BILL ANALYSIS �
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|Hearing Date:April 23, 2012 |Bill No:SB |
| |1236 |
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SENATE COMMITTEE ON BUSINESS, PROFESSIONS
AND ECONOMIC DEVELOPMENT
Senator Curren D. Price, Jr., Chair
Bill No: SB 1236Author:Price
As Amended:April 17, 2012 Fiscal:Yes
SUBJECT: Healing arts boards.
SUMMARY: Extends the provisions establishing the California Board of
Podiatric Medicine (BPM), and extends the Physician Assistant
Committee (PAC), and its executive officer, and makes other changes,
as specified.
Existing law:
1)Licenses and regulates some 2,000 doctors of podiatric medicine
(DPMs) by the California Board of Podiatric Medicine (BPM) under the
Medical Board of California (MBC) within the Department of Consumer
Affairs (DCA), and makes the BPM inoperative and repealed on January
1, 2013. (Business and Professions Code (BPC) � 2460)
2)Provides that the BPM is composed of seven members, three public
members, and four professional members. The Governor appoints five
members, and the Senate Rules Committee and the Assembly Speaker
each appoints a public member. (BPC � 2462)
3)Provides that protection of the public shall be the highest priority
for the BPM in exercising its licensing, regulatory, and
disciplinary functions, and whenever the protection of the public is
inconsistent with other interests sought to be promoted, the
protection of the public shall be paramount. (BPC � 2460.1)
4)Defines the practice of "podiatric medicine" to mean the diagnosis,
medical, surgical, mechanical, manipulative, and electrical
treatment of the human foot, including the ankle and tendons that
insert into the foot and the nonsurgical treatment of the muscles
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and tendons of the leg governing the functions of the foot. (BPC �
2472 (b))
5)Authorizes a DPM to administer local anesthetic, and requires an
anesthetic other than local to be administered by another
appropriately-licensed health care practitioner. (BPC � 2472 (c))
6)Provides that a DPM of podiatric medicine who is ankle certified by
the board on and after January 1, 1984, may do the following: (BPC
� 2472 (d))
a) Perform surgical treatment of the ankle and tendons at the
level of the ankle, as specified.
b) Perform services under the direct supervision of a physician
and surgeon, as an assistant with surgical procedures beyond the
DPM scope of practice.
c) Perform a partial amputation of the foot, as specified.
1)Prohibits a DPM from performing an admitting history and physical
examination of a patient in an acute care hospital where doing so
would violate the regulations governing the Medicare program. (BPC
� 2472 (f))
2)Provides that a graduate of an approved school of podiatric medicine
may apply for and obtain a resident's license from the BPM,
authorizing them to practice podiatric medicine, as specified. A
resident's license may be renewed annually for up to four years.
(BPC � 2475)
3)Provides that podiatric law does not prohibit the manufacture,
recommendation or the sale of either corrective shoes or appliances
for the human feet. (BPC � 2477)
4)Requires applicants for a DPM license to complete at least two years
of postgraduate podiatric medical and podiatric surgical training in
a general acute care hospital approved by the Council of Podiatric
Medical Education. (BPC � 2484)
5)Requires "a passing score one standard error of measurement higher
than the national passing scale score" on the American Podiatric
Medical Licensing Examination (APMLE) Part III, the national
examination administered by the National Board of Podiatric Medicine
Examiners. (BPC � 2493 (b))
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6)Specifies that an Administrative Law Judge's (ALJ's) proposed
decision shall be voted on by the BPM by mail, and requires the vote
of two members of the BPM to defer final decision until the board
has discussed the case as a whole. (BPC � 2335)
7)Authorizes the BPM to request an ALJ in a disciplinary matter to
direct a licensee found guilty of unprofessional conduct in a
proposed decision to pay to the BPM a sum not to exceed the actual
and reasonable costs of the investigation and prosecution of the
case. The law provides that the costs shall be fixed by the ALJ and
shall not in any event be increased by the BPM. (BPC � 2497.5)
8)Licenses and regulates more than 7,500 physician assistants (PAs)
under the Physician Assistant Practice Act by the PAC within the
MBC, and makes the PAC inoperative and repealed on January 1, 2013.
(BPC � 3504)
9)Authorizes the PAC to appoint an executive officer, and makes that
authority inoperative and repealed on January 1, 2013. (BPC � 3512)
10)The PAC is comprised of nine members; 4 PAs, 4 public members and
one physician representative of MBC. Four PAs, the physician
members and two public members are appointed by the Governor.
Senate Rules Committee and the Assembly Speaker each appoint a
public member. (BPC � 3505)
11)Provides that protection of the public shall be the highest
priority for the PAC in exercising its licensing, regulatory, and
disciplinary functions, and whenever the protection of the public
is inconsistent with other interests sought to be promoted, the
protection of the public shall be paramount. (BPC � 3504.1)
12)Places specific reporting requirements upon specified health care
licensing boards and upon licensees of those boards, including the
following:
a) Requires boards to create and maintain a central file on each
of its licensees, which shall include information regarding:
convictions, judgments, specified public complaints. (BPC � 800)
b) Requires licensees to report to his or her licensing board the
occurrence of an indictment or information charging a felony
against the licensee or the conviction of the licensee of a
felony or misdemeanor. (BPC � 802.1)
c) Specifies procedures when a coroner receives information, as
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specified, that a death may be the result of a specified
licensee's gross negligence or incompetence, and in connection
with disciplinary actions against those licensees. (BPC � 802.5)
d) Requires a district attorney, city attorney, or other
prosecuting agency to notify specific health licensing boards
whenever a licensee is convicted of or charged with a felony, as
specified. (BPC � 803.5)
e) Provides for the professional review of specified healing
arts licentiates through a peer review process. (BPC � 805)
This bill:
1)Extends the BPM's sunset date 4 years to January 1, 2017. (BPC �
2460)
2)Amends BPC � 2472 (d) (1) Removes the reference to "ankle
certification after January 1, 1984," thereby confirming a single
scope of licensure for DPMs.
3)Repeal an obsolete provision prohibiting a DPM from performing an
admitting history and physical exam at an acute care hospital. BPC
� 2472)
4)Eliminates the four year limit for postgraduate training. (BPC �
2475)
5)Clarifies that anyone may offer special shoes and inserts without a
license to aid comfort and athletic performance, but that a medical
license is needed to diagnose and prescribe for medical conditions.
(BPC � 2477)
6)Removes a requirement that applicants obtain a specific score on the
licensing examination. (BPC � 2493)
7)Authorizes that the vote of only one board member of the BPM is
necessary to defer a decision for consideration by the entire board.
(BPC � 2335)
8)Authorizes BPM to increase costs assessed when a proposed decision is
not adopted by the BPM and the BPM finds grounds for increasing the
assessed costs (BPC � 2497.5)
9)Extends sunset dates for PAC/BPM and executive officer to January 1,
2013. (BPC �� 3504, 3512)
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10)Changes the name the PAC to Physician Assistant Board (PAB) and
correspondingly changes "Board" to "Medical Board of California."
(BPC multiple sections)
11)Changes the composition of the "Board" to replace the physician with
a PA. (BPC � 3505).
12)Establishes an exemption for active military from payment of the PA
license renewal. (BPC � 3521.3)
13)Establishes a "retired" license status for PA licensees no longer
practicing to retain their license without payment of renewal fees
or completion of continuing education. (BPC � 3521.4)
14)Clarifies that the reporting requirements in the 800 series apply to
PAs. (BPC �� 800-805)
FISCAL EFFECT: Unknown. This bill has been keyed "fiscal" by
Legislative Counsel.
COMMENTS:
1.Purpose. This bill is sponsored by the Author . According to the
Author, in 2012, the Business, Professions and Economic Development
Committee (BPED) conducted oversight hearings to review 7 regulatory
boards within the DCA: the Board of Podiatric Medicine, the
Physician Assistant Committee, the Acupuncture Board, the Board of
Pharmacy, the Court Reporters Board, the Board of Behavioral
Sciences and the Board of Psychology. The Committee began its
review of these licensing agencies in March and conducted two days
of hearings. This bill, and the accompanying sunset bills, is
intended to implement legislative changes as recommended in the
Committee's Background Issue Papers for the agencies reviewed by the
Committee this year.
This bill is one of four "sunset bills" authored by the Chair of
this Committee. According to the Author, this bill is necessary to
extend the sunset date of the BPM and the PAC in order to continue
the regulation of the practice of podiatric medicine, and the
practice of PAs in California. The continued regulation will help
to ensure that the BPM's and the PAC's mission of protecting the
public is in place for an additional four years.
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2.Background on the California Board of Podiatric Medicine (BPM). The
BPM in the is responsible for licensing and regulating DPMs in
California. Although the BPM functions in an independent manner,
similar to other boards under DCA, the BPM lies within the
jurisdiction of the MBC, and it is the MBC that officially issues
licenses to these practitioners upon the "recommendation" of the
BPM.
The BPM licenses approximately 2,000 DPMs. The BPM issues some 55
licenses each year, and approximately 1,000 licenses are renewed
each year.
The DPM license as defined in the BPC and in the regulations of the BPM
are specialists in the foot and ankle. Some DPMs specialize in
conservative care while others practice mostly as surgeons. Many
DPMs specialize in care and preservation of the diabetic foot. DPMs
also assist other doctors in non-podiatric surgeries. DPMs are the
only medical specialty limited to its area of expertise by the
license itself, which enhances patient protection.
Currently, the BPM is composed of seven members. It has a professional
majority with three public members, and four professional members.
The Governor appoints five members of the BPM. The Senate Rules
Committee and the Assembly Speaker each appoints one public member.
The BPM is required to meet at least three times each calendar year
and meets at various locations throughout the state. Board meetings
are open and give the public the opportunity to testify on agenda
items and on other issues.
The BPM currently has five committees that perform various functions:
Public Outreach Committee: external communication & public
liaison.
Enforcement Committee: enforcement procedures.
Legislative Committee: legislative liaison.
Licensing & Medical Education Committee: licensing, exams,
approval of schools & residencies.
Professional Practice Committee: guides & advises staff on
practice matters.
As a Special Fund agency, the BPM receives no General Fund support,
relying solely on fees set by statute and collected from licensees
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and applicants. The total revenues anticipated by the BPM for FY
2011/2012 is $918,000. The total expenditures anticipated for BPM
for FY 2011/2012 are $960,000, and for FY 2012/2013, $979,000.
Based upon these figures, the BPM would have approximately 10 months
in reserve in FY 2011/2012, and 9.3 months in reserve in FY
2012/2013. The BPM spends approximately 70% of its budget on
enforcement-related functions. The BPM has a staff level of five
authorized positions and currently has no vacancies.
1.Prior Review of the BPM. The BPM was last reviewed by the former
Joint Legislative Sunset Review Committee (JLSRC) in 2002. At that
time, the JLSRC made eight final recommendations regarding BPM. In
November 2011, the BPM submitted its required Sunset Review Report
to the Committee. In this report, the BPM described actions that
have been taken since the BPM's last review. Below are the BPM's
responses to the issues raised during the last sunset review.
Increase Residency Training From One to Two Years. The JLSRC
recommended that the BPM should thoroughly assess the need for
this additional training. The BPM provided evidence that the
American Podiatric Medical Association (APMA) and its affiliates
had conducted an occupational analysis demonstrating that
two-years of postgraduate residency training is the minimum
required to achieve entry-level competence. Subsequently, BPC �
2484 was amended to reflect the two-year requirement by AB 932
(Koretz, Chapter 88, Statutes of 2004).
Model Law Adoption. Neither the JLSRC nor DCA had a
recommendation regarding adoption of a Model Law as had been
proposed by the BPM. The JLSRC emphasized that a model law
should reflect the consumer protection goals of this state.
Accordingly, following further documentation and justification
the BPM was instrumental in legislation enacting many Model Law
provisions (AB 1777, Assembly B&P Committee, Chapter 586,
Statutes of 2003; AB 932, Koretz, Chapter 88, Statutes of 2004).
Renewal Fee Increase Extension. The BPM implemented a
temporary license renewal fee increase, of from $800 to $900,
effective in 2000 on a four-year basis (AB 1252, Wildman, Chapter
977, Statutes of 1999; extended by SB 724, Senate B&P Committee,
Chapter 728, Statutes of 2001). The JLSRC recognized that the
demands on the BPM's operating fund suggested continuation of the
fee increase to maintain the BPM's licensing and enforcement
activities, and enable the BPM's fund condition to stabilize.
Since that time, the fee level was extended through 2005, and SB
1549 (Figueroa, Chapter 691, Statutes of 2004) removed the sunset
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date and the renewal fee has remained $900. The fee level has
been supported by the California Podiatric Medical Association.
Audits of Continuing Medical Education (CME). Faced with
fiscal challenges, the BPM discontinued its contract with the
Medical Board to conduct random audits of CME. The JLSRC
recommended that the BPM resume conducting random audits of CME
courses and providers to guarantee that licensees are receiving
CME courses of quality and relevance to the profession. The BPM
resumed the annual Continuing Competence/CME random audit in
2004; however, the audits have been interrupted by staffing
limitations, furloughs, and budget constraints. The annual
random audit is of one percent of licensees. It verifies
self-certification under penalty of perjury in the current
renewal for compliance with the Continuing Competence and 50-hour
CME requirements. The BPM has recently completed its 2011 random
compliance audit of 20 licensees and found a 95% compliance rate
with 19 providing documentation of CME (50 hours) and the
required Continuing Competence. One licensee was granted a
one-time waiver by the BPM.
Review of Complaints by Board Members. In 2002, the JLSRC
emphasized that Board members should not review complaints and
the BPM should continue to contract with subject matter experts
to do so. Board staff should conduct initial complaint review
and forward select complaints to a panel of experts when
technical expertise is needed. The BPM agrees and complies with
this recommendation.
Transition to a National Examination. SB 1955 (Figueroa,
Chapter 1150, Statutes of 2002) amended BPC � 2486 to reflect a
transition from the state oral clinical licensing examination to
Part III of the National Board of Podiatric Medical Examiners
(NBPME) examination.
Refine Continuing Competency Program. The JLSRC recommended
that the BPM's continuing competency program should be refined to
provide additional pathways and ease compliance. Accordingly, SB
1955 (Figueroa, Chapter 1150, Statutes of 2002) amended BPC �2496
to provide that upon renewing a license, the DPM may show
continued competency in practice by passing within the past 10
years Part III of the examination administered by the National
Board of Podiatric Medical Examiners. The BPM deems this as
landmark legislation, to reinforce lifelong learning. The BPM
believes that the complaint data over time showing a steady
50-percent decline reflects that patient harm is being prevented
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by these changes.
1. Current Issues Identified. The following are some of the major
issues pertaining to the BPM along with background information
concerning the particular issue and the BPM's response to the
issue. Recommendations were made by Committee staff regarding the
particular issue areas which needed to be addressed.
a) Issue : Ankle certification.
Background : The podiatric practice provisions of the Medical
Practice Act essentially provide for a two-tier license system,
depending on whether a DPM was ankle certified "on or after
January 1, 1984," the date that legislation took effect (Chapter
305, Statutes of 1983) to clarify that a podiatrist may treat the
ankle as part of the licensed scope of practice.
Joint Committee staff discussed in 1997 whether this two-tiered
system could be eliminated, upon receipt of BPM's first Sunset
Review report. The BPM staff commented then that it was probably
premature. In 1998, SB 1981 (Greene, Chapter 736, Statutes of
1998) repealed the requirement that licensed podiatrists obtain a
certificate from BPM in order to perform ankle surgery, and
instead, simply authorized a DPM certified by the BPM after
January 1, 1984 to perform ankle surgery.
Now, a decade and a half later, and approaching three decades since
1984, the BPM states in its Report that it would support a single
scope of practice for DPMs. The useful life of the 1984 two-tier
licensing has run its course, according to the BPM.
More than 80-percent of the BPM's licensees are "ankle licensed"
and this percentage continues to increase. According to the BPM,
it is a small number of older licensees who do not perform ankle
surgery, amputations or surgical assisting to MD and DO surgeons
that the "ankle license" now allows.
According to the BPM, a single-scope licensure would simplify the
statute and its administration without harm to the public.
Recommendation : Committee staff recommended that consideration
should be given to the to remove reference to "ankle
certification by the BPM on and after January 1, 1984" in BPC �
2472(d)(1) thereby confirming a single scope of licensure for
doctors of podiatric medicine.
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b) Issue : Status of BReEZe implementation by the BPM
Background : The BreEZe Project will provide DCA boards, bureaus,
and committees with a new enterprise-wide enforcement and
licensing system. BreEZe will replace the existing outdated
legacy systems and multiple "work around" systems with an
integrated solution based on updated technology.
BreEZe will provide all DCA organizations with a solution for all
applicant tracking, licensing, renewal, enforcement, monitoring,
cashiering, and data management capabilities. In addition to
meeting these core DCA business requirements, BreEZe will improve
DCA's service to the public and connect all license types for an
individual licensee. BreEZe will be web-enabled, allowing
licensees to complete applications, renewals, and process
payments through the Internet. The public will also be able to
file complaints, access complaint status, and check licensee
information. The BreEZe solution will be maintained at a
three-tier State Data Center in alignment with current State IT
policy.
BreEZe is an important opportunity to improve the BPM operations to
include electronic payments and expedite processing. Staff from
numerous DCA boards and bureaus have actively participated with
the BreEZe Project. Due to increased costs in the BreEZe
Project, last year SB 543 (Steinberg, Chapter 448, Statutes of
2011) was amended to authorize the Department of Finance (DOF) to
augment the budgets of BPMs, bureaus and other entities that
comprise DCA for expenditure of non-General Fund moneys to pay
BreEZe project costs within the 2011-2012 Budget Year.
The BPM indicated in its Report that in August 2011, DCA advised
the BPM that the BPM budget and fund will be charged assessments
of $4,000 in FY 2011/2012 followed in succeeding FYs by $11,000,
$9,000, $8,000, $9,000 and $9,000 consecutively through FY
2016/2017 for BreEZe SPR Funding. The BPM is scheduled to begin
using BreEZe in the Summer of 2012.
Recommendation : Committee staff recommended the BPM should update
the Committee about the current status of its implementation of
BreEZe. What have been the challenges to implementing this new
system? What are the costs of implementing this system? Is the
cost of BreEZe consistent with what the BPM was told the project
would cost?
2. Responses regarding Issues Raised by the Committee. The BPM
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responded to the issues raised by Committee staff on April 10,
2012. In terms of removing the distinction regarding ankle
certification for DPMs, the BPM concurs with amending BPC Section
2472 to strike the reference to "January 1, 1984." BPM states that
82% of its licensees are now "ankle licensed," and this percent
will continue increasing.
With reference to the status of BreEZe computer project, BPM indicates
that it has met multiple times with the BreEZe team, and provided
all the program data requested. BPM further states that it is
participating in configuration sessions to assess the new system
"hands on," and that implementation is scheduled for summer or fall
2012 (FY 2013). The cost to BPM is $50,000 through FYs 2012-2017.
This is a $38,000-increase over the $12,000 previously budgeted for
i-Licensing. Beginning in FY 2018, annual maintenance costs will
be about $1,000, according to BPM.
3. This Bill Includes the Following Statutory Changes Related to the
BPM Identified by this Committee During the March 2012 Oversight
Hearings:
a) Extends the sunset date of the BPM. The health, safety and
welfare of consumers are protected by a well-regulated medical
profession, including podiatric medicine. DPMs make independent
medical judgments with patients including diagnosis, prescription
medication, and method of treatment. The BPM continues to be an
effective mechanism for licensure and oversight of DPMs and
should be continued. The BPM has shown over the years a strong
commitment to improve the BPM's overall efficiency and
effectiveness and has worked cooperatively with the Legislature
and this Committee to bring about necessary changes. The BPM
should be continued under the jurisdiction of the MBC with a
four-year extension of its sunset date so that the Committee may
review once again if the issues and recommendations in this paper
and others of the Committee have been addressed. This bill
extends the sunset dates for the BPM to January 1, 2017 .
b) Ankle Certification. As noted above, nearly three decades
since the separate ankle certification was first established, the
useful life of the 1984 two-tier licensing has run its course,
according to BPM. The BPM supports a single scope of practice
for DPMs. This bill establishes a single scope of licensure for
DPMs by removing the reference to "ankle certification after
January 1, 1984." .
c) Admitting History and Exam. BPC Section 2472(f) provides that
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"A doctor of podiatric medicine shall not perform an admitting
history and physical examination of a patient in an acute care
hospital where doing so would violate the regulations governing
the Medicare program." In 2010, a California Attorney General
Opinion No. 09-0504, regarding the effect of these provisions
regarding the ability of a doctor of podiatric medicine to
perform an admitting history and physical (H&P) at an acute care
hospital found that "not only is a podiatrist not precluded from
performing an admitting H&P by Business and Professions Code
Section 2472, but failing to do so may fall below the standard of
care expected of podiatrists generally."
In stating this opinion, the AG points out that the prohibition of
Section 2472 is for performing an H&P "where doing so would
violate the regulations governing the Medicare program" and was
placed in the statute in response to a former federal rule, which
imposed restrictions on federal reimbursements of podiatric
services under Medicare. The federal restriction was superseded
by 42 C.F.R. Section 410.25 to provide that "Medicare Part B pays
for the services of a doctor of podiatric medicine acting within
the scope of his or her license, if the services would be covered
as physician's services when performed by a doctor of medicine or
osteopathy."
Therefore, the BPM points out, Medicare regulations no longer
restrict DPM history and physical examinations, thereby making
Section 2472(f) obsolete. The BPM states that the provision is
confusing to the public and should be deleted from the Code. The
bill repeals this obsolete provision prohibiting a DPM from
performing an admitting history and physical exam at an acute
care hospital .
d) Eliminate 4-year limit for postgraduate training. The law
provides that a graduate of an approved school of podiatric
medicine may apply for and obtain a resident's license from the
BPM, authorizing them to practice podiatric medicine, as
specified. A resident's license may be renewed annually for up
to four years. In its Sunset Report, the BPM proposed that the
four-year limitation of the resident's license be deleted, thus
ending the four-year cap on DPM postgraduate training. According
to the BPM, few individuals may participate in residency and
fellowship training for more than four years, but the limit on
education is unnecessary. The BPM argues that this limitation is
the only known statutory cap on education anywhere in this
country for any profession or group. Ultimately, the BPM
believes that the four-year cap will interfere with advanced
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training of some leading practitioners. The BPM states that it
is a principle of medical education that there is no such thing
as too much education and training. This bill eliminates the
four year limit for postgraduate training .
e) Corrective Shoes. In its Report, the BPM proposed that BPC �
2477 be amended to clarify that a medical license is required in
order to diagnose and prescribe corrective shoes or appliances
(called orthotics) for the foot.
Orthotics typically refers to custom-made shoe inserts prescribed
by a licensed doctor of podiatric medicine, an osteopathic
doctor, or a medical doctor after a medical examination and
diagnosis. Orthotics are designed to accommodate or correct an
abnormal or irregular walking pattern, and ultimately make
standing, walking, and running more comfortable and efficient by
altering the angles at which the foot strikes the ground.
Orthotics placed inside of an individual's shoes can absorb
shock, improve balance, and take pressure off sore spots.
The BPM has recommended amending the law to clarify that anyone may
offer special shoes and inserts without a license to aid comfort
and athletic performance, but that a medical license is needed to
diagnose and prescribe for medical conditions. This bill
clarifies that a medical license is needed to diagnose and
prescribe for medical conditions .
f) Examination Score. Following the BPM's 2001-2002 sunset
review, BPC �2484 was amended to reflect the two-year residency
requirement by AB 932 (Koretz, Chapter 88, Statutes of 2004).
That bill correspondingly amended BPC � 2493 to require "a
passing score one standard error of measurement higher than the
national passing scale score" on the American Podiatric Medical
Licensing Examination (APMLE) Part III, the national examination
administered by the National Board of Podiatric Medicine
Examiners (NBPME).
In the BPM's experience, the California score, one standard error
of measurement higher than the national scale passing score,
raises the passing score from 75 one or two points, e.g., to 77,
and slightly lowers the overall pass rate percentage.
Numerically, this means that for each bi-annual Part III exam,
one or two California candidates might achieve the national scale
passing score of 75, but fall just below California's one
standard error of measurement higher, and must retake the
examination.
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The BPM's requirement by law for a higher score than the national
passing score confuses and disappoints applicants, and delays or
blocks their entering practice, sometimes losing job offers in
the process. In the judgment of the BPM's professional staff, it
has a marginal if any effect on the quality of licensees and
patient care. This bill removes the requirement that applicants
obtain a specific score on the licensing examination .
g) Remove Two-Vote Requirement. The BPM licenses DPMs under the
authority of the MBC. The law creates the Health Quality
Enforcement Section within the Department of Justice with the
primary responsibility of prosecuting proceedings against
licensees and applicants within the jurisdiction of MBC and
various other boards, including the BPM. Under these provisions,
a panel of administrative law judges, the Medical Quality Hearing
Panel (MQHP) within the Office of Administrative Hearings,
conducts disciplinary proceedings against a DPM. BPC Section
2335 provides that all proposed decisions of the MQHP are
transferred to the executive officer of the BPM, and sent by
Board staff to each Board member within 10 days. The BPM staff
then polls each member regarding his or her vote on the proposed
decision. By majority vote, the BPM may do any of the following:
approve the decision, approve the decision with an altered
penalty, refer the case back to the administrative law judge in
order to take additional evidence, defer final decision pending
discussion of the case by Board as a whole, or non-adopt the
decision.
The law provides that the votes of two members of the BPM are
required to defer a final decision pending discussion of the case
by the BPM as a whole. If two or more members vote to defer the
final decision until after a discussion of the entire Board, then
the BPM must engage in that discussion before 100 calendar days
of the date the proposed decision is received by the BPM.
In its Report, the BPM stated that the requirement that, "The votes
of two members of the panel or board are required to defer a
final decision pending discussion of the case by the panel or
board as a whole," effectively prevents the BPM Board Members
from discussing a case in closed session as a jury even when one
member of the BPM identifies an issue and wishes to have
discussion with her or his colleagues prior to voting. The BPM
has recommended deleting this provision as it relates to the BPM,
and believes that doing so, could empower the BPM as a jury in
disciplinary matters and make its role more meaningful. This
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bill authorizes the vote of only one board member of the BPM to
defer a decision for consideration by the entire board .
h) Increase Assessed Costs for Discipline. As part of the
Medical Board, and utilizing MBC staff for enforcement, the BPM
has cost recovery authority through BPC � 2497.5. The BPM's
Manual of Disciplinary Guidelines and Model Disciplinary Orders
provide that cost recovery is a standard condition for all cases.
According to the BPM, Administrative Law Judges (ALJs) are
inconsistent in the amount of cost recovery they propose from one
case to another. In stipulated agreements, the BPM's staff and
the Attorney General always seek cost recovery as part of the
negotiation.
In its Report, the BPM recommended amending BPC � 2497.5(b) to give
the BPM discretion to increase cost recovery in disciplinary
cases when it non-adopts a proposed decision from an
administrative law judge "and in making its own decision finds
grounds for increasing the costs to be assessed." The BPM
indicated that it is unusual to non-adopt an ALJ's proposed
decision and for the BPM to make its own decision. However, the
BPM contends that it should not be prohibited from ordering
actual and reasonable cost recovery in such cases. This bill
authorizes BPM to increase costs assessed when a proposed
decision is not adopted by the BPM and the BPM finds grounds for
increasing the assessed costs .
i) Technical cleanup. This bill makes several cleanup provisions
to clarify the law as recommended by the BPM and Committee staff .
4.Background on the Physician Assistant Committee (PAC). The PAC was
established in 1975. At the time, the Legislature was concerned
about the existing shortage and geographic maldistribution of health
care services in the state. The intent was in part to "create a
framework for the development of a new category of health manpower,
the physician assistant," and to encourage their utilization as a
way of serving California's health care consumers. PAs are medical
practitioners who perform services under the supervision of
physicians.
The PAC's primary role is the licensure of PAs. The PAC exists within
the MBC but has limited ties to that board and acts independently on
many of its mandates. The PAC continues to rely on MBC for
investigative and other services and generally has a cooperative
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working arrangement with the Board.
The scope of practice of the PA is described in the Physician Assistant
Practice Act and in regulations promulgated by MBC. Pursuant to
these laws, each PA may perform only those services he or she is
authorized to perform pursuant to a written delegation of authority
by the supervising physician.
The PAC is comprised of nine members; 4 PAs, 4 public members and one
physician representative of MBC. Four PA members are appointed by
the Governor. Two public members are also appointed by the
Governor. One public member is appointed by the Senate Committee on
Rules and one member is appointed by the Speaker of the Assembly.
The PAC is a special fund agency, receiving its funding from the
licensing of PAs and biennial renewal fees of PAs. Currently, the
license fee for PAs is $200 while the renewal fee is $300. These
fees provided approximately 60% of the PAC's revenue therefore to
compensate for the loss of revenue from the supervising physician
fees, the PA application and renewal fees were increased. The PAC
currently licenses 7,589 licensees.
The total revenues anticipated by the PAC for FY 2011/2012, is
$2,002,000 and for FY 2012/2013, $1,948,000. The total expenditures
anticipated for FY 2011/2012, is $1,371,000, and for FY 2012/2013,
1,469,000. The PAC anticipates it would have approximately 5.2
months in reserve for FY 2011/2012, and 3.8 months in reserve for FY
2012/2013. The PAC spends approximately 62 percent of its budget on
its enforcement program, 20 percent on its licensing program, 8
percent on its diversion program and 10 percent on administration.
The PAC's staff is comprised of the Executive Officer and four
additional staff including two Associate Governmental Program
Analysts, one Staff Services Analyst, and a .5 Office Technician.
5.Prior Review of the PAC. The PAC was last reviewed by the former
JLSRC in 2005. At that time, the JLSRC raised 13 issues regarding
PAC. In November 2011, the PAC submitted its required Sunset Review
Report to the Committee. Below are actions which the PAC and the
Legislature took over the past 6 years to address many of these
issues, as well as significant changes to the PAC's functions.
Probation monitoring of PA licensees and associated costs.
The PAC assumed responsibility for monitoring its probationers in
2008 upon notification that the MBC would not be able to provide
this monitoring. The PAC hired four retired annuitants with
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investigator experience to provide necessary probation monitoring
for licensees. The probation monitors began to conduct
background checks for petitioners who were petitioning the PAC
for reduction or modification of their probation or reinstatement
of licensure. Prior to this, MBC provided these services;
however, this change resulted in the petitions being processed in
one to two months rather than four to six months.
In its Sunset Report for 2005, the PAC noted that the cost of
monitoring PAs who have had their license disciplined and were
placed on probation was paid by the PAC through the enforcement
budget. With that arrangement, all licensees would pay for the
actions of a limited number of licensees who are placed on
probation for violations of the laws and regulations. In 2007,
the PAC amended its Disciplinary Guidelines to require that
probationers pay the costs of their probation. Probationers are
now required to pay the costs for an investigation and
prosecution of the case, and if they fail to pay, their name is
then forwarded to the Franchise Tax Board for collection. Prior
to 2007, probation monitoring costs were included in stipulated
settlements.
Pocket licenses. In 2005, the PAC requested authorization to
release funds to cover the costs of providing original and
renewal pocket plastic licenses to its licensees. Paper
licenses, which were previously issued, were not durable, often
became illegible, and due to handling, often did not hold up for
the two-year license period. As a result, many PAs had to order
a replacement pocket license. Additionally, many hospitals and
clinics make copies of the licenses and the plastic licenses
contain security features not available on paper licenses and
also are not as alterable. In 2008, the PAC secured a small
business contract using existing funds to provide plastic
licenses for all initial licenses and renewals. The PAC began to
issue plastic credit card type pocket licenses in order to
prevent fraudulent tampering and to provide a more durable
license.
Greater utilization of the profession. The JLSRC raised the
issue of whether the PAC was "meeting its legislative mandate to
encourage utilization of physician assistants by physicians in
underserved areas of the state, and to allow for development of
programs for the education and training of physician assistants."
The passage of AB 3 in 2008 allowed supervising physicians the
authority to supervise four PAs at any one time instead of two.
Previously, supervising physicians could only supervise two PAs
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at any one time unless they were practicing in underserved areas.
This change provided more opportunity for PAs to be utilized in
California and is essential to meet the growing demand for health
care.
AB 3 also expanded the scope of practice for PAs to include
prescriptive authority to provide for more effective utilization
of PAs by physicians. Prior to the bill's passage, PAs had to
obtain patient specific authority before prescribing class II-V
controlled substances but under the legislation, that requirement
was eliminated and PAs who complete an approved educational
course in controlled substances, and if delegated by the
supervising physician, can write the order. The bill required a
PA and his or her supervising physician and surgeon to establish
written supervisory guidelines and specifies that this
requirement may be satisfied by the adoption of specified
protocols. If a PA chooses not to take the educational course,
the requirements for patient-specific authority are still in
place.
SB 1069 (Pavley, Chapter 512, Statutes of 2010) provided that a PA
acts as the agent of the supervising physician when performing
authorized activities, and authorized a PA to perform physical
examinations and other specified medical services, and sign and
attest to any document evidencing those examinations and other
services, as required pursuant to specified provisions of law.
The bill also clarified that a delegation of services agreement
may authorize PAs to order durable medical equipment and make
arrangements with regard to home health services or personal care
services. Additionally, SB 1069 authorized PAs to perform a
physical examination that is required for participation in an
interscholastic athletic program.
According to the PAC, it engages in outreach to encourage
utilization of PAs by: publishing informational articles during
each publication of the MBC's Newsletter, which is sent via email
to subscribers; providing information on its Website for
supervising physicians, potential PA students and consumers and;
participating at PA programs and conferences throughout the year.
Use of a national practitioner database. The PAC began to
request applicants to request a report on their licensing
background through the National Practitioner Data Bank if they
held a PA license in another state or held any previous health
care licenses. The purpose of the report is to receive
information about any previous disciplinary actions taken by
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another state or licensing agency.
Continuing Education. In 2010, the PAC updated its
regulations to require 50 hours of continuing medical education
(CME) or maintain certification by the National Commission on
Certification of Physician Assistants (NCCPA) for each renewal
period beginning with their license renewal on or after June
2012.
Examination given on a continuing basis. Senate Bill 819
(Yee, Chapter 308, Statutes of 2009) eliminated interim approval
from the application process to reflect that the Physician
Assistant National Certification Examination was previously only
given twice a year. Prior to SB 819, interim approval was a
method to allow applicants who had completed a PA training
program to practice as a PA before they obtained licensure;
however, with the examination offered on a continuing basis,
applicants can only practice once they have taken and passed the
examination. Additionally, exam scores are now being submitted
via a secure Website from the NCCPA to provide for timelier
transmittal to the PAC.
Streamlining efforts. Notices of deficient applications and
other license-related notices are now generated by the DCA's
Applicant Tracking System which results in consistent and
standardized correspondence and less staff time to prepare such
notices. These notices are also issued to applicants via email,
if provided on an application, to allow for quicker receipt by
the applicant as well as cost savings to the PAC on supplies and
postage. The PAC has also performed routine evaluations of its
application and eliminated questions and sections unrelated to
the licensure process.
1. Current Issues Identified. The following are some of the major
issues pertaining to the PAC along with background information
concerning the particular issue and the PAC's response to the
issue. Recommendations were made by Committee staff regarding the
particular issue areas which needed to be addressed.
a) Issue : Continued Enhancement of the Committee's Internet
Services and Implementation of BreEZe.
Background : One of the major changes since its last sunset review
has been its increased utilization of the Internet and computer
technology to provide services and information to the public and
its licensees on the PAC's Website. These include: creating a
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career page with links and specific information regarding the PA
profession; adding a link for out of state licensure applicants
to order fingerprint cards online; adding a customer satisfaction
survey so that consumers, licensees and others may provide their
comments to the PAC regarding service they receive or
enhancements to the PAC program; adding licensing statistics for
counties throughout the state which are updated quarterly; adding
a quarterly Disciplinary Actions Report which allows consumers to
view disciplinary actions by date or by practitioner name; adding
a quarterly Enforcement Statistical Report which provides
information regarding complaints, investigations, disciplinary
actions, cost recovery, probationers and citation and fines;
adding an online change of address link for licensees and
applicants; developing and implementing a voluntary Website-based
self-test for PA laws and regulations which allows Website
visitors to test their current knowledge of PA laws and
regulations; adding all citations issued by the Committee to the
section of documents available to the public on the Website
(previously only disciplinary actions such as statements of
issue, accusations, decisions, probationary orders, surrenders,
defaults and revocations were available on the PAC Website) ; and
making the licensing application available on the Website.
Despite these improvements, PA licensees are still not able to
renew licenses online or by using credit cards. According to the
PAC , licensees and employers have been asking for several years
that the PAC enable them to renew on line and with credit cards.
As consumers, licensees are typically used to making electronic
payments often online for purchases and payments. No doubt it
would be of great benefit to the licensing population and be more
efficient for the PAC to be able to make credit card payments for
fees online. Providing this service of allowing online renewals
with a credit card will allow PAs to continue providing needed
health care and would decrease staff work.
As previously indicated, DCA is in the process of establishing a
new integrated licensing and enforcement system, BreEZe, which
would also allow for licensure and renewal to be submitted via
the internet. BreEZe will replace the existing outdated legacy
systems and multiple "work around" systems with an integrated
solution based on updated technology. The goal is for BreEZe to
provide all the DCA organizations with a solution for all
applicant tracking, licensing, renewal, enforcement, monitoring,
cashiering, and data management capabilities.
BreEZe is an important opportunity to improve PAC operations to
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include electronic payments and expedite processing. Staff from
numerous DCA boards and bureaus have actively participated with
the BreEZe Project and PAC staff continues to meet with BreEZe
consultants to develop Committee-specific components of the
system.
Recommendation : The PAC should update the current status of its
efforts to fully implement electronic payments of fees and online
application and renewal processing, including anticipated
timelines, existing impediments and current status of BreEZe.
The PAC may wish to consider putting an interim plan in place to
ease the collection of license renewal fees. The PAC should
continue to explore ways to enhance its Internet Services to
licensees and members of the public, including posting meeting
materials, policies, and legislative reports on the Internet and
webcasting meetings.
b) Issue : Continuing Education Audits.
Background : Assembly Bill 2482 (Maze & Bass, Chapter 76, Statutes
of 2008) authorized the PAC to require a licensee to complete CME
as a condition of license renewal. This requirement may be met
by completing 50 hours of CME every two years or by obtaining
certification by the NCCPA, or other qualified certifying body as
determined by the PAC. January 2011, PAC regulations became
effective to implement the provisions of AB 2482, including
establishing criteria for complying with the statute, provisions
for non-compliance, record-keeping requirements, approved course
providers, audit and sanction provisions for non-compliance, and
waiver provisions. Additionally, the regulatory change
established an inactive status, allowing licensees to be exempt
from renewal or continuing medical education requirements.
The PAC verifies completion of CME through a self-reporting
question on license renewal applications, allowing licensees to
verify whether they met the requirement or not by simply checking
a yes or no box. According to the PAC, PAs are currently
required to meet the CME requirements; however, the
self-reporting certification will only start appearing on renewal
notices later this year. While the PAC plans to conduct random
audits to verify compliance of those licensees who stated they
had completed their CME hours, it has not yet conducted any
audit. The PAC may be lacking information about improper
compliance reporting, as licensees have yet to be required to
provide any certification or records of complying with the
continuing education requirement. The only licensees whose
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compliance can be verified directly are those PAs certified by
the NCCPA, as the PAC can obtain records directly from the
Commission.
Recommendation : The PAC should explain the lack of self-reporting
audits and describe plans to implement audits.
c) I ssue : Promoting and Understanding Workforce Development
Issues for Physician Assistants.
Background : In establishing the PA profession in this state, the
Legislature intended to address "the growing shortage and
misdistribution of health care services in California" by
eliminating "existing legal constraints" that constitute "an
unnecessary hindrance to the more effective provision of health
care services." PAs have effectively and safely fulfilled this
role and are widely recognized as an effective solution to access
to care problems in all settings. A disproportionate number of
PAs provide services in medically underserved settings (e.g.,
health manpower shortage areas) and settings where cost
containment is especially important, e.g., HMOs). The PA
profession has an exemplary safety record, and there is no
evidence that PAs commit malpractice more frequently than
physicians or nurse practitioners.
Recent federal health care reform efforts will result in a large
need for new health care providers to a growing population across
the nation and in California. However, the state already faces a
shortage of primary care providers which can result in
potentially lower standards of care and longer wait times to
access care. Recognizing the role that PAs can play in meeting
health care needs, the Patient Protection and Affordable Care
Act, the law, among other things, supported the educational
preparation of PAs who intend to provide primary care services in
rural and underserved communities and integrated PAs into newly
established models of coordinated care, such as the patient
centered primary care medical home and the independence at home
models of care. The Act also funded a program to expand PA
training with the intention of increasing student enrollment in
PA programs. Over a five-year period beginning in 2010, the
program will provide $32 million in funding for approximately 40
primary care PA training programs. Funds go to PA student
stipends, educational expenses, reasonable living expenses and
indirect costs for a total of $22,000 per student, for a maximum
of two years per student, plus indirect costs.
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According to the PAC, it monitors efforts by the California Academy
of Physician Assistants to promote the use of PAs in health care
settings. The PAC states that it plans to continue to review the
relationship of PAs and Medical Assistants (MAs) in the health
care workplace setting, including a discussion of the supervision
of MAs by PAs, as several attempts have been made by the CAPA to
pass legislation regarding this issue which could allow further
use of PAs in delivery of health care in California and promote
workforce development. The PAC has also encouraged California PA
training programs to work with the Office of Statewide Health
Planning and Development (OSHPD) for new graduates to apply for
grants to work in medically underserved areas. OSHPD is also
currently collecting data on the use of PAs in health care
settings which could also allow better utilization of PAs,
particularly in underserved areas. The PAC also states that it
works collaboratively with MBC to ensure that physicians are able
to utilize PAs effectively.
Recommendation : The PAC should explain what additional efforts it
can take or models it can follow to increase the PA workforce and
ensure participation of its licensees in the state's health care
delivery system. The PAC should look closely at the efforts and
the collection of data by the Registered Nursing Board in
determining workforce needs and in making future recommendations
to policymakers, the Legislature and the Governor.
2. Responses regarding Issues Raised by the Committee. The PAC
responded to the issues raised by Committee staff on April 16,
2012. In terms of the implementation of the BreEZe project, the
PAC will begin using the database developed for BreEZe, and will
begin offering online renewal payments and payment for initial
licensing for both licensees and applicants. Additionally, all
enforcement tracking activities will also migrate to BreEZe. The
anticipated time for implementation to BreEZe is September 2012.
The PAC further continues to enhance and improve information on the
PAC Website. New enhancements to be made include the following:
update the PAC Career Page to ensure it is more informative to
perspective students interested in the PA profession.
Additionally, the PAC will develop a new brochure for Career
information. The PAC will place regulatory rulemaking files on the
Website. Currently, the Website contains the past three years' of
rulemaking files, but for historical purposes will include all
rulemaking files on the Website, or will make the files available
electronically. The PAC currently posts meeting minutes on the
Website and will add all historical minutes on the Website for
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historical purposes, space permitting.
In the area of webcasting, the PAC continues to webcast all public
meetings to allow members of the public and interested parties to
view meetings without being physically present. The PAC began
webcasting in 2011 and has received positive comments from the
public and interested parties.
Enhanced public participation: The PAC is exploring ways to enhance
public participation in their meetings by including, if possible,
the ability for the public to interact in real time at meetings by
telephone at a designated location or some other media system. The
PAC will work with the Department of Consumer Affairs in this area
to determine how best to accomplish this task.
Regarding the lack of continuing education audits, the PAC indicates
that AB 2482 (Maze, Chapter 76, Statutes of 2008) authorized the
PAC to require licensees to complete 50 hours of CME every two
years as a condition of license renewal. Regulations implementing
the CME requirement became effective January 2011, and beginning
January 1, 2013, licensees who renew their license will
self-certify if they have satisfied the CME requirement.
Licensees are given a two year cycle in order to accrue the 50 hours
of CME required to renew the license. Therefore, a PA who renews
his or her license on or after January 2013 will be required to
certify his or her compliance with the CME requirement by noting
that they are either nationally certified or have completed the
required CME if they are not nationally certified. The CME
requirement is similar to the requirement for physicians licensed
by the MBC as well as other boards who require self-certification,
according to the PAC.
Any audit of CME will occur after the January 2013 reporting
requirement date. Prior to January 2013 renewal notices being
sent, we will modify the renewal form to include the new
certification requirements.
Regarding workforce development, the PAC states that it recognizes the
need for training, employing and retention of qualified, licensed
PAs in California, especially in light of the health care reforms
underway. At the May 7, 2012 PAC meeting promotion of Workforce
Development will be considered, including forming a Subcommittee to
review this issue and retention and distribution of PAs in
California to support increased access to health care by consumers.
The PAC will also be working with the California Academy of
Physician Assistants on this issue. Additionally, the PAC will
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work with the Department of Consumer Affairs to develop an
information bulletin and brochure for distribution to persons
interested in pursuing a career as a PA and work with them on
development of more reporting on employment statistics of PAs in
California. As recommended by the Committee, the PAC supports the
suggestion that the Executive Officer meet with the Board of
Registered Nursing to discuss their data collection efforts
regarding workforce needs.
3. This Bill Includes the Following Statutory Changes Related to the
PAC Identified by this Committee During the March 2012 Oversight
Hearings:
a) Extends the sunset date of the PAC and its executive officer.
The PAC has shown over the years a strong commitment to improve
its overall efficiency and effectiveness and has worked
cooperatively with the Legislature and this Committee to bring
about necessary changes. The PAC should be continued with the
name change to the "Physician Assistant Board" with a four-year
extension of its sunset date so that this "Board" may once again
review if the issues and recommendations in this Background Paper
have been addressed. This bill extends the sunset dates for the
PAC and its executive officer to January 1, 2017
b) Changes the name of the Committee. Over the years, the PAC
has continued its current status with ties to MBC and reliance on
the Board for investigative and administrative services. At a
July 2010 meeting, the PAC agreed to move forward to seek
legislation to change its name from the "Physician Assistant
Committee" to the "Physician Assistant Board," a change that is
not intended to alter or do away with the current cooperative
working arrangement with MBC; as PAs will continue to work under
supervising physicians and that relationship is paramount to the
PA practice. An example of the affiliation which the Committee
has with the MBC is that of the BPM. This Board also relies on
the MBC to provide many of the services that the PAC receives.
This bill changes the name the "Committee" to "Board" and
correspondingly changes "board" to "Medical Board of California."
c) Composition of the Board. There is a question as to whether
or not the PAC should still continue with a voting physician
member once it is considered as an independent "board." It would
not appear necessary to continue with a physician as a member of
this board if the primary focus of this agency is on the practice
of PAs. When the PAC, as well as other health boards (former
committees) were considered as part of the "allied health
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professions," they were primarily under the jurisdiction of the
MBC and physicians were added to some of the former committees.
This is no longer the case, and now all other health boards have
independence from the MBC; even though this committee is still
unique in that it utilizes the services of the MBC. There does
not appear to be any good reason to continue with a physician on
this committee, and it would seem more appropriate to replace the
physician with a PA. It is recognized that the PAC maintains a
close relationship with the MBC and that the relationship would
continue, according to PAC, who states: "Because physician
assistants may not practice independently and are required to
have a supervising physician, our interaction and current
relationship with the Medical Board is valued and important."
This bill changes composition of the "Board" to replace the
physician with a PA .
d) Employer Reporting. Current law, the Business and Professions
Code Section 800 series provides several reporting mandates for
the MBC and several other health professions to assist licensing
boards in protecting consumers from licensees who have had action
taken against them by their employers, altering their workplace
privileges. In its Sunset Report, the PAC maintained that the
current Physician Assistant Practice Act does not clarify whether
reports should be made to the PAC about certain actions against
its licensees. The PAC encourages agencies to voluntarily
provide 800 series reports on PAs to the PAC for review and
processing and when a report is received, the PAC opens a
complaint and takes appropriate action. However, under current
PA laws, it is not explicitly clear that health plans and health
care facilities are required to report certain actions taken by
these entities against a licensee's privileges. The only
reporting mandate that applies to PAs requires that the district
attorney, city attorney, and prosecuting agencies to notify the
PAC immediately upon obtaining information of any filings
charging a felony against a PAC licensee.
The PAC is interested in adding PAs to the 800 series, which it
believes would enhance consumer protection and allow the PAC to
receive critical information about its licensees. Employers
would be required to report any actions taken against PAs by peer
review bodies for medical disciplinary cause or reason to the
PAC. This bill clarifies that the reporting requirements in the
800 series apply to PAs .
e) Fee Waiver for Military Status. During the March oversight
hearings, the issue was raised regarding providing an exemption
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under the Physician Assistant Act for licensed PAs on active
military duty from the license renewal fee requirement. In its
written response, the PAC states its support for such a fee
waiver for active duty military licensees. The PAC staff has
received numerous requests from active duty military PAs asking
for a renewal fee waivers. The PAC supports offering an
exemption as an appropriate way to honor licensees in active
military service. This proposal is similar to the Medical
Board's exemption status for active military physicians. This
bill establishes an exemption for active military from payment of
license renewals .
f) Retired license status. The PAC has further recommended that
the PAC be granted a "retired" license status to accommodate
licensees who are no longer practicing to retain their license
without payment of renewal fees or completion of the CME. This
license status is similar to other licensing boards within the
Department of Consumer Affairs. This bill establishes a
"retired" license status for licensees no longer practicing to
retain their license without payment of renewal fees or
completion of continuing education .
4. Arguments in Support. The Board of Podiatric Medicine states that
it strongly supports SB 1236, the sunset review bill extending the
BPM for an additional four years and updating the BPC sections
administered by the BPM as recommended in the Board's report.
Although the Physician Assistant Committee has not had the opportunity
to meet to take a position on this bill, the Chairman of the PAC
Robert Sachs writes his support of SB 1236. Chairman Sachs states:
"I support the recommendation to changing the name of the
Physician Assistant Committee to the Physician Assistant Board. I
also believe that consumer protection will be further enhanced by
including physician assistants in the BPC � 800 series reporting
requirements. Additionally, the proposed change of the composition
of the Physician Assistant Committee from four physician assistant
members to five members by replacing the Medical Board physician
member will further enhance the legislative mandate for consumer
protection."
"I believe that this bill will also benefit physician assistant
licensees by amending the Physician Assistant Practice Act to add
two new license status types; retired and military exemptions. The
military status will address special requirements of those
licensees who serve in the military. Licensees who wish to retire
from practice will have an opportunity to take advantage of the
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retire status." SB 1236 will be considered by the members of the
PAC at the May 7, 2012 meeting. At that time the PAC will take a
formal position on this bill.
SUPPORT AND OPPOSITION:
Support :
Board of Podiatric Medicine
Robert Sachs, Chairman of the Physician Assistant Committee
Opposition : None received as of April 18, 2012
Consultant:G. V. Ayers