 40,000
primary care doctors around the country over the next decade.
(Neergaard, Lauran, Health overhaul likely to strain doctor
shortage, Associated Press, March 29, 2010.) Due to an ever
increasing demand by patients, physicians have less time to
dedicate to patients and are relying on physician assistants to
provide certain medical services.
The shortage of physicians is not new to California. In 1975,
in its concern with the growing shortage and geographic
maldistribution of health care services in California, the
Legislature enacted the Physician Assistant Practice Act (the
Act). (AB 392 (Duffy, Ch. 634, Stats. 1975).) The Act allows
physicians to better utilize their time by delegating certain
health care tasks to qualified physician assistants. It also
(more)
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enables low income and uninsured families greater access to
medical care through physician assistants acting under physician
supervision. As physicians need additional assistance with
medical services, the Act has expanded the authority of
physician assistants accordingly. (See SB 633 (Deddeh, Ch. 643,
Stats. 1993) and AB 3 (Bass, Ch. 376, Stats. 2007).)
This bill furthers a physician's ability to delegate health
care tasks to a physician assistant. This bill also provides
that requisite physical examination certificates executed by
physician assistants can be accepted by various state and local
government agencies. Further, this bill establishes statutory
limitations on claims brought against physician assistants in
accordance with statutory limitations for physicians and nurses.
This bill also codifies the long-held understanding that a
physician assistant acts as the agent of the physician, as
specified.
This bill was approved by the Senate Business, Professions and
Economic Development Committee on April 12, 2010, by a vote of 8
to 0.
CHANGES TO EXISTING LAW
Existing law provides for the regulation and licensing of
physician assistants by the Physician Assistant Committee
(Committee) of the Medical Board of California (MBC). (Bus. &
Prof. Code Sec. 3500 et seq.)
Existing law provides that a physician assistant may perform
medical services, as specified, when the services are rendered
under the supervision of a licensed physician and surgeon
approved by the MBC, except as otherwise provided. (Bus. &
Prof. Code Sec. 3502.)
Existing law authorizes physician assistants to administer
medications, as specified. (Bus. & Prof. Code Sec. 3502.1.)
Existing law authorizes physician assistants to perform
unsupervised medical services during a state of war emergency.
(Bus. & Prof. Code Sec. 3502.5.)
Existing law authorizes state and local government agencies to
accept certification of medical examinations by physician
assistants for certain agency safety requirements. (Veh. Code
Secs. 5007, 9105, 12517.2(a), 12804.9(a)(2), 22511.55, 22511.59;
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Ed. Code Sec. 44839 et seq.)
Existing law provides for statutes of limitations on claims
against health professionals, including physicians,
psychologists, respiratory care practitioners, marriage and
family therapists, social workers, and dentists. (Bus. & Prof.
Code Secs. 2230.5, 2960.05, 3735.51, 4982.05, 4990.32, 1670.2.)
Existing law provides that a physician assistant acts as an
agent for the supervising physician. (16 CCR 1399.541.)
This bill would clarify the definitions of "delegation of
services agreement" and "other specified medical services."
This bill would further codify that the physician assistant acts
as an agent of the supervising physician.
This bill would authorize physician assistants to perform and
certify medical examinations, and allows state and local
government agencies to rely on certificates executed by
physician assistants, as specified.
This bill would provide that a delegation of services agreement
between a physician and a physician assistant may authorize the
physician assistant to: (1) order durable medical equipment; (2)
perform and certify a medical exam for disability purposes, as
specified; and (3) approve, sign, modify, or add to a plan of
home health treatment, as specified.
This bill would establish statute of limitations regulations for
claims brought against physician assistants.
This bill would authorize a physician assistant to provide a
written statement regarding medications prescribed to minor aged
patients, as may be required by school policies.
COMMENT
1. Stated need for the bill
The author writes:
SB 1069 would clarify various inconsistencies and omissions in
existing law by allowing physician assistants to order durable
medical equipment, certify disability for purposes of
unemployment insurance eligibility, approve, sign, modify or
add to a treatment plan for home health or personal care
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services, and conduct specified physical examinations and sign
corresponding certificates or forms. All of these functions
would be performed under physician supervision and consistent
with existing physician assistant scope of practice. Also,
this bill would establish a statute of limitation for
accusations against a licensed physician assistant that are
consistent with statute of limitation provisions for other
health care providers.
According to the California Academy of Physician Assistants,
"[t]his bill would also help to reduce cost of and increase
access to [medical] examinations and services without negatively
affecting patient care or safety."
2. The role of physician assistants in expanding access to care
In establishing the physician assistant profession in this
state, the Legislature intended to address "the growing shortage
and misdistribution of health care services in California" by
eliminating "existing legal constraints" that constitute "an
unnecessary hindrance to the more effective provision of health
care services." Physician assistants have effectively and
safely fulfilled this role. Physician assistants are widely
recognized (e.g., by the Office of Statewide Planning and
Development and other state and federal agencies) as an
effective solution to access to care problems in all settings.
A disproportionate number of physician assistants provide
services in medically underserved settings (e.g., health
manpower shortage areas) and settings where cost containment is
especially important (e.g., HMOs).
3. Physician assistants are appropriate professionals to
perform and certify medical examinations as required by state
and local agencies
Physician assistants are highly educated and trained and act
under the supervision of physicians. Further, as the sponsor
argues, "the Legislature has already determined that physician
assistants can safely perform . . . medical examinations and
various other medical services and sign corresponding
certificates or forms under physician supervision . . . ." For
these reasons, the Physician Assistant Committee, the regulatory
body of physician assistants, has already authorized physician
assistants to perform and certify medical examinations under the
California Code of Regulations (CCR). In addition, the
Business and Professions Code has authorized physician
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assistants to perform and certify medical examinations for
purposes of obtaining disability placards, commercial vehicle
licenses, and employment. This bill codifies in the Business
and Professions Code the medical services that the CCR has
already authorized.
4. State and local government agencies will require specific
statutory language to accept physical examination certificates
executed by physician assistants
Existing law provides that state and local government agencies
are authorized to accept certain medical examination
certifications signed only by physicians and surgeons. As
discussed above, physicians and surgeons have less time to
devote to certain medical services, including medical
examinations required for governmental administration. As one
supporter, the California Assisted Living Association, notes,
"Assisted Living residents increasingly face challenges getting
timely physician reports which can delay their transition to
Assisted Living. This delay puts additional stress and risk on
the senior and their family." By utilizing physician assistants
for these medical services, patients will have increased access
to physical examinations and will be able to comply with state
and local government agency requirements in a more timely
fashion. Further, allowing state and local agencies to accept
medical examination certificates executed by physician
assistants will take some of the burden off of the already
over-taxed physicians.
5. This bill codifies that a physician assistant acts as a
physician's agent
A primary tenet of physician assistant practice is that the
physician assistant functions as an agent of the supervising
physician. The supervising physician has full legal
responsibility for the services performed by the physician,
including liability for any negligence on the part of the
physician. For this reason, the Physician Assistant Committee
included agency language in the California Code of Regulations.
This bill codifies the agency responsibility as it pertains to
the Business and Professions Code.
6. Statute of limitations is the same as required of
physicians and surgeons
Existing law does not provide for a statute of limitations on
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claims against physician assistants. Yet, many other health
professionals are protected by such statutes. Since a physician
assistant is licensed and regulated like other medical
professions, this bill would add statute of limitations
provisions to protect physician assistants and their patients.
The language proposed by this bill is modeled after the language
provided in Business and Professions Code Section 2230.5, which
applies to physicians and surgeons.
Support : American Congress of Obstetricians and Gynecologists;
American Federation of State, County and Municipal Employees;
California Academy of Family Physicians; California Assisted
Living Association; California Medical Association; California
Psychiatric Association; California Radiological Society; United
Nurses Associations of California/Union of Health Care
Professionals
Opposition : None Known
HISTORY
Source : California Academy of Physician Assistants
Related Pending Legislation : None Known
Prior Legislation :
AB 3 (Bass, Ch. 376, Stats. 2007), among other things,
authorized physician assistants to administer and order
medications.
AB 753 (Morrow, Ch. 454, Stats. 1996) authorized physician
assistants to provide medical services under the supervision of
podiatrists and required physicians to be physically available
for consultation at the time of the physician assistant
examination of patients.
SB 633 (Deddeh, Ch. 643, Stats. 1993) authorized physician
assistants to perform unsupervised medical services during any
state of war emergency.
AB 1529 (Lancaster, Ch. 1104, Stats. 1989) changed the
regulating committee of physician assistants to the Physician
Assistant Examining Committee.
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AB 392 (Duffy, Ch. 634, Stats. 1975) (See Background.)
Prior Vote : Senate Business, Professions and Economic
Development Committee (Ayes 8, Noes 0)
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