BILL ANALYSIS �
AB 1890
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Date of Hearing: May 6, 2014
ASSEMBLY COMMITTEE ON BUSINESS, PROFESSIONS AND CONSUMER
PROTECTION
Susan A. Bonilla, Chair
AB 1890 (Chau) - As Amended: April 28, 2014
SUBJECT : Athletic trainers.
SUMMARY : Establishes title protection for certified athletic
trainers. Specifically, this bill :
1)Prohibits a person from holding himself or herself out to be
an athletic trainer or a certified athletic trainer, or from
using the term "AT," "ATC," or "CAT" to imply or suggest that
the person is an athletic trainer unless he or she meets both
of the following requirements:
a) He or she has done either of the following:
i) Graduated from a college or university after
completing an athletic training education program
accredited by the Commission on Accreditation of Athletic
Training Education, or its predecessors or successors; or
ii) Completed requirements for certification by the
Board of Certification, Inc. (BOC), prior to January 1,
2004; and,
b) He or she is certified by BOC.
2)Deems that it is an unfair business practice for any person to
use the title of "athletic trainer," "certified athletic
trainer," or any other term, such as "certified," "licensed,"
"registered," "AT," "ATC," or "CAT," that implies or suggests
that the person is certified as an athletic trainer, if the
person does not meet the specified requirements.
3)Provides that a person who has practiced athletic training in
California for a period of 20 consecutive years prior to
January 1, 2015, and who is not otherwise eligible to use the
title of "athletic trainer," may use the title "athletic
trainer."
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EXISTING LAW provides for the regulation of various professions
and vocations, including those of an athlete agent.
FISCAL EFFECT : None. This bill is keyed non-fiscal by the
Legislative Counsel.
COMMENTS :
1)Purpose of this bill . This bill would enact title protection
for athletic trainers certified by BOC, meaning that
individuals who are not certified athletic trainers would be
prohibited from holding themselves out to the public as
athletic trainers. An exemption is provided to uncertified
individuals who have practiced athletic training in California
for 20 consecutive years prior to 2015. This bill is
sponsored by the California Athletic Trainers' Association
(CATA).
2)Author's statement . According to the author, "Although many
high school and college sports teams already employ [athletic
trainers], and several California State University campuses
offer bachelor degrees in athletic training, California is one
of only 2 states that do not regulate this vital and growing
profession. Currently, anyone can label him[self] or herself
an athletic trainer without the proper education, training, or
certification. Without state oversight, the public could be
harmed by relying on someone who calls themselves an [athletic
trainer] without the appropriate background. AB 1890 would
protect Californians by ensuring that only those people who
have the proper education, training, and certification may
call themselves an athletic trainer."
3)The practice of athletic training . According to the sponsor,
athletic trainers are physical medicine and rehabilitation
specialists who generally work in institutional settings under
the direction of a physician. In practice, they may be the
first healthcare providers on the scene when injuries occur
(whether at sporting events or on job sites), and must be able
to recognize, evaluate and assess injuries and provide
immediate care when needed.
Athletic trainers are considered "health care professionals"
by the American Medical Association, which states that
"athletic training encompasses the prevention, diagnosis and
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intervention of emergency, acute, and chronic medical
conditions involving impairment, functional limitations, and
disabilities." Athletic trainers are distinct from "personal
trainers", who are generally thought of as individuals who
prescribe, monitor and modify individual exercise programs in
a fitness or sports setting. Athletic training and physical
therapy are also different professions, although there are
certainly substantial areas of overlap.
The US Department of Labor describes the areas of expertise
for certified athletic trainers as: application of protective
or injury-preventative devices; evaluation of injuries; first
aid and emergency care; development and execution of
rehabilitation programs for injured athletes; and program
planning for injury and illness prevention of athletes.
Athletic trainers are usually employed by organizations such
as professional sports teams, colleges and universities, high
schools, outpatient rehabilitation clinics, hospitals,
corporations, performing arts groups, physicians groups, the
military and health clubs. Roughly 44% of certified athletic
trainers nationwide work with athletes in educational or
professional sports settings, with nearly 19% working in
health care facilities, and more than 10% working in industry,
public safety and the military. The sponsor reports that
large employers use athletic trainers in part because of their
utility in reducing employee injuries and workers'
compensation costs.
4)Current state of regulation for athletic trainers . The
educational system for athletic training has been standardized
and accredited by a national agency, the Commission on
Accreditation of Athletic Training Education (CAATE).
According to the author, all 48 states currently regulating
athletic training utilize the BOC certification examination,
which is based on CAATE educational principles. BOC is the
only entity that currently provides athletic training
certification, which means that it would be the sole provider
of the certification exam required by this bill.
Certification is not currently required to practice athletic
training in California, and noncertified individuals are not
subject to regulatory discipline.
Despite its widespread adoption, BOC has a limited ability to
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investigate complaints against certified athletic trainers
because they have no subpoena power and limited staff with no
authority in California. Its sole disciplinary power is the
suspension or revocation of the national certification which
is not recognized in California and thus poses no barrier to
an individual's continued practice here.
According to the sponsor, there are 48 states that regulate
athletic trainers, 39 of which provide licensure (five require
registration and four require certification).
There are 16 accredited athletic training programs in
California. In 2010, 182 Californians became certified
athletic trainers.
Currently, there are approximately 2,500 certified athletic
trainers practicing in California. The sponsor of this bill,
CATA, represents roughly 2,300 athletic trainers in
California.
1)The role of title protection . This bill would provide
BOC-certified athletic trainers with what is termed "title
protection". Title protection means that certified athletic
trainers would have an exclusive right to use the title
"athletic trainer", while noncertified athletic trainers who
advertise the same title risk legal action. The only
exception would be individuals who have been practicing
continuously in California for 20 years or more before 2015,
who would be allowed to use the title as well.
Title protection is generally intended to be a means of market
differentiation, whereas a "practice act" would literally
prohibit individuals from engaging in the practice regardless
of how it is described. In this case, other individuals could
still practice athletic training in California, but they would
not be permitted to call themselves athletic trainers.
Legislation providing title protection or registration for
athletic trainers has been passed and vetoed three separate
times in recent years: AB 1647 (Hayashi) of 2010, SB 284
(Lowenthal) of 2007, and SB 1397 (Lowenthal) of 2006.
Governor Schwarzenegger's veto message of AB 1647 stated "This
bill is similar to legislation I have vetoed twice before in
the past because there is no evidence that regulating the use
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of the term "certified athletic trainer" poses any threat to
the public health and safety."
2)Evidence of substandard practice. According to the author,
"[a] survey of 760 certified athletic trainers?.found more
than 60 cases of harm as the result of improper care provided
by non-certified 'athletic trainers.'
"According to the U.S. Department of Labor Division of
Practitioner Data Banks, a voluntary reporting repository for
sanctions made by state boards, there were 469 reports of
sanctions to athletic trainers - both certified and
uncertified - from 2000 to 2010. These sanctions were based
upon misconduct including incompetent practice/harm,
practicing beyond the scope of practice, and sexual
misconduct. The BOC reported over 2,700 violations
[nationwide] of professional practice standards in five years
(2005-10) with nearly 300 violations in California, including
three sexual offenses. In a 2011 case, a collegiate athlete
died because of negligence of a collegiate athletic trainer,
although no lawsuit has been filed to date. Two additional
athletic trainers were fired after being arrested on sexual
abuse charges."
The sponsor reports that it is aware of at least 150
individuals practicing as athletic trainers without BOC
certification in California high schools, and seven
individuals working in California community colleges who are
similarly uncertificated.
Finally, the sponsor contends that "the lack of oversight of
athletic trainers is a consumer protection problem. The
athletes with whom these unqualified individuals work, and the
employers who hire them, have no way of knowing that these
individuals are not qualified to be athletic trainers. The
public has no way to determine if someone practicing athletic
training is qualified. The public has no way to file a
complaint, or ask for a practitioner to be investigated and/or
sanctioned for incompetence, unethical practice, etc. This
creates a huge regulatory gap in the healthcare system."
1)Arguments in support . According to the sponsor, CATA, "The
unregulated status of the athletic training profession is a
major public concern, which would be partially addressed if AB
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1890 were to pass. Unqualified individuals are posing as
athletic trainers and providing healthcare to our children
without the proper education or training. Also, individuals
who have lost their national certification or license in other
states are coming to practice in California with impunity.
Currently, there is no mechanism for the public to lodge a
complaint or to remove an individual that is practicing
incompetently. Only licensure will rectify the aforementioned
issues however, AB 1890 would at least ensure that individuals
who call themselves athletic trainers have had the proper
education and training and are certified by a nationally
recognized certifying agency."
2)Arguments in opposition . According to the California
Federation of Teachers (CFT), which has an Opposed Unless
Amended position, "CFT is concerned that this bill does not
have a provision to exempt from the licensure requirements
persons who are currently employed and have worked as athletic
trainers for years. CFT represents athletic trainers who have
worked in this field for years and the enactment of this bill
could result in the termination of their employment.
Therefore, we respectfully request an amendment that would
grandfather in persons who have worked in this profession for
15 years and allow them to continue to practice as athletic
trainers and use the title of an athletic trainer."
3)Technical amendment . Given that the bill restricts its
effects to those working as athletic trainers (which title is
restricted) rather than those practicing athletic training
(which remains unrestricted), the exemption granting title
protection to uncertified individuals in practice more than 20
years should be recast to apply to those who have actually
worked as athletic trainers, rather than anyone who practiced
athletic training.
Page 2, line 29, strike the words "practiced athletic
training" and insert "worked as an athletic trainer"
4)Previous legislation . AB 864 (Skinner) of 2013 would have
established the Athletic Training Practice Act to license and
regulate athletic trainers through the creation of an Athletic
Trainer Licensing Committee under the Physical Therapy Board
of California. AB 864 was held in the Assembly Appropriations
Committee.
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AB 252 (Yamada and Eggman) of 2013 would have prohibited an
individual from holding himself or herself out professionally
as a "social worker" unless he or she has received a degree
from an accredited academic institution. AB 252 was held in
the Assembly Appropriations Committee.
SB 1273 (Lowenthal) of 2012 was very similar to AB 864 in most
respects. SB 1273 failed passage in the Senate Business,
Professions and Economic Development Committee.
AB 374 (Hayashi) of 2011 in its most recent version would have
extended title protection to athletic trainers. AB 374 was
amended in the Assembly Appropriations Committee to address an
unrelated issue.
AB 1647 (Hayashi) of 2010 would have extended title protection
to athletic trainers. AB 1647 was vetoed by Governor
Schwarzenegger.
SB 284 (Lowenthal) of 2007 would have provided for
registration of ATs. SB 284 was vetoed by the Governor.
SB 1397 (Lowenthal) of 2006 would have provided for
registration of ATs. SB 1397 was vetoed by the Governor.
AB 614 (Lowenthal) of 2003 would have required the Department
of Consumer Affairs to review the need for licensing of ATs.
AB 614 was held in the Senate Business, Professions and
Economic Development Committee.
AB 2789 (Lowenthal) of 2002 would have required the Department
of Consumer Affairs to review the need for licensing of ATs
and undertake an occupational analysis. AB 2789 was held on
the Assembly Appropriations Committee Suspense file.
REGISTERED SUPPORT / OPPOSITION :
Support
California Athletic Trainers' Association (sponsor)
American Medical Society for Sports Medicine (4/10/14 version)
2333 private individuals (2/19/2014 version)
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Opposition
California Federation of Teachers (4/21/14 version)
301 private individuals (2/19/2014 version)
Analysis Prepared by : Hank Dempsey / B.,P. & C.P. / (916)
319-3301