BILL ANALYSIS
SB 1069
Page 1
Date of Hearing: June 15, 2010
ASSEMBLY COMMITTEE ON BUSINESS, PROFESSIONS AND CONSUMER
PROTECTION
Mary Hayashi, Chair
SB 1069 (Pavley) - As Amended: May 5, 2010
SENATE VOTE : 30-0
SUBJECT : Physician assistants.
SUMMARY : Authorizes physician assistants (PAs) to perform and
certify physical examinations and other specified medical
services, as specified, authorizes state and local government
agencies to rely on certificates executed by PAs, as specified,
and establishes statute of limitations regulations for claims
brought against PAs. Specifically, this bill :
1)States that a PA acts as an agent of his or her supervising
physician when performing any authorized activity, as
specified.
2)Permits a PA to perform certain physical examinations and
other medical services, as specified, and sign and attest to
any certificate, card, form, or other documentation evidencing
the examination or other specified medical services.
3)Authorizes state and local government agencies to rely on
certificates executed by PAs.
4)Permits a delegation of services agreement to authorize a PA
to do the following:
a) Order durable medical equipment, subject to any
limitations in current law, the delegation of services
agreement, or third-party payer requirements;
b) Certify disability pursuant to the Unemployment
Insurance Code after performance of a physical examination
by the PA under the supervision of a physician and surgeon;
and,
c) Approve, sign, modify, or add to a plan of treatment or
plan of care for individuals receiving home health services
or personal care services after consultation with the
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supervising physician.
5)States that this bill shall not be construed to affect the
validity of any delegation of services agreement in effect
prior to the enactment of this bill or adopted subsequent to
its enactment.
6)Requires any accusation filed against a licensee that would
jeopardize his or her license to be filed within three years
after the PA Committee (committee) discovers the act or
omission alleged as the ground for disciplinary action, or
within seven years after the act or omission alleged as the
ground for disciplinary action occurs, whichever occurs first.
However, the time limitations shall be tolled during any
period if material evidence necessary for prosecuting or
determining whether a disciplinary action would be appropriate
is unavailable to the committee due to an ongoing criminal
investigation. The following situations are exceptions to the
time limitations:
a) An accusation alleging the procurement of a license by
fraud or misrepresentation;
b) An accusation alleging unprofessional conduct based on
incompetence, gross negligence, or repeated negligent acts
of the licensee upon proof that the licensee intentionally
concealed from discovery his or her incompetence, gross
negligence, or repeated negligent acts;
c) If an alleged act or omission involves a minor, the time
limitations period shall be tolled until the minor reaches
the age of majority. However, if the committee discovers
an alleged act of sexual contact with a minor, as
specified, after the limitations periods have otherwise
expired, and there is independent evidence that
corroborates the allegation, an accusation shall be filed
within three years from the date the committee discovers
that alleged act; and,
d) An accusation alleging sexual misconduct shall be filed
within three years after the committee discovers the act or
omission alleged as the ground for disciplinary action, or
within 10 years after the act or omission alleged as the
ground for disciplinary action occurs, whichever occurs
first. This shall apply to a complaint alleging sexual
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misconduct received by the committee on and after January
1, 2011.
7)Permits PAs to authorize children to take prescribed
medications, including auto-injectable epinephrine, during the
school day.
8)Permits PAs to waive vision tests for schoolchildren.
9)Permits PAs to certify the needs of an individual who has been
diagnosed by a physician and surgeon as being deaf or hearing
impaired after reviewing the medical records or copies of the
medical records containing that diagnosis.
10)Permits PAs to certify that an individual has a visual or
medical need for specialized telecommunications equipment, as
specified.
11)Defines the following terms:
a) "Delegation of services agreement" means the writing
from a supervising physician delegating to a PA the medical
services a PA is authorized to perform, as specified;
b) "Other specified medical services" means tests or
examinations performed or ordered by a PA practicing in
compliance with current law;
c) "Discovers" means the latest of the occurrence of any of
the following with respect to each act or omission alleged
as the basis for disciplinary action:
i) The date the committee receives a complaint or
report describing the act or omission;
ii) The date, subsequent to the original complaint or
report, on which the committee becomes aware of any
additional acts or omissions alleged as the basis for
disciplinary action against the same individual; or,
iii) The date the committee receives from the complainant
a written release of information pertaining to the
complainant's diagnosis and treatment.
d) "Practitioner" is expanded to include a PA.
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EXISTING LAW :
1)Provides for the regulation and licensing of PAs by the
committee of the Medical Board of California (MBC).
2)Provides that a PA 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.
3)Authorizes PAs to administer medications, as specified.
4)Authorizes state and local government agencies to accept
certification of medical examinations by PAs for certain
agency safety requirements.
5)Provides for statutes of limitations on claims against health
professionals, including physicians, psychologists,
respiratory care practitioners, marriage and family
therapists, social workers, and dentists.
FISCAL EFFECT : Unknown
COMMENTS :
Purpose of this bill . According to the author's office,
"California is in the midst of an access to care crisis and
these inconsistencies and omissions in existing law overburden
physicians with routine duties that should be performed by
clinically competent PAs. Particularly in medically underserved
areas, it is not always practical for a physician to be
available at all times.
"[This bill] simply builds upon existing law by permitting
clinically competent PAs to perform necessary medical
examinations and sign corresponding certificates or forms for
their patients. This bill would also help to reduce the cost of
an increased access to these examinations and services without
negatively affecting patient care or safety."
Background . PAs practice medicine under the supervision of
physicians and surgeons. PAs are formally trained to provide
diagnostic, therapeutic, and preventive healthcare services.
Many PAs work in primary care specialties, such as general
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internal medicine, pediatrics, and family medicine. Other
specialty areas include general and thoracic surgery, emergency
medicine, orthopedics, and geriatrics. PAs specializing in
surgery provide preoperative and postoperative care and may work
as first or second assistants during major surgery.
The duties of PAs are determined by the supervising physician
and by current law. 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. This bill codifies this agency relationship.
Current California law authorizes PAs to perform and certify
medical examinations for purposes of obtaining disability
placards, commercial vehicle licenses, and employment. This
bill brings consistency across the codes by permitting PAs to
perform other, similar examinations and certifications.
Existing law does not provide for a statute of limitations on
claims against PAs, although many other health professionals are
protected by such statutes. This bill's language is modeled the
statute of limitations for physicians and surgeons.
Prior legislation . SB 171 (Pavley), Chapter 23, Statutes of
2009, allowed PAs and advanced practice registered nurses to
perform a physical examination and submit directly to the
governing board or county superintendent of schools the medical
certificate of a person wishing to be employed in a position
requiring certification qualifications, or in a retirant
position, as a condition of initial employment.
AB 3 (Bass), Chapter 376, Statutes of 2007, authorized PAs to
administer and order medications.
REGISTERED SUPPORT / OPPOSITION :
Support
California Academy of Physician Assistants (sponsor)
California Academy of Family Physicians
California Assisted Living Association
California Chapter of the American College of Emergency
Physicians
California Medical Association
California Psychiatric Association
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California Radiological Society
Medical Board of California
Osteopathic Physicians and Surgeons of California
The American Congress of Obstetricians and Gynecologists,
District IX, California
The American Federation of State, County and Municipal
Employees, AFL-CIO
United Nurses Associations of California/Union of Health Care
Professionals
Opposition
None on file.
Analysis Prepared by : Sarah Weaver / B.,P. & C.P. / (916)
319-3301