| According to witnesses, Senators Alquist, Aanestad, and Poochigian questioned Assemblyman Yee about why it was necessary to include diagnosis in statute, and why the alternatives suggested by the California Medical Association -- "assessment" or "evaluation" -- were not sufficient. |
| The Senators' questions were based upon CMA recommendations and claims that Asian medicine practitioners are incapable of the complex analysis and decision-making processes needed to make a diagnosis, and that "therapeutic evaluation or assessment" would be more appropriate. The CMA argues that the authority to diagnose and plan treatments, (a prerequisite for access to third-party insurance reimbursement), should only be given to licensed physicians, and not to any of their competing professions. |
| If the CMA has its way, acupuncturists would not be paid by insurance for treating patients unless a prior diagnosis existed, and acupuncturists would become dependent upon prior diagnosis, treatment planning, and referral from physicians and other diagnosticians. |
| CAOMA has supported acupuncturists' authority to diagnose, which dates back to 1980, when the prior diagnosis and referral requirements were eliminated. Testifying on behalf of CAOMA were CAOMA Vice President An York Lee and lobbyist Sandy Carey. Also testifying in support was lobbyist Deborah Mattos from Southern California University of Health Sciences. Testimony in appropriations committees is usually limited to budgetary implications. Since there are no identifiable budgetary effects, few were present to testify. |
| [For those unfamiliar with the health care terminology, assessment and evaluation are generally used in reference to a pre-diagnostic review of a patient's condition, or in reference to a post-diagnostic process used to implement or modify a treatment plan. An assessment or evaluation without a diagnosis cannot be used to develop a treatment plan. Commonly accepted standards of "medical necessity,' which have been gradually implemented by both government and private health plans, require a diagnosis in order to develop and authorize a treatment plan. A diagnosis is thus necessary for authorization of reimbursement. |
| COMMITTEE ANALYSIS |
| Committee Staff Analysis of AB 1113 stated the following: |
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"STAFF COMMENTS: The author argues that clarification of an acupuncturist's authority to diagnose is necessary as acupuncturists are frequently the first, and often the only, practitioner to see a particular patient. The author notes that authority of an acupuncturist to diagnose has been well established in a series of legal opinions dating back to 1982. The Little Hoover Commission's report on acupuncture found that the scope of practice for acupuncture was clearly established, but that the acupuncturist's authority to diagnose and role as a primary care provider was controversial and less well established. The Little Hoover Commission stated that clear statutory language was needed to affirm consumer access to acupuncturists who can diagnose patients using traditional Asian techniques. |
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The scope of practice of an acupuncturist includes prescribing the use of oriental massage, acupressure, breathing techniques, exercise, heat, cold, magnets, nutrition, diet, herbs and animal and plant products. Acupuncture is defined as the stimulation of a certain point or points on the body by the insertion of needles to prevent or modify the body function, including pain control, treatment of certain diseases, and dysfunctions. |
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The California Medical Association asserts that the diagnosis of a medical condition requires a complex analysis of symptoms and biological systems and is an activity that has traditionally been reserved for physicians who have the highly specialized training necessary to perform this complex task. CMA contends acupuncturists have training in acupuncture and in general principals of Western medical science, but lack the extensive clinical training necessary to engage in sophisticated medical diagnosis. |
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STAFF NOTES: This bill is linked to AB 1117 (Yee) and becomes operative only if both bills are chaptered and this bill is chaptered last. AB 1117 changes the term "oriental medicine" to "Asian medicine" within the acupuncture codes." |
| VOTES |
| AYES: Migden, Aanestad, Alarcon, Ashburn, Battin, Florez, Murray, Ortiz, Poochigian |
| NOES: Dutton |
| ABSENT, ABSTAINING, OR NOT VOTING: Alquist, Escutia, Romero |
| NEXT VOTE ON AB 1113: SENATE FLOOR |
| CAOMA's battle in support of AB 1113 will continue all the way to the Governor, who needs to know what this bill means to our profession. |
| Go to the California Legislation Pages for Current Status on Acupuncture Bills |