BILL ANALYSIS                                                                                                                                                                                                    



                                                                  SB 1069
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          SENATE THIRD READING
          SB 1069 (Pavley)
          As Amended  May 5, 2010
          Majority vote

           SENATE VOTE  :30-0  
           
           BUSINESS & PROFESSIONS     11-0 JUDICIARY           10-0        
           
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          |Ayes:|Hayashi, Conway, Eng,     |Ayes:|Feuer, Tran, Brownley,    |
          |     |Hernandez, Hill, Ma,      |     |Evans, Hagman, Huffman,   |
          |     |Nava, Niello, Ruskin,     |     |Jones, Knight, Monning,   |
          |     |Smyth, Logue              |     |Saldana                   |
           ----------------------------------------------------------------- 

           APPROPRIATIONS      17-0                                        
          
           ----------------------------------------------------------------- 
          |Ayes:|Fuentes, Conway,          |     |                          |
          |     |Bradford,                 |     |                          |
          |     |Charles Calderon, Coto,   |     |                          |
          |     |Davis,                    |     |                          |
          |     |De Leon, Gatto, Hall,     |     |                          |
          |     |Harkey, Miller, Nielsen,  |     |                          |
          |     |Norby, Skinner, Solorio,  |     |                          |
          |     |Torlakson, Torrico        |     |                          |
           ----------------------------------------------------------------- 
           
          SUMMARY  :   Authorizes physician assistants (PAs) to perform and  
          certify physical examinations and other specified medical  
          services, as specified, and authorizes state and local  
          government agencies to rely on certificates executed by PAs, as  
          specified.  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.









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          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 (UIC) 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  
            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  








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               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  
               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)Adds PAs to the definition of "practitioner" in the UIC. 

          12)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; 








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             b)   "Other specified medical services" means tests or  
               examinations performed or ordered by a PA practicing in  
               compliance with current law; and,

             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. 

           FISCAL EFFECT  :  According to the Assembly Appropriations  
          Committee, no direct fiscal impact for the PA Committee within  
          the Department of Consumer Affairs. 

           COMMENTS  :  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  
          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  








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          bill brings consistency across the codes by permitting PAs to  
          perform other, similar examinations and certifications.  


           Analysis Prepared by  :    Sarah Weaver / B.,P. & C.P. / (916)  
          319-3301 


                                                                FN: 0005911