BILL ANALYSIS �
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THIRD READING
Bill No: AB 2214
Author: Fox (D)
Amended: 6/26/14 in Senate
Vote: 21
SENATE BUSINESS, PROF. & ECON. DEV. COMM. : 7-1, 6/23/14
AYES: Lieu, Wyland, Corbett, Galgiani, Hernandez, Hill, Torres
NOES: Berryhill
NO VOTE RECORDED: Block
SENATE APPROPRIATIONS COMMITTEE : Senate Rule 28.8
ASSEMBLY FLOOR : 60-13, 5/19/14 - See last page for vote
SUBJECT : Emergency room physicians/surgeons: continuing
medical education: geriatric care
SOURCE : Author
DIGEST : This bill enacts the Dolores H. Fox Act to require
the Medical Board of California (MBC) to consider including a
course in geriatric care for emergency room physicians and
surgeons as part of its continuing education (CE) requirements;
and makes nonsubstantive, technical, and conforming changes.
ANALYSIS :
Existing law:
1. Licenses and regulates physicians and surgeons under the
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Medical Practice Act by MBC within the Department of Consumer
Affairs (DCA).
2. Requires MBC to adopt and administer standards for the CE of
licensees, and requires each licensee to demonstrate
satisfaction of the requirements at regular intervals.
3. Requires all general internists and family physicians, who
have a patient population of which over 25% are 65 years of
age or older, to complete at least 20% of all mandatory CE
hours in a course in the field of geriatric medicine or the
care of older patients.
4. Requires all physicians and surgeons to complete a mandatory
CE course in the subjects of pain management and the
treatment of terminally ill and dying patients, as specified.
5. Restructures MBC to eliminate the Division of Licensing.
6. Requires MBC to consider including a course in the following
subjects when determining its CE requirements: (a) human
sexuality and nutrition; (b) child abuse detection and
treatment; (c) acupuncture; (d) nutrition; (e) elder abuse
detection and treatment; (f) early detection and treatment of
substance abusing pregnant women; (g) special care needs of
drug addicted infants; (h) how to routinely screen for signs
exhibited by abused women; (i) special care needs of
individuals and their families facing end-of-life issues; and
(j) pain management.
This bill enacts the Dolores H. Fox Act to require MBC to
consider including a course in geriatric care for emergency room
physicians and surgeons as part of its CE requirements; and
makes nonsubstantive, technical, and confirming changes.
Background
A March 13, 2014 New York Times article titled "Emergency Rooms
Are No Place for the Elderly" states: "The number of older
people seeking health care is expected to increase significantly
over the next 40 years, doubling in the case of those older than
65, potentially tripling among those over 85. In a health care
system already critically short of primary care providers and
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geriatrics specialists, many of these older patients will likely
end up in emergency rooms." The article further indicates that
over the last five decades quality emergency care has become
synonymous with speed. Survival rates for patients suffering
stroke, heart attack or traumatic injury depend on the number of
minutes needed to triage, diagnose and treat. However, when it
comes to elderly patients, it is nearly impossible to work
quickly. Many are plagued with chronic diseases like diabetes,
high blood pressure and heart disease, and take numerous
prescription drugs which interact in complex and oftentimes
dangerous ways. The elderly are also more likely to suffer
dementia and cognitive disorders that make answering even the
simplest questions difficult.
The Times further notes that in recent years a growing number of
physicians and health facilities have begun to focus on the
needs of the growing elderly population as it interacts with the
emergency room. A number of changes have been suggested,
including routine screening for dementia and cognitive
impairments, the use of non-slip flooring to decrease the risk
of falls and training staff to be more effectively tuned to the
needs and circumstances of the elderly. The Times writes that
in recent years, "?about 50 medical centers have incorporated
such changes in their emergency rooms, a notable improvement
from a decade ago when none existed."
Geriatric care . Geriatric medicine is medical specialty that
addresses the complex needs of older patients and emphasizes
maintaining functional independence even in the presence of
chronic disease. Geriatric medicine requires an
interdisciplinary approach between physicians, nurses, social
workers, occupational therapists and family members in order to
provide comprehensive care for these patients with multiple
needs.
Geriatric medicine is its own specialty. After an internal
medicine or family practice residency, physicians can complete a
one or two-year fellowship training in the medical, social and
psychological issues that concern older adults to become
certified in geriatric medicine. This specialty is increasing
in importance as the population ages and that aging population
lives longer. People over the age of 85 are the fastest growing
segment of the population, and it is no longer a rarity for
people to live to be 100 years of age.
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Geriatricians are primary care physicians who specialize in care
for people aged 65 years and older and can also serve as
consultants to other physicians and to hospital programs that
work with the elderly. Geriatricians are typically board
certified in Internal Medicine and have additional training in
areas pertaining to elder care. They address issues such as
memory loss, arthritis, osteoporosis, mobility and Alzheimer's
disease.
The Rand Corporation states that there is a shortage of
geriatricians in the United States, with fewer than four
certified geriatricians in the U.S. per 10,000 individuals 75
years of age or older. Less than 1% of graduates from U.S.
medical schools choose geriatric medicine as a career.
With diminishing access to specialized care for older patients,
an inevitable consequence will be more older patients will seek
treatment in the emergency room. These facts underscore the
need for this bill.
CE requirements . MBC requires all physicians to complete at
least 50 hours of approved CE for each two-year period
immediately preceding the expiration date of the license. MBC
approves CE providers and establishes criteria for acceptable
courses.
MBC requires all physicians to complete a mandatory CE course in
the subjects of pain management and the treatment of terminally
ill and dying patients. It also requires all general internists
and family physicians who have a patient population of which
over 25% are 65 years of age or older, to complete at least 20%
of all mandatory CE hours in a course in the field of geriatric
medicine or the care of older patients.
Existing law further establishes a list of subjects that MBC
considers when establishing CE requirements for physicians and
surgeons. This bill requires MBC to add geriatric care for
emergency room physicians to that consideration list, but does
not mandate that the actual courses be required.
Comments
According to the author, "California faces a critical shortage
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of physicians with geriatric care expertise. For many elderly,
the emergency room is where the first signs of major health
complications are revealed, but often they are not recognized or
properly diagnosed."
The author believes that the lack of specific training in
geriatric care hinders emergency room physicians in their
ability to provide the best care to senior patients. The author
argues that current CE training requirements for emergency room
physicians are insufficient to meet the needs of the elderly,
and states that this bill is necessary to ensure that emergency
room physicians have the knowledge and skills required to
competently treat elderly patients.
FISCAL EFFECT : Appropriation: No Fiscal Com.: Yes
Local: No
SUPPORT : (Verified 7/30/14)
California Commission on Aging
California Long-Term Care Ombudsman Association
ARGUMENTS IN SUPPORT : The California Commission on Aging
argues that "California faces a critical shortage of medical
professionals with geriatric care expertise. For many elderly,
the emergency room is where the first signs of major health
complications are revealed, but often they are not recognized or
properly diagnosed. By recommending that geriatric care
training be made available in continuing education coursework,
AB 2214 could provide emergency room professionals access to
important information on the complex health issues that elders
face."
The California Long-Term Care Ombudsman Association states,
"Frequently, the lack of specific training in geriatric care
hinders emergency room physicians in their ability to provide
the best quality care for their senior patients. The current
continuing education training requirements for emergency room
physicians are insufficient to meet the needs of seniors,
particularly those seniors who live in long-term care
facilities. AB 2214 is an appropriate solution to this
problem."
ASSEMBLY FLOOR : 60-13, 5/19/14
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AYES: Achadjian, Alejo, Ammiano, Bloom, Bocanegra, Bonilla,
Bonta, Bradford, Brown, Buchanan, Ian Calderon, Campos, Chau,
Ch�vez, Chesbro, Cooley, Dababneh, Daly, Dickinson, Eggman,
Fong, Fox, Frazier, Garcia, Gatto, Gomez, Gonzalez, Gordon,
Gorell, Gray, Hall, Roger Hern�ndez, Holden, Jones-Sawyer,
Levine, Linder, Lowenthal, Maienschein, Medina, Mullin,
Muratsuchi, Perea, John A. P�rez, V. Manuel P�rez, Quirk,
Quirk-Silva, Rendon, Ridley-Thomas, Rodriguez, Salas, Skinner,
Stone, Ting, Waldron, Weber, Wieckowski, Wilk, Williams,
Yamada, Atkins
NOES: Allen, Bigelow, Dahle, Donnelly, Beth Gaines, Grove,
Hagman, Harkey, Jones, Melendez, Olsen, Patterson, Wagner
NO VOTE RECORDED: Conway, Logue, Mansoor, Nazarian, Nestande,
Pan, Vacancy
MW:k 8/5/14 Senate Floor Analyses
SUPPORT/OPPOSITION: SEE ABOVE
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