BILL ANALYSIS �
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|Hearing Date:May 2, 2011 |Bill No:SB |
| |628 |
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SENATE COMMITTEE ON BUSINESS, PROFESSIONS
AND ECONOMIC DEVELOPMENT
Senator Curren D. Price, Jr., Chair
Bill No: SB 628Author:Yee
As Amended:April 25, 2011 Fiscal:Yes
SUBJECT: Acupuncture: regulation.
SUMMARY: Changes the name of the California Acupuncture Board to the
"Traditional Chinese Medicine Board," retitles the Acupuncture
Licensure Act into the "Traditional Chinese Medicine Licensure Act"
and changes the designation of a licensed acupuncturist into a
licensed "Traditional Chinese Medicine Practitioner." Provides for
the certification of traumatologists and includes traumatology in the
authorized activities of a licensed acupuncturist.
Existing law:
1) Establishes the California Acupuncture Board (Board) within the
Department of Consumer Affairs (DCA), which licenses and regulates
the acupuncture profession pursuant to the Acupuncture Licensure
Act. (Business and Profession Code (BPC) � 4925)
2) Defines an acupuncturist as an individual who has been licensed to
practice acupuncture pursuant to the Acupuncture Licensure Act.
Defines acupuncture as the stimulation of a certain point or
points on or near the surface of the body by the insertion of
needles to prevent or modify the perception of pain or to normalize
physiological functions, including pain control, for the treatment
of certain diseases or dysfunctions of the body and includes the
techniques of electroacupuncture, cupping, and moxibustion. (BPC �
4927)
3) States that a licensed acupuncturist is authorized to do the
following:
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a) To engage in the practice of acupuncture.
b) To perform or prescribe the use of Asian massage, acupressure,
breathing techniques, exercise, heat, cold, magnets, nutrition,
diet, herbs, plant, animal, and mineral products, and dietary
supplements to promote, maintain, and restore health. Nothing in
this section prohibits any person who does not possess an
acupuncturist's license or another license as a healing arts
practitioner from performing, or prescribing the use of any of
these modalities, as specified. (BPC � 4937)
4) States that the Board shall issue a license to practice acupuncture
to any person who applies and meets the following requirements:
(BPC � 4938)
a) Is at least 18 years of age.
b) Furnishes satisfactory evidence of completion of one of the
following: 1) an education and training program, as specified; 2)
satisfactory completion of a tutorial program in the practice of
an acupuncturist which is approved by the Board; or 3) In the
case of an applicant who has completed education and training
outside the United States and Canada, documented education
training and clinical experience, as specified.
c) Passage of a written examination administered by the Board, as
specified.
d) Completion of a clinical internship training program approved
by the Board.
This bill:
1)Renames the Acupuncture Licensure Act as the Traditional Chinese
Medicine Licensure Act, renames the Board as the Traditional Chinese
Medicine Board, and changes the name of the Acupuncture Fund into
the Traditional Chinese Medicine Fund.
2)Defines Traditional Chinese Medicine (TCM) to be similar to the
current definition of acupuncture and changes the designation of an
acupuncturist into TCM Practitioner.
3)Includes in the authorized activities of a licensed acupuncture the
performance of traumatology, which includes a range of treatments to
address both acute and chronic musculoskeletal conditions, as well
as many nonmusculoskeletal conditions. Techniques include, but are
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not limited to, brushing, kneading, rolling, pressing, and rubbing
the areas between each of the joints to open the body's defensive
chi and stimulate the energy movement in both meridians and the
muscles so that the licensee is able to use range of motion,
traction, and massage with the stimulation of acupuncture points.
4)Requires the Board, on or before March 1, 2012, to establish a
Traumatology Advisory Committee (Committee) within the Board to
consist of six members composed of representatives from the clinical
settings of traumatology.
5)Requires the Committee to determine certification standards,
including the level of experience and training needed for an
individual to qualify for traumatology certification. Requires the
Committee to advise the Board in developing the application form and
the written examination for the certification.
6)Requires the Board, commencing May 1, 2012 until December 15, 2012,
to issue a certificate for traumatology to any person who makes an
application and meets all of the following requirements:
a) Is at least 18 years of age;
b) Furnishes satisfactory evidence of training and clinical
experience which meets the standards established by the Committee
and confirmed by the Board.
c) Passes a written examination administered by the Board that
tests the applicant's ability, competency, and knowledge of
traumatology. Requires the written examination to be developed
by the Office of Professional Examination Services of the DCA.
d) Is not subject to denial, as specified.
7)Requires an applicant for traumatology certification, commencing
January 1, 2012, to apply for a certificate for traumatology until
December 15, 2012. Prohibits the Board, on and after December 15,
2012, from issuing an initial license to any applicant. Specifies
that on and after December 15, 2012, the Board may issue only a
renewal of a certificate. State that an individual who is not
qualified to receive a certificate or who fails to apply for
certification by December 15, 2012, shall not hold himself or
herself out as a certified traumatologist.
8)Defines traumatology as treating both acute and chronic
musculoskeletal conditions through stimulation of acupressure points
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using a range of hands-on body treatment, including traction and
massage. States that traumatology addresses pain associated with
the muscles joints and skeletal system. Provides that traumatology
involves manipulation techniques to realign the musculoskeletal and
ligamentous relationships, a technique called bone-setting.
9)Requires a certified traumatologist to maintain a relationship with
an orthopedic surgeon when involved in manipulation techniques to
realign the musculoskeletal and ligamentous relationships, a
technique called bone setting. States that the extent of the
relationship between a traumatologist and orthopedic surgeon in the
case of bone-setting shall be determined by the Board in
consultation with the Medical Board of California.
10)Requires an applicant for certification as a traumatologist to pay
an application fee of $75 when submitting his or her application to
the Board.
11) Requires that the certificate must be renewed every five years,
and that an expired certificate may be renewed at any time within
the three years after its expiration.
12)Specifies fees for the following: renewal ($75), delinquency ($25),
duplicate or replacement wall certificates ($15), and duplicate or
replacement renewal receipt ($10).
13)States that moneys received pursuant to certification shall be
deposited in the TCM Fund.
14)Provides that it is an unfair business practice for any person to
hold himself or herself out as a certified traumatologist or use the
title "certified traumatologist" without meeting the requirements of
this bill.
15)Applies existing law provisions that currently relates to licensed
acupuncturists to certified traumatologists.
16)Provides that a person who holds a certificate to practice
traumatology is subject to existing disciplinary provisions
contained in the Acupuncture Licensure Act.
17)Applies relevant provisions of the Acupuncture Licensure Act to
certified traumatologists. Makes other technical, clarifying and
conforming changes.
18)States findings and declarations relating to TCM and traumatology.
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FISCAL EFFECT: Unknown. Legislative Counsel has keyed this bill as
"fiscal."
COMMENTS:
.
1. Purpose. This bill is sponsored by the Author . According to the
Author, "the current Acupuncture Licensure Act incorrectly refers
to practitioners as Acupuncturist when in fact an Acupuncturist
practices all modalities of TCM of which Acupuncture is only one
modality. The Author states that this bill "seeks to change the
name of the Board and the title practitioners assume to more
accurately reflect their scope of practice. Additionally, this
bill provides a way for traumatologists to become certified.
Traumatology is one of the modalities that constitute TCM. Before
China systemized their health care system, individuals acquired
their mastery of traumatology through a master-apprentice
relationship. These practitioners learned from a master through
hands-on training. Although highly skilled, it is extremely
difficult for these practitioners to obtain proof of their training
to qualify for the existing requirement for licensure."
2. Background. According to the National Institutes of Health's (NIH)
National Center for Complementary and Alternative Medicine
(Center)," TCM originated in ancient China and has evolved over
thousands of years. TCM practitioners use herbs, and other methods
to treat a wide range of conditions. In the United States, TCM is
considered part of complementary and alternative medicine. Herbal
remedies and acupuncture are the treatments most commonly used by
TCM practitioners. Other TCM practices include cupping, mind-body
therapy and dietary therapy. Although TCM is used by the American
public, scientific evidence of its effectiveness is, for the most
part, limited. Acupuncture has the largest body of evidence and is
considered safe if practiced correctly." In 1996, the United
States Food and Drug Administration approved acupuncture needles
for use by licensed practitioners. The FDA requirements stipulate
that the needles must be sterile, nontoxic, and labeled for single
use by qualified practitioners only. In the past two decades,
acupuncture's popularity has grown in the United States. According
to the 2002 National Health Interview Survey, the largest and most
comprehensive survey of complementary and alternative medicine, an
estimated 8.2 million adults have used acupuncture.
According to the Board, there are currently 10, 271 licensed
acupuncturists and 19 approved acupuncture schools in California.
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The Acupuncture Licensure Act (Act) defines acupuncture as the
stimulation of a certain point or points on or near the surface of
the body by the insertion of needles to prevent or modify the
perception of pain or to normalize physiological functions,
including pain control, for the treatment of certain diseases or
dysfunctions of the body and includes the techniques of
electroacupuncture, cupping, and moxibustion. The Act provides
that an acupuncturist's license authorizes the holder to engage in
the practice of acupuncture and to perform or prescribe the use of
Asian massage, acupressure, breathing techniques, exercise, heat,
cold, magnets, nutrition, diet, herbs, plant, animal, and mineral
products, and dietary supplements to promote, maintain, and restore
health. The Act further provides an applicant for acupuncture
licensure to furnish evidence of completion of an educational and
training program approved by the Board or a tutorial program in the
practice of acupuncture that is approved by the Board. Students
entering programs on or after January 1, 2005 are required to
fulfill a minimum of 3,000 hours of study pertaining to the
practice of acupuncture. Additionally, an applicant must pass a
written examination administered by the Board, and complete a
clinical internship training program, as specified.
3. Related Legislation. AB 72 (Eng), pending in Assembly Health
Committee would require every health care service plan, as
specified, to provide acupuncture coverage, as specified.
AB 1117 (Yee), Chapter 649, Statutes of 2006, among other provisions,
changed the term "oriental medicine" to "Asian medicine" and the
term "oriental massage" to "Asian massage."
4. Policy Questions.
a) Will changing the name of acupuncture into Traditional Chinese
Medicine and the Acupuncture Board into the Traditional Chinese
Medicine Board and in the best interests of consumers? According
to the Board's Website, the term acupuncture has been used in
California since 1972 when the Board of Medical Examiners (now
Medical Board of California) allowed the practice of acupuncture
under the supervision of licensed physicians as part of
acupuncture research in medical schools. Since the creation of
the Acupuncture Advisory Committee in 1975, a precursor to the
Acupuncture Examining Committee, which was later renamed into the
Acupuncture Board, members of the public have identified
practitioners of acupuncture to be licensed and regulated by the
Acupuncture Board. Changing the name now could create confusion
on members of the public who have known and are familiar with the
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practice of acupuncture and the Acupuncture Board.
Additionally, it is unclear if designating acupuncture to be
similar to TCM would make the public perceive that TCM is as
scientific and evidence-based as the practice of acupuncture. As
the NIH had indicated, "Although TCM is used by the American
public, scientific evidence of its effectiveness is, for the most
part, limited. Acupuncture has the largest body of evidence and
is considered safe if practiced correctly."
b) Is the education, curriculum, and training requirements for
acupuncturists sufficient to authorize them to practice
traumatology? This bill includes the performance of traumatology
in the list of authorized activities that acupuncturists could
perform. The bill defines traumatology as treating both acute
and chronic musculoskeletal conditions through stimulation of
acupressure points using a range of hands-on body treatment,
including traction and massage, and, involves manipulation
techniques to realign the musculoskeletal and ligamentous
relationships; a technique called bone setting. Although the
bill requires a certified traumatologist to maintain a
relationship with an orthopedic surgeon when involved in bone
setting, it remains unclear if current and future practitioners
of acupuncture have sufficient education, training, and clinical
experience to perform traumatology safely on consumers,
especially since bone setting is outside the current scope of
practice of acupuncturists.
5. Arguments in Support. Numerous individuals who support this bill
indicate, "Acupuncture is one of the many modalities within TCM.
This nomenclature is misleading and problematic, as the scope of
practice of a licensed acupuncturist includes other modalities of
TCM, and not just acupuncture. Additionally, Traumatology is one
of the modalities that constitute TCM. It is a very important part
of TCM science, with a complete theoretical system. Before China
systematized its health care system, individuals acquired their
competence of traumatology through clinical practicum and
internships. Although highly skilled, these practitioners'
trainings are not yet recognized in California."
6. Arguments: Oppose Unless Amended. The California Orthopaedic
Association (Association) has taken an oppose unless amended
position and states that the scope of practice of a traumatologist
as specified in this bill is broad, including aspects of
orthopedics. The Association indicates that in the United States,
an orthopedic surgeon must complete four years of undergraduate
training, four years of medical school and five years of
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orthopaedic residency. This training must be complete in
nationally accredited programs and institutions. However, in this
bill, the standards for the traumatologist certificate would be set
by a subcommittee of the Acupuncture Board, composed of
representatives of unnamed clinical and academic settings of
traumatology. It states that there are too many unanswered
questions about what traumatologists will be allowed to do, and
what their training and education must be for this practice to be
authorized.
7. Arguments in Opposition. The National Guild of Acupuncture and
Oriental Medicine (NGAOM) is opposed to this bill and states the
following: "The Acupuncture Licensure Act specifically
distinguishes between acupuncture and "Oriental medicine." The
Legislators specifically intended to only license needling therapy
i.e. acupuncture, and not the broader practice of "Oriental"
medicine. Traditional Chinese Medicine remains a non-scientific
approach to diagnosing and treating disease that is inconsistent
not only with mainstream medicine as it is practiced in the USA but
also as it is practiced across different Asian cultures." NGAOM
also states that "traumatology is orthopedics. Licensing
acupuncturists as traumatologists comprises an encroachment on the
orthopedist scope of practice.
Additionally, the Association of Korean and Asian Medicine and
Acupuncture of California (AKAMAC) states that this bill is a step
backward for the practice of acupuncture and poses a grave danger
to public safety. AKAMAC, in pointing out the history of TCM,
states that the California Legislature did not intend to license
TCM practitioners when they licensed acupuncturists or they would
have done so, and suggesting that acupuncture and TCM are
interchangeable is ambiguous and clouds reality. Though the scope
of practice of a licensed acupuncturist in California includes
specific related modalities, there is no evidence within this bill
that one could conclude that these modalities are the whole of TCM.
AKAMAC states that TCM remains a non-scientific, by Western
medicine standards, approach to diagnosing and treating disease and
is inconsistent with mainstream or Western medicine. Additionally,
AKAMAC states that defining acupuncture by a specific restrictive
definition of a country does a disservice to other Asian cultures
that share in the practice of this health care modality.
Furthermore, like NGAOM, AKAMAC believes that traumatology is
orthopedics and allowing acupuncturists to practice traumatology is
an encroachment on the orthopedist scope of practice and is clearly
outside an acupuncturist's scope of practice and current training,
education, and expertise.
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8. Technical Amendment. The Author would like to strike the word
"license" on page 21, line 15, and replace it with "certificate" to
more accurately reflect his intent.
SUPPORT AND OPPOSITION:
Support:
Numerous individuals
Oppose Unless Amended:
California Orthopaedic Association
Opposition:
Association of Korean Asian Medicine and Acupuncture of California
National Guild of Acupuncture and Oriental Medicine
Numerous Individuals
Consultant:Rosielyn Pulmano