BILL ANALYSIS
SB 1069
Page 1
Date of Hearing: June 22, 2010
ASSEMBLY COMMITTEE ON JUDICIARY
Mike Feuer, Chair
SB 1069 (Pavley) - As Amended: May 5, 2010
PROPOSED CONSENT
SENATE VOTE : 30-0
SUBJECT : PHYSICIAN ASSISTANTS
KEY ISSUES :
1)SHOULD VARIOUS CODE SECTIONS OF CALIFORNIA LAW THAT ARE SILENT
OR INCONSISTENT WITH EXISTING SCOPE OF PRACTICE OF PHYSICIAN
ASSISTANTS BE CLARIFIED TO AUTHORIZE PHYSICIAN ASSISTANTS TO
PERFORM AND CERTIFY MEDICAL EXAMINATIONS AND OTHER SERVICES,
UNDER PHYSICIAN SUPERVISION AND IN ALL CASES CONSISTENT WITH
EXISTING SCOPE OF PRACTICE?
2)BECAUSE NO STATUTE OF LIMITATIONS CURRENTLY EXISTS FOR
LICENSED PHYSICIAN ASSISTANTS, SHOULD ONE BE ESTABLISHED FOR
PHYSICIAN ASSISTANTS THAT IS CONSISTENT WITH THOSE THAT APPLY
TO OTHER HEALTH CARE PROVIDERS?
FISCAL EFFECT : As currently in print this bill is keyed fiscal.
SYNOPSIS
This non-controversial bill, sponsored by the California Academy
of Physician Assistants, authorizes physician assistants (PA) to
perform and certify physical examinations and other specified
medical services, and also authorizes state and local government
agencies to rely on certificates executed by physician
assistants, as specified. Because all of these functions would
be performed under physician supervision and consistent with
existing scope of practice for PA, this bill simply codifies
existing scope of practice in various sections of California law
that are otherwise inconsistent with scope of practice for PA
and thus invite clarification. In addition, this bill
establishes a statute of limitations for claims of misconduct
brought against PA that is closely modeled after existing
statutes of limitations under the Business and Professions Code
that apply to other health care providers. In addition to
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removing inconsistencies in existing law with respect to PA
scope of practice, the author and supporters contend another
benefit of this bill is that it will help expand access to
health care because the bill furthers a physician's ability to
delegate certain health care tasks to qualified, well-trained
physician assistants. This benefit would be especially
magnified in medically underserved areas where physician
resources are spread thinner. For these reasons, the bill
enjoys broad support from the California Medical Association,
the Medical Board of California, and numerous associations of
health care providers. This bill passed in the Senate by a 30-0
vote and the Assembly Business, Professions and Consumer
Protection Committee by a 11-0 vote. There is no known
opposition.
SUMMARY : Seeks to clarify inconsistencies and omissions in
existing law to explicitly authorize physician assistants (PA)
to perform and certify medical examinations and other services
that they may already perform within existing scope of practice,
and establishes for the first time a statute of limitations for
physician assistants that is consistent with statutes of
limitation applying to other health care professionals.
Specifically, this bill :
1)Provides that a PA acts as an agent of the supervising
physician when performing any activity authorized by Chapter
7.7 of Division 2 of the Business and Professions Code
(governing licensing of physician assistants) or promulgated
by the Medical Board of California under this Chapter.
2)Authorizes a PA to perform and certify physical examinations
and other specified medical services required pursuant to
various sections of the Public Utilities Code and Education
Code, and also permits a PA to sign and attest to any
certificate, card, form, or other documentation evidencing the
physical examination or other specified medical services.
These include:
a) Authority to permit children to take prescribed
medications, including auto-injectable epinephrine, during
the school day.
b) Permission to waive vision tests for schoolchildren.
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c) Authority 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.
d) Authority to perform a physical examination on a student
when such examination is required by school officials as a
condition of participation in a school athletic program.
e) Authority to certify that an individual has a visual or
medical need for specialized telecommunications equipment,
as specified.
3)Authorizes state and local government agencies to rely on
certificates executed by physician assistants, as specified.
4)Permits a delegation of services agreement, defined as the
writing from a supervising physician delegating to a PA the
medical services the PA is authorized to perform, to authorize
the PA to:
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
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
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within seven years after the act or omission alleged as the
ground for disciplinary action occurs, whichever occurs first,
with the following exceptions:
a) No limitation applies for an accusation alleging the
procurement of a license by fraud or misrepresentation;
b) No limitation applies for 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 provision applies only to any complaint
alleging sexual misconduct received by the committee on and
after January 1, 2011.
7)Provides that the statute of limitations period 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.
EXISTING LAW:
1)Provides for the regulation and licensing of physician
assistants by the Physician Assistant Committee of the Medical
Board of California (MBC). (Chapter 7.7 of Division 2 of the
Business and Professions Code, commencing with Section 3500.)
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2)Authorizes physician assistants to perform medical services,
as specified, only when the services are rendered under the
supervision of a licensed physician and surgeon approved by
the MBC, except as otherwise provided. (Business and
Professions Code Section 3502.)
3)Authorizes physician assistants, under the supervision of a
licensed physician and surgeon, to administer or provide
medications to a patient, as specified. (Business and
Professions Code Sec. 3502.1.)
4)Authorizes physician assistants to perform unsupervised
medical services during a state of war emergency. (Business
and Professions Code Sec. 3502.5.)
5)Authorizes state and local government agencies to accept
certification of medical examinations by physician assistants
for certain agency safety requirements, pursuant to a number
of different California code sections. (Vehicle Code Sections
5007, 9105, 12517.2(a), 12804.9(a)(2), 22511.55, 22511.59;
Education Code Sec. 44839 et seq.)
6)Provides for statutes of limitations on claims against health
professionals, including physicians, psychologists,
respiratory care practitioners, marriage and family
therapists, social workers, and dentists. (Business and
Professions Code Sections 2230.5, 2960.05, 3735.51, 4982.05,
4990.32, and 1670.2.)
7)Provides that because physician assistant practice is directed
by a supervising physician, and a physician assistant acts as
an agent for that physician, the orders given and tasks
performed by a physician assistant shall be considered the
same as if they had been given and performed by the
supervising physician. (Section 1399.541 of Title 16 of the
California Code of Regulations.)
COMMENTS : This non-controversial bill, sponsored by the
California Academy of Physician Assistants, authorizes physician
assistants (PA) to perform and certify physical examinations and
other specified medical services, and also authorizes state and
local government agencies to rely on certificates executed by
physician assistants, as specified. Because all of these
functions would be performed under physician supervision and
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consistent with existing scope of practice for PA, this bill
simply codifies existing scope of practice in various sections
of California law that are otherwise inconsistent with scope of
practice for PA and thus invite clarification. In addition,
this bill establishes a statute of limitations for claims of
misconduct brought against PA that is closely modeled after
existing statutes of limitations under the Business and
Professions Code that apply to other health care providers.
Author's statement; Expansion of access to health care. In
addition to removing inconsistencies in existing law with
respect to PA scope of practice, the author and supporters
contend another benefit of this bill is that it may help expand
access to health care, especially in underserved areas. As the
author explains:
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 physician
assistants. Particularly in medically underserved
areas, it is not always practical for a physician to
be available at all times. For example, a single
physician may supervise multiple clinics or the
physician may need to spend part of each day
performing patient rounds at the local hospital.
SB 1069 is a measure to ensure that doctors and
physician assistants can cover as many patients as
possible in a timely manner. Physician assistants are
an invaluable resource for doctors, and increase
access to services especially in underserved and rural
areas of the state.
This bill codifies existing authority and does not expand
existing scope of practice for physician assistants. Existing
law allows physician assistants to perform a variety of medical
services under physician supervision. For example, physician
assistants perform medical services set forth by regulations
adopted by the Medical Board of California (MBC) when rendered
under the supervision of a physician. Specifically, regulations
promulgated by the Physician Assistant Committee of the MBC
authorize a physician assistant to perform medical services such
as patient histories and physical examinations, ordering X-rays,
diagnostic studies, instituting treatment procedures, initiating
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hospital admissions, ordering medications, and performing
surgical procedures. (16 CCR 1399.541.)
Furthermore, existing sections of the Business and Professions
Code already authorize PAs to perform and certify medical
examinations for various purposes such as obtaining a disability
placard or obtaining a vehicle license. The same applies for
applicants seeking a license who primarily drive standard
commercial vehicles, school buses, general public transportation
vehicles and farm labor vehicles. Existing law also explicitly
allows physician assistants to conduct medical examinations and
sign corresponding certificates or forms for applicants seeking
employment by a school district or county superintendent of
schools. This bill adds language to authorize state and local
government agencies to accept certification of certain medical
examinations that otherwise must be signed by physicians or
surgeons under current law. By utilizing physician assistants
for these certifications and other 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.
For all of these reasons, the sponsor contends this bill should
raise few safety concerns about the authority it grants to
physician assistants because the appropriate regulatory bodies
have already determined through California Code Regulations
(CCR) that physician assistants can safely perform these medical
examinations and responsibilities. This bill merely codifies
certain medical services already authorized under the CCR, but
that were apparently never codified in the Business and
Professions Code and elsewhere, creating inconsistencies and
unnecessary confusion in some places.
This bill establishes a statute of limitations similar for
doctors and surgeons. Existing law does not provide for a
statute of limitations on claims against physician assistants.
Yet, many other health professionals are protected by such
statutes. Because 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.
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According to the author, establishing a statute of limitation
for complaints against a physician assistant that is consistent
with similar statutes for other licensed health care providers
ensures fairness for the defendant, and efficiency and relevance
for prosecuting agencies who may now "devote their resources to
more recent misdeeds." The statute of limitation provisions
also contains several exemptions that protect the prosecuting
agency's ability to pursue misconduct for as long as justice
dictates. For example, the statute does not apply to cases
involving procurement of a license by fraud and the limitations
period is extended in cases involving concealment of negligent
conduct, sexual misconduct or misconduct involving minors, and
situations where an ongoing criminal investigation may delay
disciplinary action.
REGISTERED SUPPORT / OPPOSITION :
Support
California Academy of Physician Assistants (sponsor)
Medical Board of California
California Medical Association
California Academy of Family Physicians
American Federation of State, County and Municipal Employees
(AFSCME)
California Chapter of the American College of Emergency
Physicians
California Psychiatric Association
California Radiological Society
American Congress of Obstetricians and Gynecologists
California Assisted Living Association
United Nurses Association of California / Union of Health Care
Professionals (UNAC/UHCP)
Opposition
None on file
Analysis Prepared by : Anthony Lew / JUD. / (916) 319-2334