BILL ANALYSIS �
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|Hearing Date:June 16, 2014 | Bill No:AB 1890|
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SENATE COMMITTEE ON BUSINESS, PROFESSIONS
AND ECONOMIC DEVELOPMENT
Senator Ted W. Lieu, Chair
Bill No: AB 1890Author:Chau
As Amended:May 13, 2014 Fiscal: No
SUBJECT: Athletic trainers.
SUMMARY: Establishes certification and training requirements for
athletic trainers and prohibits individuals from calling themselves
athletic trainers unless they meet those requirements.
Existing law:
1)Establishes the Unfair Practices Act which defines unfair
competition as any unlawful, unfair, or fraudulent business act or
practice and unfair, deceptive, untrue or misleading advertising.
(BPC � 17000 et. seq.)
This bill:
1) Makes it unlawful for any person to hold himself or herself out as
an athletic trainer or a certified athletic trainer, or use the
term "AT", "ATC" or "CAT" to imply the person is an athletic
trainer unless he or she is certified by the Board of
Certification, Inc., and has done either of the following:
a) Graduated from a college or university, after completing an
accredited athletic training education program, as specified.
b) Completed eligibility requirements for certification by the
Board of Certification, Inc., prior to January 1, 2004.
1) Makes it an unfair business practice for a person to use the title
"athletic trainer", "certified athletic trainer" or any other term,
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such as "certified", "licensed", "registered", "AT", "ATC", or "CAT"
that implies or suggests that the person is an athletic trainer, if
the person does not meet the requirements set forth in this bill.
2) Provides that a person who has worked as an athletic trainer in
California for a period of 20 consecutive years prior to January 1,
2015, and who is not otherwise eligible to use the title "athletic
trainer", may use the title "athletic trainer".
FISCAL EFFECT: Unknown. This bill is keyed non-fiscal by Legislative
Counsel.
COMMENTS:
1. Purpose. The California Athletic Trainers' Association (CATA) is
the sponsor of this bill. According to the Author, this bill would
ensure that only people with the proper education, training, and
certification, may call themselves an athletic trainer. The Author
notes that "athletic trainers and other individuals are currently
practicing athletic training - a health care profession - in an
unregulated manner". According to the Author, 48 states and the
District of Columbia regulate athletic trainers, but in California
anyone can label him or herself an athletic trainer without the
proper education, training, or certification. The Author points
out that in some cases, individuals such as janitors, coaches,
shipping and receiving clerks and others have been given the title
"Athletic Trainer" and the responsibility for evaluating and
managing concussions, spinal cord injuries, shoulder dislocations,
and knee injuries.
According to the Author, 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, or other
issues which creates a huge regulatory gap in the healthcare
system.
The Author states that AB 1890 "would protect Californians by
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ensuring that individuals calling themselves athletic trainers have
had the proper education and training and are certified by a
nationally accredited athletic training certification agency."
2. Athletic Trainers. In compliance with the sunrise process, CATA
completed and submitted an extensive "sunrise questionnaire" to
this Committee in December 2011 in support of its proposal for
licensure (at the time, a bill proposing licensure was moving
through the Legislative process). According to information
contained in the sunrise questionnaire, athletic trainers are
allied healthcare professionals recognized by the American Medical
Association, the American Medical Society of Sports Medicine and
others. Athletic trainers work in collaboration with a physician
and their education is predicated upon a formalized relationship
with a physician, working under established guidelines. According
to the sunrise questionnaire, athletic trainers evaluate injuries
and determine a patient's disposition, respond to emergencies and
make "split second decisions" regarding the management of an injury
as well as making decisions regarding the course of rehabilitation.
Athletic trainers also make "immediate decisions regarding serious
conditions such as concussion, spinal cord injury, heat illness and
sudden cardiac arrest without the intervention or advice of other
health care professionals" in situations where an incorrect
decision could lead to a catastrophic or fatal outcome.
An individual can become an athletic trainer by graduating with a
minimum of a bachelor's degree from an accredited athletic training
education program and by passing a national certification
examination offered by Board of Certification, Inc. (BOC).
According to the sunrise questionnaire, 70 percent of athletic
trainers practicing today hold a master's degree or higher.
Athletic trainers, like other health care professionals, take
science based courses in anatomy, physiology, chemistry and physics
and must understand all systems of the body and their normal and
pathological functions, including biochemical functions. Athletic
training education also includes didactic instruction and clinical
training in risk management and injury prevention, orthopedic
clinical assessment and diagnosis, medical conditions and
disabilities, acute care of injuries and illness, therapeutic
modalities and conditioning and rehabilitative exercise,
psychosocial intervention and referral, nutritional aspects of
injuries and illness, health care administration and professional
development. Although there are currently 16 accredited athletic
training programs in California, no person in California is
required to obtain a degree or to become certified to work as an
athletic trainer.
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Currently, there are approximately 2,500 certified athletic
trainers practicing in California. Athletic trainers specialize in
the prevention, evaluation, immediate care, treatment and
rehabilitation of injuries and activity related conditions in a
wide range of people engaged in physical activities from
professional and amateur athletes to industrial workers and
entertainers. Athletic trainers are employed by professional
sports teams, colleges and universities, high schools, outpatient
rehabilitation clinics, hospitals, industry/corporations,
performing arts groups, physicians, the military and other
institutions. Nearly 40 percent of athletic trainers in California
work with non-athletes from a variety of backgrounds because they
may reduce employee injuries and subsequent worker's compensation
costs. Information provided in the sunset questionnaire
highlighted cost savings of around $7 million annually by a large
manufacturing firm with over 3000 employees as a result of the firm
hiring five athletic trainers to work in an injury preventive role.
Information provided in the sunrise questionnaire found more than
60 cases of harm as the result of improper care provided by
non-certified "athletic trainers." Of 760 respondents who took
part in a CATA survey for the sunrise questionnaire, 400 reported
instances of harm as the result of improper care due to certified
and 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.
BOC reported over 2,700 violations of professional practice
standards in five years (2005-10) with nearly 300 violations in
California, including three sexual offenses, and in some cases
included those practicing without a valid certification or practice
by those who had lost their licensure in other states.
CATA asserts that there are "currently no other unregulated
professions that are providing services similar to those of
athletic trainers."
3. Board of Certification, Inc. According to their Website, BOC was
incorporated in 1989 to provide a certification program for
entry-level athletic trainers. BOC establishes and regularly
reviews both the standards for the practice of athletic training
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and the continuing education requirements for BOC certified
athletic trainers. BOC asserts that is has the only accredited
certification program for athletic trainers in the U.S.
Additionally, BOC cites accreditation by the National Commission
for Certifying Agencies (NCCA) and requirements that it undergo
review and re-accreditation every five years through the NCCA.
NCCA is the accreditation body of Institute for Credentialing
Excellence, a non-profit organization that provides educational,
networking, and advocacy resources to the credentialing community,
and is charged with evaluating certification organization for
compliance with the NCCA Standards for the Accreditation of
Certification Programs.
BOC's Website further asserts that they have been responsible for
the certification of athletic trainers since 1969. BOC was the
certification arm of the professional membership organization of
the National Athletic Trainers' Association until 1989 when BOC
became an independent non-profit organization. Athletic trainers
currently have the option for certification through BOC. For BOC
certification, athletic trainers must have received a minimum of a
bachelor's degree from a National Athletic Training Association
(NATA) accredited institution and pass a comprehensive exam. All
states currently regulating athletic trainers utilize the BOC
examination which is based on the Commission on Accreditation of
Athletic Training Education (CAATE). To retain certification,
credential holders must continue taking medical-related courses and
adhere to the BOC standards of practice.
4. Title Act vs. Practice Act Protection. It is important to note the
distinction between "title act" and certification or registration
regulation versus "practice act" and licensing regulation. A
practice act along with licensure confers the exclusive right to
practice a given profession on practitioners who meet specified
criteria related to education, experience, and examination, and
often is embodied in a statutory licensing act (i.e., those who are
not licensed cannot lawfully practice the profession). A practice
act is the highest and most restrictive form of professional
regulation, and is intended to avert severe harm to the public
health, safety or welfare that could be caused by unlicensed
practitioners.
A title act and a certification or registration program, on the other
hand, reserves the use of a particular professional (named)
designation to practitioners who have demonstrated specified
education, experience or other criteria such as certification by
another organization. A title act typically does not restrict the
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practice of a profession or occupation and allows others to
practice within that profession; it merely differentiates between
practitioners who meet the specified criteria, and are authorized
by law to represent themselves accordingly, (usually by a specified
title) and those who do not. Some title acts also include a state
certification or registration program, or reliance on a national
certification or registration program, so that those who use the
specified title, and hold themselves out to the public, have been
certified or registered by a state created or national entity as
having met the specified requirements. This entity may also
regulate to some extent the activities of the particular profession
by setting standards for the profession to follow, and to also
provide oversight of the practice of the profession by reporting
unfair business practices or violations of the law and either
denying or revoking a certification or registration if necessary.
AB 1890 does not establish a licensing practice act, but instead
provides for a title act. It restricts the use of the title
"athletic trainer" to only those who have met certain education or
certification requirements. There is no state program created to
provide oversight of this profession, there is instead reliance on
whether the person meets the education requirements or if they have
been certified by a specific corporation.
5. Related Legislation. AB 864 (Skinner) of 2013 would have
established the licensure and regulation of athletic trainers
through the creation of an Athletic Trainer Licensing Committee
under the Physical Therapy Board of California. ( Status: The bill
was held under submission in the Assembly Committee on
Appropriations.)
SB 1273 (Lowenthal) of 2012 was very similar to AB 864. ( Status:
The bill failed passage in this Committee.)
AB 374 (Hayashi) of 2011 would have established the Athletic
Trainer Licensing Committee within the Medical Board of California
to license and regulate athletic trainers commencing January 1,
2013 and sunsetting on January 1, 2018. The bill was later amended
to provide title protection for athletic trainers. ( Status: The
bill was amended to become a bill by Assemblymember Hill that dealt
with funeral embalmers and signed by the Governor.)
AB 1647 (Hayashi) of 2010 would have established certification and
training requirements for athletic trainers and prohibited
individuals from calling themselves athletic trainers unless they
meet those requirements. ( Status : The bill was vetoed by Governor
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Schwarzenegger.)
SB 284 (Lowenthal) of 2007 would have enacted the Athletic Trainers
Registration Act prohibiting a person from representing himself or
herself as a "certified athletic trainer," unless he or she is
registered by an athletic training organization. ( Status: The
bill was vetoed by Governor Schwarzenegger.)
SB 1397 (Lowenthal) of 2006 would have enacted the Athletic
Trainers Certification Act, prohibiting a person from representing
him or herself as an athletic trainer unless he or she is certified
as an athletic trainer by an athletic training organization, as
defined. ( Status: The bill was vetoed by Governor Schwarzenegger.)
AB 614 (Lowenthal) of 2003 would have required the DCA to submit a
recommendation to the Legislature as to whether the state should
license and regulate athletic trainers by January 1, 2006, if the
DCA is provided with an occupational analysis of persons providing
athletic trainer services by July 1, 2005. ( Status: This bill was
held in this Committee to allow JCBCCP to examine whether athletic
trainers should be licensed as part of the "sunrise" process.)
AB 2789 (Lowenthal) of 2002 would have required the Department of
Consumer Affairs to review the need for licensing of athletic
trainers and undertake an occupational analysis. ( Status : This bill
was held under submission in the Assembly Committee on
Appropriations.)
6. Arguments in Support. The California Athletic Trainers Association
(CATA) writes in support of this bill, noting that "without state
oversight, the public could be harmed by relying on someone who
calls themselves an athletic trainer without the appropriate
background."
According to the American Medical Society for Sports Medicine ,
California is now one of only two states that does not license
athletic trainers, despite a clear, accredited pathway for degrees
in athletic training, a national certification process that ensures
the profession remains consistent from state to state, recognition
by the federal government via National Provider Identifier numbers
and other codes specific to athletic training and the fact that
athletic trainers are currently working in California in an
unregulated manner, providing healthcare to a variety of consumers
in a variety of clinical settings.
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The University of Southern California believes that given the
complexity of the work involved, it is important that only those
individuals who use the "Athletic Trainer" title demonstrate the
educational, training and certification qualifications outlined in
this bill.
SUPPORT AND OPPOSITION:
Support:
California Athletic Trainers Association
American Medical Society for Sports Medicine
University of Southern California
Opposition:
None received as of June 11, 2014.
Consultant:Mark Mendoza and Sarah Mason