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124125126127128129In response to Ms. Hazelton's request as to why the processing time of initialapplications has changed, Ms. Winslow stated that numbers reported previouslywere higher due to applicants submitting applications too early; the average timeframe to receive a new physician assistant (PA) license is 30 days.130131132133134135In response to Mr. Grant's question of whether the board has provided PAprograms with a timeframe to follow when submitting a new application and alsoasked for clarification on the "desk age" and "application age" informationdepicted in the report, Mr. Winslow stated she has not reached out to theprograms. She specified that the "desk age" is the number of days an applicationhas been assigned to a current staff member and the "application age" is thenumber of days the application has been in the system. Ms. Forsyth stated thatthe board has provided initial licensing education to the PA programs in the pastbut due to staffing limitations the presentations were put on hold.136137138139140141142143144Renewal applications processed - 1,116Total licenses renewed and current - 11,782Average time to process an initial application - 35 days e. Diversion Program Activity Report145Ms. Winslow reported as of October 1, 2017, total licensees participating in thedrug and alcohol diversion program are:146147148 149 150151 Voluntary referrals - 2Board referrals - 14Total participants - 16Cases closed year-to-date - 127152Ms. Winslow indicated a correction to the handout provided to the board shouldread "as of October 1, 2017" not January 1, 2017.153154155In response to Mr. Sachs request for clarification on report information showing"applicants of public risk - 5", Ms. Winslow stated the individuals were removedfrom diversion because they failed to complete the program.156157158159160161Mr. Sachs requested that Maximus, who provides diversion program services tothe PAB, be invited to the next board meeting. This would provide an opportunityfor Maximus to make a presentation to the board regarding their services.162163164165166167168169f.Enforcement Program Activity ReportMs. Firdaus reported the following statistics from July 1, 2017 to September 30,2017: 170 171172173 174 Three licensees placed on probation;One public letter of reprimand issued;Zero revocationsTwo licenses were surrendered;Two probationary licenses issued;Zero cease practice order issued;4

08209210211212213214215216217218219220221222223224 Zero petitions for reinstatement denied;Zero petitions for reinstatement granted;Zero petitions for termination of probation denied;Zero petitions for termination of probation granted;Four accusations filed;Zero accusations withdrawn or dismissed;One statement of issues;Zero statement of issues withdrawn or dismissed;Zero accusations or petition to revoke filed;Zero petitions to compel a physical or psychiatric examination;Zero interim suspension orders issued;Zero license applications denied;Six new cases initiated with the Attorney General's office;Forty-one cases pending with the Attorney General's office;Two citations pending and 500 in fines pending from the last fiscal year,payments received this quarter: 250;· ·Fifty-three active probationers;Seven probationers who are tolling;Eighty-nine complaints received;Zero complaints closed without investigation;Ninety complaints referred for investigation; ten pending;Two pending citations/fines from previous quarter totaling 500.00;Five citations issuedIn addition to the Enforcement Program Activity Report, Ms. Firdaus reviewed a newreport pertaining the types of complaints the PAS receives and the source of thecomplaints. The board appreciated the additional information and requested that thisreport be included in future board meetings.In response to Mr. Martinez's question of the aging of the fines due, Ms. Firdausstated some of the balances due are from the last fiscal year and Ms. Forsythresponded that if fines aren't paid the information is turned over to Franchise TaxBoard (FTB), she also confirmed that interest starts accruing once the fine reachesFTB.Ms. Schieldge stated the Franchise Tax Board's program is titled the Tax InterceptProgram and if an individual is entitled to a refund the refund will be intercepted.Ms. Firdaus provided clarity to the reports discrepancy with the amount ofcomplaints received. Ms. Winslow clarified that the board has only been placinglicensees in an inactive status based on failing the CME audit not failure to respondto the CME audit letter.7. Department of Consumer Affairs - Director's UpdateChristopher Castrillo introduced himself to the board and stated he was appointedthe Deputy Director to the Office of Board and Bureau Services on October 9, 2017.His background consists of public policy and campaign management having mostrecently worked as a legislative advocate where he covered a variety of policy areasincluding labor, higher education, youth mental health, foster care, health care, local5

275276government and public transit. He has worked on both candidate and initiativecampaigns in both California and Oregon. He looks forward to applying hisexperience and skill set towards establishing an Office of Board and BureauServices that implements goals laid out in the strategic plan, exemplifyingorganizational effectiveness, and providing relevant, timely and accurate informationto all stakeholders.Mr. Castrillo shared information regarding additional individuals recently appointedby Governor Brown to the Department of Consumer Affairs. Karen Nelson, has beenchief operations officer at the American Leadership Forum Mountain Valley Chaptersince 2014, appointed Assistant Deputy Director at the Office of Board and BureauServices. Patrick Le, has been Assistant Chief of External Affairs at CoveredCalifornia since 2015, appointed Assistant Deputy Director at the Office of Boardand Bureau Services. Christopher Shultz, has been Deputy Commissioner ofCommunity Programs and Policy Initiatives at the California Department ofInsurance since 2011, appointed Chief Deputy Director at the California Departmentof Consumer Affairs. Natalie Daniel, has been Fiscal Supervisor at the JudicialCouncil of California since 2015, appointed Deputy Director of administration and willbe overseeing the department's Office of Human Resources, Business ServicesOffice and Fiscal Operations.He stated with the new staff structure we'll be able to further the mission vision andvalues we have set forth as a department and most importantly serve the needs ofCalifornia's consumers.Mr. Castrillo stated that in September the second director's quarterly meeting withboard executive officers was held. Mr. Castrillo stated as a department we arefocused on ensuring open dialogue with the boards and bureaus and will be holdingan annual meeting with all board presidents to ensure that the director's available tohear feedback from board leadership. One of the items announced at that meeting isthat DCA has released a riew 9nline license verification search for all boards andbureaus using the Breeze platform.DCA officially launched its new Future Leadership Development Program in May2017 and recently held a kickoff meeting with program participants and mentors onAugust 28, 2017. The program includes executive mentoring, customized leadershiptraining and project management.The department has also established a pro-rata work group for board executives todiscuss potential improvements on how DCA communicates with boards on the prorata process the department uses to distribute departmental service costs amongthe boards and bureaus. These services include IT, legal and publication. The nextmeeting is scheduled for August 31, 2017 at DCA headquarters. A pro-rata openhouse is scheduled for November 14, 2017.In July the department released its new strategic plan that outlines DCA's goals andobjectives for the next four years. The plan is available on the publication's page ofthe DCA website.The final Board Member Orientation Training for 2017 is scheduled for November15th .6

3294295296Reminder that 2017 is a mandatory sexual harassment prevention training year, thismeans all employees and board members are required to complete this training in2017.PETITION FOR EARLY TERMINATION HEARINGPetition for Early Termination of Probation - MariJo Hanson, PA 16359, CaseNo.950-2016-001018The Board was notified by petitioner MariJo Hanson that she was declining theopportunity to appear so the scheduled hearing was cancelled.8. Approval of Passing Score for 2018 PA Initial Licensing Examination and2018 Dates and Locations for PA Initial ExaminationM/-- -Je .:d -- G.:.:ra::.:.n:.:.t S/ -"· S o ny a - E a rle y to:To approve the passing score for the physician assistant initial licensing examinationfor year 2018 as established by the National Commission on Certification ofPhysician Assistants.297MemberCharles AlexanderJennifer CarlauistSonva EarlevJavier Esauivel-AcostaJed GrantCatherine HazeltonXavier MartinezRobert SachsMarv NoAbstainAbsentRecusal.Motion approved.M/-- -Je .:d -- G.:.:ra::.:.n:.:.t S/ - S- o.:.:n, ya -- E: a.:.:rl ey, to:To approve the dates and locations for the physician assistant initial licensingexamination for year 2018; the examine dates will be given on a year-round basis.There will be no testing December 17-31, 2018. The locations will be at PearsonVUE Professional Centers.MemberCharles AlexanderJennifer CarlauistSonva EarlevJavier Esauivel-AcostaJed GrantCatherine HazeltonXavier MartinezRobert SachsMarv ValenciaYesXXXXXXXXXNoAbstainAbsentRecusal7

4Motion approved.9. Schedule of 2018 Board meeting Dates and LocationsMr. Sachs presented the dates available and suggested holding the August 2018meeting in San Diego to coincide with the CAPA conference.M/Earley- Jed- -Grant- - - - - - - S/- - - Sonya- - - - - to:Approve the following dates and locations of the PAB's board meetings:January 22, 2018 - SacramentoApril 23, 2018 - SacramentoAugust 10, 2018 - San DiegoNovember 5, 2018 - SacramentoMemberCharles AlexanderJennifer CarlquistSonva EarleyJavier Esquivel-AcostaJed GrantCatherine HazeltonXavier MartinezRobert SachsMarv inAbsentRecusal'.·.'.·Motion approved.10.Discussion Regarding Nationwide Trends Related to Optimal Team Practiceof Physician AssistantsMr. Grant stated he attended the Physician Assistant Education Association (PAEA)national conference, where discussions by the professional organization,credentialing body for PA programs, certifying body for PAs and EducationAssociation focused on the strong demand for PAs. Last year there were 34,000 jobposting for both PA and nurse practitioners (NP) and about 7,000 PA graduates.Mr. Grant stated that because of the administrative requirements that some statelaws, including California, put on PAs, the American Academy of PhysicianAssistants' (AAPA) House of Delegates voted to recommend removal of some of thebarriers placed on PA practice. The AAPA has developed some goodrecommendations for optimal team practice (OTP). OTP doesn't change therelationship between the physician and the PA it changes who determines the role ofthe PA in that practice. Other recommendations include having an independent PAboard at the state level and being able to see the work that the PA is providing interms of billing and reimbursement.Mr. Grant stated that there is a misconception that OTP is independent practice butPAs are not, now nor have they ever been, independent and they will always have a8

3493503513523533543553563573583593603613623633 7398399400relationship with a physician. One of the things that can be problematic is thesupervising physician's or collaborating physician's responsibility for what the PAdoes, even when the physician may not be on-site. PAs are trained to thinkindependently and should be responsible for what they are doing unless they consultwith or collaborate with a physician on a specific case.Mr. Grant indicated that OTP is about modernizing the practice act, state by state, toreflect the optimal practice for PAs and to appropriately relieve physicians ofunneeded responsibility and restrictive documentation requirements regardingsupervision. There are a lot of conversations on the impact these changes may haveregarding PA education and training, accreditation of PA programs and certificationof PAs. The PA Education Association is conducting a study on the changes to thelaws and will report the outcome of the study in October 2018.In response to Mr. Martinez's question of whether or not California NPs are requiredto have a supervising agreement, Mr. Gnint stated that NP's are required tocollaborate with a physician but the way their collaboration is documented is lessburdensome.Mr. Sachs stated that the topic needs to be looked into very seriously whileremembering the primary charter which is public protection. He stated that part ofOTP is having an independent board which the .PAB has partly achieved. The PABuses shared services, provided by the Medical Board, and if PAB were to becomeindependent from the Medical Board would the current license renewal fee of 350be sufficient to cover additional costs.Ms. Forsyth stated that the PAB has outgrown their facility and if they were tobecome independent then the shared services provided by the Medial Board wouldbe the sole responsibility of the PAB. This would make it necessary for the board tohire additional staff, increase office space and provide their own informationtechnology services.Public Comment: Teresa Anderson, Public Policy Director for California Academy ofPAs (CAPA), concurred with Mr. Grant, changes need to be made to the PA PracticeAct. PA services are hidden, there isn't a good way to collect information on thecontributions that PAs make to the healthcare industry. CAPA has voted to look atexploring what OTP looks like in California. Parity in the profession needs to beaddressed in terms of nurse practitioners and the administrative processes. Thereare a lot of differences in terms of what the administrative burdens are for nursepractitioners versus PAs and the differences need to be evaluated to determine whatneeds to be done and who we need to work with to make changes.11.CLOSED SESSION:Pursuant to Section 11126(c)(3) of the Government Code, the Board moved intoclosed session to deliberate and take action on disciplinary matters.RETURN TO OPEN SESSION9

45112.California Highway Patrol Presentation "Safety in the Workplace"Officer Gabriel Parker with the North Sacramento California Highway Patrol (CHP)office provided the board with a presentation on safety. In 1995 the CHP absorbedthe state police and any duties carried out by the state police. The CHP hasjurisdiction over county roadways, freeways and all state facilities. The presentationcovered topics such as workplace safety, personal safety, destroying complacency,awareness of criminal indicators and safe driving tips. These topics were designedto increase awareness of criminal activity and promote personal safety on stateproperty. Officer Parker also shared a video titled Run, Hide, Fight - Surviving anActive Shooter Event and stressed the requirement that every state agency needs tohave an Emergency Action Plan in place.13.RegulationsMs. Winslow introduced and reviewed flowcharts depicting the regulatory processand provided the following updates:Proposed Amendments to Title 16, California Code of Regulations, Section1399. 514 - Renewal of LicenseThis amendment is currently under review with the Department of Consumers AffairsBudget Office.Ms. Earley requested clarification for reason why the reporting threshold needed tobe increased when licensees renew, Ms. Winslow responded that licenseescurrently have to report convictions involving fine amounts ranging from 300 to 500 dollars. By raising the reporting threshold to 500 or more the workload will begreatly reduced without compromising the public because fines for drug relatedconvictions are above the 500 threshold.Proposed Amendments to Title 16, California Code of Regulations, Section1399.515 - Retirement Status for Physician Assistant LicensesThis amendment is currently under review with the Department of Consumers AffairsBudget Office.Proposed Repeal of Title 16, California Code of Regulations, Sections 1399.531 Curriculum Requirements for an Approved Program for Primary Care PhysicianAssistants and 1399.32 - Board Requirements for Approving Specialty Training forPhysician AssistantsThis amendment is currently under review with the Department of Consumers AffairsLegal Office.Proposed Amendments to title 16, California Code of Regulations, Section 1399.573- Citations for Unlicensed PracticeThis amended is currently with Business, Consumer Services and Housing Authority(Agency).10

8469470471472473474475476477Discussion and possible Action to Initiate a Rulemaking to Amend Title 16, CaliforniaCode of Regulations, section 1399.545 - Supervision RequiredBusiness and Professions Code (BPC) sections 3502 and 3502.1 were amended in2016 with the implementation of SB 337. This bill recast requirements fordocumenting supervision by the supervising physician using one or moremechanisms, and recast prescribing provision, including setting forth a newmechanism for how a supervising physician ensure adequate supervision of theadministration, provision or issuance by a physician assistant of a drug order to apatient for Schedule II controlled substances.In comparing the amendments enacted by SB 337 to the regulatory requirements,staff has determined that Section 1399.545 needs to be amended to eliminateduplicative and inconsistent provisions and to reflect all mechanisms available undercurrent law for supervising a physician assistant.Ms. Winslow provided the board with the proposed changes. stated that theproposed changes hold no fiscal impact and asked that the board approve theproposed changes so the rulemaking process could begin.Ms. Schieldge stated the proposal is to conform regulation 1399.545 to the changesin SB 337 and that includes striking language in subdivision (e) of what's duplicativein 3502 and making sure that the regulation refers back to the other mechanismsthat are now available for supervision. In addition language is being added tod

2005 Evergreen Street, Suite 1100, Sacramento, CA 95815-3893 (916) 561-8780 FAX: (916) 263-2671 www.pac.ca.gov Forms PA1-PA5 -As an applicant, you are personally responsible for all information disclosed on your appli