BILL ANALYSIS �
SB 747
Page 1
Date of Hearing: June 21, 2011
ASSEMBLY COMMITTEE ON BUSINESS, PROFESSIONS AND CONSUMER
PROTECTION
Mary Hayashi, Chair
SB 747 (Kehoe) - As Amended: June 13, 2011
SENATE VOTE : 25-12
SUBJECT : Continuing education: lesbian, gay, bisexual, and
transgender patients.
SUMMARY : Requires physicians and surgeons, physician
assistants, registered nurses, nurse practitioners, licensed
vocational nurses, psychiatric technicians, psychologists,
marriage and family therapists, licensed clinical social
workers, and certified nurse assistants to complete specified
continuing education (CE) or training in cultural competency,
sensitivity, and best practices for providing adequate care to
lesbian, gay, bisexual and transgender (LGBT) persons.
Specifically, this bill :
1)Requires, on and after January 1, 2013, the healing arts
boards or committees that regulate the professions specified
above 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. The course must be between two and five hours
in duration and must 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." The boards or committees
may specify the required contents of the course by regulation.
2)Requires persons licensed by these boards, except the Board of
Registered Nursing (BRN), before January 1, 2013, to complete
the course no later than January 1, 2017. Persons who are
newly licensed by these boards on and after January 1, 2013,
must complete the course within four years of their initial
license issuance date or their second license renewal date,
whichever occurs first. These boards must enforce this
requirement in the same manner as they enforce other required
CE requirements.
3)Requires persons licensed by BRN before January 1, 2013, to
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complete the course no later than January 1, 2018. The BRN
must not enforce this requirement in the same manner as it
enforces other required CE requirements, but must instead
request all persons licensed by BRN to disclose on the renewal
form or a supplemental form whether they have complied with
this requirement. The requirement applies to all persons
licensed by the BRN, including nurse practitioners.
4)Requires, on and after January 1, 2013, at least two, but not
more than five, hours of the classroom training required for
nurse assistant certification to provide instruction on
cultural competency, sensitivity, and best practices for
providing adequate care to LGBT persons. Nurse assistants
certified by the Department of Public Health (DPH) before
January 1, 2013, must complete the course no later than
January 1, 2017. Persons who are newly certified on and after
January 1, 2013, must complete the course within four years of
their initial certificate issuance date or their second
certificate renewal date, whichever occurs first. The
instruction must contain content similar to the content
described in the publication of the Gay and Lesbian Medical
Association, as specified. DPH may specify the required
contents of the course by regulation, and must enforce this
requirement in the same manner as it enforces other training
requirements.
EXISTING LAW
1)Establishes the Medical Board of California (MBC) to regulate
physicians and surgeons, and specifies 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)Establishes 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.
3)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.
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4)Establishes the Physician Assistant Committee within the MBC
to regulate the practice of physician assistants. Prescribes
CE requirements for physician assistants.
5)Establishes the Board of Psychology to regulate the practice
of psychologists. Requires licensed psychologists to complete
CE courses.
6)Establishes the Board of Behavioral Sciences to regulate the
practice of marriage and family therapists and clinical social
workers. Prescribes CE requirements for these practitioners.
7)Establishes DPH to, among other functions, provide
certification for nurse assistants. Specifies the
requirements for an approved nurse assistant training program.
FISCAL EFFECT : Unknown
COMMENTS :
Purpose of this bill . According to the author's office, "The
lesbian, gay, bisexual, and transgender 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 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?While 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."
Background . Physicians and surgeons, physician assistants,
registered nurses, licensed vocational nurses, psychologists,
psychiatric technicians, marriage and family therapists, and
clinical social workers must complete CE 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
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and the treatment of terminally ill and dying patients.
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 CE
courses, similar to the requirements of this bill, are one-time
course requirements.
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; and, 100 hours of supervised
and on-the-job training in clinical practice.
This bill requires that 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 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
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of resources that can be used to obtain more information about
specific health concerns.
Support . Equality California states, "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. Unfortunately, from
1996-2005, the quality of care provided to LGBT patients in the
U.S. did not improve substantially. There are hundreds of
hospitals and thousands of medical offices and mental health
facilities whose policies and procedures regarding LGBT health
are unknown.
California has previously adopted CE mandates, such as cultural
competency training, for other medically underserved
populations?Additional legislative mandates for (continuing
medical education) content include pain management and
palliative end-of- life care. The goal of SB 747 is to provide
LGBT people a safe and understanding environment when they are
being cared for in hospitals, medical offices, or mental health
facilities."
Opposition . Opponents express concern with mandating CE courses
through legislation, and state, "Mandating CME on LGBT health or
any other single issue has the potential to divert scarce time
and resources from other important training that may be more
relevant to a physician and his or her medical practice.
"Attempting to mandate specific education requirements has the
potential to cause already overwhelmed clinicians to focus on
educational areas that may be redundant or have little health
benefit to patients at the cost of learning about conditions or
areas of clinical practice that are more immediately relevant to
their education needs and the clinical needs of their patients."
Related legislation . AB 675 (Hagman) prescribes the content of
all continuing education (CE) or competency courses required by
any of the boards under the Department of Consumer Affairs
(DCA). This bill was held in Assembly Business, Professions and
Consumer Protection Committee.
Previous legislation . AB 378 (Hagman) of 2010 requires that CE
courses for nurses contain only content relevant to the practice
of nursing, as specified. CE courses that advance or promote
labor organizing on behalf of a union, or that advance or
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promote statutory or regulatory changes, political candidates,
political advocacy, or political strategy shall not be
considered content relevant to the practice of nursing and shall
not be acceptable for meeting requirements for licensure
renewal. This bill was held in Senate Business, Professions and
Economic Development Committee.
AB 1195 (Coto) Chapter 514, Statutes of 2005, requires all
continuing medical education courses, unless exempted, to
contain curriculum pertaining to cultural and linguistic
competency in the practice of medicine.
AB 487 (Aroner) Chapter 518, Statutes of 2001, requires
physicians and surgeons to complete a mandatory CE course in
pain management and end-of-life care.
REGISTERED SUPPORT / OPPOSITION :
Support
Equality California (sponsor)
Antioch University, Los Angeles, Master of Arts in Clinical
Psychology
Asian and Pacific Islander American Health Forum
California Association of Marriage and Family Therapists, San
Francisco Chapter
California Communities United Institute
California Mental Health Directors Association
California National Organization for Women
California STD Controllers Association
Dr. Susan Love Research Foundation
Gay and Lesbian Medical Association
Gaylesta, the LGBT Psychotherapists Association of the San
Francisco Bay Area
Greater San Diego Business Association
Lavender Seniors of the East Bay
Lesbian and Gay Psychotherapy Association of Southern California
Mental Health America of Northern California
National Association of Social Workers, California Chapter
Openhouse
Pacific Center for Human Growth
Planned Parenthood Affiliates of California
Planned Parenthood Mar Monte
Planned Parenthood of Orange and San Bernardino Counties
The Trevor Project
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Numerous individuals
Opposition
American Nurses Association of California
Board of Psychology
California Academy of Family Physicians
California Association of Marriage and Family Therapists
California Orthopaedic Association
California Psychological Association
California Right to Life Committee
Department of Consumer Affairs
Department of Finance
Kaiser Permanente
Analysis Prepared by : Angela Mapp / B.,P. & C.P. / (916)
319-3301