BILL ANALYSIS �
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|Hearing Date:April 11, 2011 |Bill No:SB |
| |747 |
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SENATE COMMITTEE ON BUSINESS, PROFESSIONS
AND ECONOMIC DEVELOPMENT
Senator Curren D. Price, Jr., Chair
Bill No: SB 747Author:Kehoe
As Amended:April 4, 2011 Fiscal: Yes
SUBJECT: Continuing education: lesbian, gay, bisexual, and
transgender patients.
SUMMARY: Requires physicians and surgeons , registered nurses , licensed
vocational nurses , psychologists , physician assistants , psychiatric
technicians , marriage and family therapists , and clinical social
workers , to take at least one continuing education course that
provides instruction on cultural competency, sensitivity, and best
practices for providing adequate care to lesbian, gay, bisexual, and
transgender persons (LGBT) on and after January 1, 2013, as specified.
Existing law:
1) Establishes the Medical Board of California (MBC) to regulate
physicians and surgeons. Establishes continuing education (CE)
standards for physicians and surgeons. Requires that on and after
July 1, 2006, all continuing medical education courses shall
contain curriculum that includes cultural and linguistic competency
in the practice of medicine.
2) Requires the MBC to adopt standards for the certification of
medical assistants.
3) Establishes the Board of Registered Nursing (BRN) to regulate the
practice of registered nurses. Requires that any registered nurse
that renews a license to submit proof of CE courses in the
registered nurse field, as specified.
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4) Establishes the Board of Vocational Nurses and Psychiatric
Technicians to regulate the practice of licensed vocational nurses
and psychiatric technicians. Requires licensed vocational nurses
and psychiatric technicians to complete CE courses as part of
licensure renewal.
5) Establishes the Physician Assistant Committee within the MBC to
regulate the practice of physician assistants. Prescribes CE
requirements for physician assistants.
6) Establishes the Board of Psychology to regulate the practice of
psychologists. Requires licensed psychologists to complete CE
courses.
7) Establishes the Board of Behavioral Sciences to regulate the
practice of marriage and family therapists (MFTs) and clinical
social workers. Prescribes CE requirements for these
practitioners.
8) Establishes the Department of Public Health (DPH), to among other
functions, provide certification for nurse assistants. Specifies
the requirements for an approved nurse assistant training program.
This bill:
1) Requires the MBC, on and after January 1, 2013, to require all
medical assistants to take at least one training course that
provides instruction on cultural competency, sensitivity, and best
practices for providing adequate care to LGBT persons. States that
the course shall be between two and five hours in duration and
contain content similar to the content described in the publication
of the Gay and Lesbian Medical Association entitled "Guidelines for
Care of Lesbian, Gay, Bisexual and Transgender Patients." Allows
the MBC to specify the required contents of the course by
regulation.
2) Requires the healing arts boards or committees that regulate and
license physicians and surgeons , registered nurses , licensed
vocational nurses , psychologists , physician assistants , psychiatric
technicians , marriage and family therapists and clinical social
workers to require their licensees to take at least one CE course
that provides instruction on cultural competency, sensitivity, and
best practices for providing adequate care to LGBT persons on and
after January 1, 2013. States that practitioners licensed by these
boards before January 1, 2013 must complete the course no later
than January 1, 2017. Requires that persons who are newly licensed
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on and after January 1, 2013 to complete the course within four
years of initial license issuance date or their second license
renewal date, whichever occurs first.
3) Requires that the CE course specified in item # 2) above, to be
between two and five hours in duration and contain content similar
to the content described in the publication of the Gay and Lesbian
Medical Association, as specified. Allows the specified healing
arts boards to specify the required contents of the course by
regulation, and to enforce these requirements in the same manner as
other required CE requirements are enforced.
4) States that on and after January 1, 2013, the training program for
nurse assistant certification must include at least two, but not
more than five, hours of the classroom training to provide
instruction on cultural competency, sensitivity, and best practices
for providing adequate care to LGBT persons. States that nurse
assistants certified by DPH before January 1, 2013 shall complete
the course no later than January 1, 2017. Persons who are newly
certified on and after January 1, 2013 shall complete the course
within four years of their initial certificate issuance date or
their second certificate renewal date, whichever occurs first.
States that the instruction must contain content similar to the
content described in the publication of the Gay and Lesbian Medical
Association, as specified.
FISCAL EFFECT: Unknown. This bill has been keyed "fiscal" by
Legislative Counsel.
COMMENTS:
1. Purpose. Equality California is the Sponsor of this measure.
According to Equality California, the LGBT community has specific
medical needs and concerns. It is critical that health care
professionals across California receive the necessary training to
understand those needs and provide compassionate and improved
patient care. The Sponsor points out that the American Medical
Association (AMA) made a public call in 1996 to improve the
education of health care personnel regarding best practices for
improving care provided to LGBT patients. A past president of the
AMA reiterated that call in 2005. The Sponsor points out that
although some training advances have been made, improving the
capacity of health care providers to adequately serve LGBT patients
is an issue that needs direct attention. Research, studies and
human experiences have demonstrated that members of the LGBT
community receive sub-par quality medical and mental health care
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when compared with the health care quality provided to the general
population. Moreover, some LGBT patients may require specialized
care because of the unique nature of their medical and mental
health problems.
2. Background. Physicians and surgeons, physician assistants,
registered nurses, licensed vocational nurses, psychologists,
psychiatric technicians, MFTs and clinical social workers must
complete continuing education courses to renew their license.
Healing arts boards generally do not mandate the courses that must
be taken but they must be relevant to the licensee's area of
practice. However, there are certain courses that are required to
be taken by specific licensees. For example, physicians and
surgeons are required to complete CE courses in cultural and
linguistic competency, pain management and the treatment of
terminally ill and dying patients. Additionally, psychologists are
required to show evidence of completion of training in human
sexuality, child abuse assessment and training, and aging and
long-term care. These required continuing education courses,
similar to the requirements of this bill, are one-time course
requirements.
3. Certification of Nurse Assistants. Currently, DPH's Licensing and
Certification Section is responsible for the certification of nurse
assistants. DPH prepares and maintains a list of approved training
programs for nurse assistants, including programs conducted by
skilled nursing or intermediate care facilities. Currently, a
nurse assistant training program includes a 16-hour orientation
program for facilities participating in the Medicare or Medicaid
programs; at least 60 classroom hours of training on basic nursing
skills, patient safety and rights, as specified; 100 hours of
supervised and on-the-job training clinical practice. This bill
would require that for purposes of certification, nurse assistants,
on and after January 1, 20113, must fulfill at least two, but not
more than five hours of classroom training on cultural competency,
sensitivity, and best practices for providing adequate care to LGBT
persons.
4. Guidelines for the Care of Lesbian, Gay, Bisexual, and Transgender
Patients. This bill requires that the CE course content required
by this measure be similar to the content described in the
publication of the Gay and Lesbian Medical Association entitled
Guidelines for the Care of Lesbian, Gay, Bisexual, and Transgender
Patients (Guidelines). The Guidelines discuss three different areas
of patient care, creating a welcoming clinical environment for LGBT
patients in general, and additional considerations specific to each
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gender. In creating a welcoming atmosphere, the Guidelines suggest
different methods for promoting openness within the
patient-provider relationship. Included in these methods are
placing materials within the office that will help LGBT patients
feel more comfortable sharing information with their health care
provider, changes to the standard intake form to allow the patient
to be more comfortable about being open about their sexual
orientation or gender identity expression, methods to facilitate
open patient and provider discussions in the initial intake
interview, and making assurances of confidentiality. There are
also some general health concerns that are prevalent within this
community, which includes depression, stress, and anxiety.
Additionally, the guidelines highlight common physical and mental
health issues and risk factors that may be particularly relevant in
the context of the lives of lesbian and bisexual women as well as
gay and bisexual men. Included in this section are some screenings
that health care providers should be offering to these groups.
Lastly, the Guidelines provide a list of resources that can be used
to obtain more information about specific health concerns.
5. Will the Health Care Boards Be Able to Implement the CE
Requirements in this Measure? To implement the provisions of this
bill, health care boards that regulate physicians and surgeons,
registered nurses, licensed vocational nurses, psychologists,
physician assistants, psychiatric technicians, MFTs, and clinical
social workers would need to audit each licensee for compliance.
It appears that the MBC may be able to audit practitioners for
compliance. However, the BRN may have difficulty enforcing this
bill's provisions. In recent months, the BRN has encountered
criticism for approving questionable CE providers, and for its lack
of staff to conduct CE audits of registered nurses and CE
providers. As such, this lack of staffing may hamper BRN's ability
to enforce the provisions of this bill. It is unknown whether
other health boards because of lack of resources or staffing will
also be able to audit these requirements.
6. Arguments in Support. Supporters, such as the Gay and Lesbian
Medical Association state that continuing education addressing
cultural competency in LGBT health is a critical component to
improving health outcomes for California's LGBT persons.
Additionally, the California STD Controllers Association , comprised
of STD control officers who lead sexually transmitted disease
prevention and control programs in California, state that education
can improve a providers' ability to care for LGBT patients,
improve knowledge and attitudes toward LGBT health, and reduce
health disparities among LGBT residents, including those related to
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sexual health.
7. Arguments in Opposition. The California Psychological Association
has taken an oppose position and states that competency to provide
care to LGBT individuals is currently being taught in multicultural
courses, family systems, lifespan development, and in real life
applications through practicum and internship. Further, it points
out that the course in human sexuality currently includes the study
of physiological-psychological and social-cultural variable
associated with sexual identity, sexual behavior, or sexual
disorders.
The California Association of Marriage and Family Therapists states
that if there is to be a requirement to enhance competency and
sensitivity with LGBT patients, the appropriate venue for this
training is part of the graduate degree program that qualifies one
for licensure.
The California Orthopaedic Association states that it opposes
mandating specific CE courses, and prefers that the mandate be
included in the medical curriculum. Alternatively, for practicing
physicians, it recommends that the CE requirement of this bill be
limited to primary care providers who provide the point of intake
for most patients in the health care delivery system.
SUPPORT AND OPPOSITION:
Support:
Equality California (Sponsor)
California Communities United Institute
California National Organization for Women
California STD Controllers Association
Dr. Susan Love Research Foundation
Gay & Lesbian Medical Association
Lesbian and Gay Psychotherapy Association of Southern California, Inc
LGBT Psychotherapists Association of the San Francisco Bay Area
Mental Health America of Northern California
Numerous health care providers and individuals
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Opposition:
California Academy of Family Physicians
California Association of Marriage and Family Therapists
California Orthopaedic Association
California Psychological Association
Consultant:Rosielyn Pulmano