BILL ANALYSIS �
Senate Committee on Labor and Industrial Relations
Ted W. Lieu, Chair
Date of Hearing: June 13, 2012 2011-2012 Regular
Session
Consultant: Gideon L. Baum Fiscal:Yes
Urgency: No
Bill No: AB 1454
Author: Solorio
As Introduced/Amended: January 9, 2012
SUBJECT
Workers' compensation: audiologists.
KEY ISSUE
Should audiologists be added to the list of medical
professionals that can be appointed as Qualified Medical
Examiners (QMEs) in the workers' compensation system?
PURPOSE
To permit the Administrative Director of the Division of
Workers' Compensation to appoint audiologists as QMEs if they
meet specified qualifications.
ANALYSIS
Existing law establishes a workers' compensation system that
provides benefits to an employee who suffers from an injury or
illness that arises out of and in the course of employment,
irrespective of fault. This system requires all employers to
secure payment of benefits by either securing the consent of the
Department of Industrial Relations to self-insure or by securing
insurance against liability from an insurance company duly
authorized by the state.
Existing law defines "physician" to include physicians and
surgeons holding an M.D. or D.O. degree, psychologists,
acupuncturists, optometrists, dentists, podiatrists, and
chiropractic practitioners licensed by California state law and
within the scope of their practice as defined by California
state law. (Labor Code �3209.3)
Existing law provides that the Administrative Director of the
Division of Workers' Compensation must appoint qualified medical
examiners (QMEs) as required for evaluation of medical-legal
issues. The AD must appoint physicians, as defined above, to be
QMEs, and provides relevant requirements for each specialty in
order to be appointed as a QME. These include:
a) Prior to his or her appointment as a qualified medical
evaluator, passes an examination written and administered
by the administrative director for the purpose of
demonstrating competence in evaluating medical-legal issues
in the workers' compensation system;
b) Devotes at least one-third of total practice time to
providing direct medical treatment, or has served as an
agreed medical evaluator on eight or more occasions in the
12 months prior to applying to be appointed as a qualified
medical evaluator;
c) Certain specified requirements for medical doctors,
chiropractors, and psychologists.
(Labor Code �139.2)
Existing law provides requirements for licensure as an
audiologist, which include possessing a doctorate in audiology
earned from an educational institution approved by the
Speech-Language Pathology and Audiology and Hearing Aid
Dispensers Board. Additional requirements of licensure
applicants include:
a) Submit evidence of no less than 12 months of
satisfactorily completed supervised professional full-time
experience or its part-time equivalent; and
b) Pass an examination or examinations approved by the
board.
(Business and Professions �� 2530.2, 2532, & 2532.25)
This bill would provide that an audiologist who holds a doctoral
Hearing Date: June 13, 2012 AB 1454
Consultant: Gideon L. Baum Page 2
Senate Committee on Labor and Industrial Relations
degree in audiology, and who has five years post-doctoral
experience in the practice of audiology, may apply to the
Administrative Director of the Division of Workers' Compensation
to be a Qualified Medical Examiner (QME), if he or she passes
the examination required of all QME applicants.
This bill would add audiologist to the definition of which
health care professions are considered "physicians" for workers'
compensation purposes.
This bill would also require, however, that an audiologist QME
must use a diagnosis made by a physician who is licensed to
practice medicine when preparing a QME report.
This bill prohibits an audiologist authorized to be a
"physician" under the workers' compensation law from advertising
or holding his or herself out as a physician.
COMMENTS
1. A Brief Discussion on the Term 'Physician' in the Workers'
Compensation System:
At first blush, the language found in AB 1454 is both
confusing and counterintuitive. As was stated above, AB 1457
includes 'audiologists' in the definition of "physician" for
the purposes of workers' compensation, but then prohibits an
audiologist from diagnosing or advertising as a physician.
The reason for this has to do with a divergence in definitions
used in Labor Code and Business and Professions Code, as well
as general conventions of the medical world.
As per Business and Professions Code �2052, only a doctor of
Medicine (M.D.), a doctor of osteopathic medicine (D.O.), or a
surgeon may refer to themselves as a physician and practice
medicine in California. That holds true in the workers'
compensation system as well: while, for example, an
acupuncturist may be included under the definition of a
physician, he or she would not be able to make a diagnosis or
Hearing Date: June 13, 2012 AB 1454
Consultant: Gideon L. Baum Page 3
Senate Committee on Labor and Industrial Relations
advertise as a physician. This is why the provisions
prohibiting an audiologist from diagnosing an occupational
injury is prohibited in AB 1454, as well as prohibits an
audiologist as advertising as a physician.
2. Occupational Injuries Involving Hearing Loss and Current
Qualified Medical Examiners:
Every year, hundreds of workers lose their hearing due to
occupational injuries. According to the Division of Workers'
Compensation's Workers Compensation Information Systems (WCIS)
data, somewhere between 435 and 558 workers suffered
occupational-related hearing loss in 2010. This range of
cases is relatively constant over the past few years.
The DWC also keeps public lists of qualified medical examiners
available for injured workers. The relevant specialty among
medical doctors would be Otolaryngologists, more commonly
referred to as ear, nose, and throat (ENT) specialists. As
medical doctors, ENT specialists are trained to diagnosis and
treat hearing loss as per California law. According to the
DWC's QME list, there are 39 ENT specialists, excluding repeat
addresses. This would average in the neighborhood of 12 to 15
claims per specialist, or 8 to 10 when including multiple
addresses.
3. Proponent Arguments :
Proponents note that, under current law, a wide variety of
medical practitioners can already serve as qualified medical
examiners (QMEs): psychologists, acupuncturists, optometrists,
dentists, podiatrists and chiropractors, as well as medical
doctors. Proponents argue that it makes sense to include
audiologists in that list, as California's workforce ages and
hearing loss becomes a larger challenge. Proponents also
argue that the professional requirements in AB 1454 will
ensure that highly trained audiologists that are experts in
studying hearing loss are examining injured workers. Finally,
proponents note that audiologists are already recognized as
treating practitioners by both federal and state governments.
4. Opponent Arguments :
Hearing Date: June 13, 2012 AB 1454
Consultant: Gideon L. Baum Page 4
Senate Committee on Labor and Industrial Relations
The Union of American Physicians and Dentists (UAPD/AFSCME) is
opposed to AB 1454. UAPD argues that defining audiologists as
physicians in inappropriate. UAPD notes that, as per Business
and Professions Code and industry practice, only medical
doctors (M.D.) or doctors of osteopathy (D.O.) are referred to
as physicians. Therefore, UAPD feels it is inappropriate for
audiologists to be included in the definition as "physicians"
since an audiologist is not M.D. On that basis, UAPD opposes
AB 1454, though they reserve the right to change their
position in the event of future amendments.
5. Prior Legislation :
SB 577 (Wiggins) from 2007 contained similar provisions to
this bill. SB 577 was vetoed by Governor Schwarzenegger.
SUPPORT
California Academy of Audiology (Sponsor)
California Chiropractic Association
California Speech-Language Hearing Association
Service Employees International Union
Voters Injured at Work
OPPOSITION
Union of American Physicians & Dentists
Hearing Date: June 13, 2012 AB 1454
Consultant: Gideon L. Baum Page 5
Senate Committee on Labor and Industrial Relations