Governor Brown and Senator Yee Are At it Again

 The following is a letter called Advocacy News put out by CSOMA, the California State Oriental Medical Association, for acupuncturists.  It seems Leland Yee is constantly bringing senseless, useless, acupuncture-related legislation up every year.  This actually got signed into law!

Tuesday, September 18, 2012

Legislative Update: Governor Signs SB 628 (Yee)

Last week, Governor Jerry Brown signed SB 628 (Yee), a bill regulating doctoral titles used by California licensed acupuncturists. CSOMA has received a number of inquiries regarding this new law. This email addresses some of the major questions we have received.

In this update…

• What does SB 628 do?
• Why was SB 628 enacted?
• Did CSOMA take a position on SB 628?
• Does this law impact my ability to use the title ‘doctor’ if its use isn’t connected with my practice?
• What licenses entitle me to use the title of ‘doctor’?
• What degrees entitle me to use the title of ‘doctor’?
• Do doctoral degrees earned abroad entitle me to use the title ‘doctor’?
• What is the proper way to use post-nominal letters?

What does SB 628 do?

Very little. SB 628 introduces nothing new. It simply takes decades-old California Acupuncture Board (CAB) regulation (16 CCR 1399.456: Use of the Title “Doctor”) and places this language—word for word—into statute. When it goes into effect on January 1, 2013, the new law will change nothing except that it will take away the CAB’s power to make changes to regulations governing doctoral titling. Any future changes in this area will require approval by the California legislature rather than the CAB.

Both the existing regulation and the new law prohibit acupuncturists from using the title ‘doctor’ or the abbreviation ‘Dr.’ in connection with an acupuncture practice unless s/he holds a doctoral title by license (e.g., MD) or unless s/he possesses an earned doctorate from an ‘accredited, approved, or authorized educational institution’ in acupuncture, oriental medicine, a biological science, or a field related to the practice of acupuncture. Both go on to prohibit the use of the title ‘doctor’ without further indicating the license or degree that authorizes its use.

Why was SB 628 enacted?

The purpose of moving CAB regulation into statute is unclear. This change does nothing more than eliminate the California Acupuncture Board’s authority to regulate in this area.

The bill’s author (Senator Leland Yee) asserts that this legislation will help improve the quality of acupuncture in California. The few supporters of the bill have claimed that the bill would raise the status of acupuncture in California and encourage advanced studies in the field.

Given that existing regulation is identical to the language of this bill and given that existing regulation has been in effect for more than 20 years, CSOMA did not and does not see meaningful or substantial positive impacts from this new law. Likewise, we do not anticipate substantial negative impacts.

Did CSOMA take a position on SB 628?

CSOMA took a ‘neutral’ position with respect to SB 628. Given negligible change to the status quo introduced by SB 628, we elected to focus our advocacy resources on higher priorities, including the successful defeat of SB 1488 (Yee), a bill that would have established a ‘California Traditional Chinese Medicine Traumatology Council’ without establishing adequate training standards.

Does this law impact my ability to use the title ‘doctor’ if its use isn’t connected with my practice?

No. SB 628 only restricts how a California licensed acupuncturist may use the title of ‘doctor’ in connection with the practice of acupuncture. It does not not impact how doctoral titles are used by licensed acupuncturists when this use is not connected with acupuncture practice in California.

What licenses entitle me to use the title of ‘doctor’?

Both current regulation and SB 628 are silent with respect to which other licenses would authorize the use of a doctoral title. Acupuncturists licensed in other medical disciplines should check with the relevant California licensing board(s) for information regarding authorization to use doctoral titles under these licenses.

For those California licensed acupuncturists who hold a doctoral title by license issued in another state (e.g., Doctor of Oriental Medicine in New Mexico, Doctor of Acupuncture in Rhode Island, medical doctor in any other state), we urge extreme caution. While SB 628 does not explicitly state that licenses authorizing the use of the title ‘doctor’ must be issued by California, it is reasonable to conclude that this is implied by the law.

What degrees entitle me to use the title of ‘doctor’?

To authorize the use of the title ‘doctor,’ both current regulation and SB 628 state that degrees must be:

1. An ‘earned doctoral degree;’
2. From an ‘accredited, approved, or authorized educational institution;’
3. In acupuncture, oriental medicine, a biological science, or is otherwise related to the authorized practice of an acupuncturist.

To meet criteria #2 above, an educational institution must either be:

1. Accredited by an accrediting agency recognized by the United States Department of Education; or
2. Approved or authorized to operate by California’s Bureau for Private Postsecondary Education (BPPE).

All DAOM post-graduate degree programs are accredited by Accreditation Commission for Acupuncture and Oriental Medicine (ACAOM), a United States Department of Education recognized accrediting agency. Therefore, all of these degrees qualify.

CSOMA believes that the second standard (approval by BPPE) is inadequate. It is our view that all education in the field should be held to the significantly more rigorous United States Department of Education standards. This may be an issue for our field to address in the future. However, given the longstanding nature of existing regulation, CSOMA did not raise objections to SB 628.

Do doctoral degrees earned abroad entitle me to use the title ‘doctor’?

Both current regulation and SB 628 restrict the use of the title ‘doctor’ to those who have an ‘earned doctoral degree’ from an ‘accredited, approved, or authorized educational institution.’ Neither the United States Department of Education nor the California Bureau of Private Postsecondary Education (BPPE) regulate international educational institutions. Therefore, California licensed acupuncturists who have earned doctoral degrees abroad may not use this as the basis for using the title ‘doctor’ or the abbreviation ‘Dr.’ in conjunction with the practice of acupuncture.

It would appear that individuals with internationally earned doctorates in the field may still list these doctoral credentials after their name (e.g., Jane Doe, LAc, PhD) as long as these credentials are not false, misleading, or deceptive.

What is the proper way to use post-nominal letters?

This isn’t directly related to SB 628, but we’ve occasionally received questions regarding the proper use of post-nominal letters (i.e., letters placed after the name of a person to indicate that the individual holds a position, educational degree, accreditation, office, or honor). So we’ll take the opportunity to provide some guidance on this front.

Here are some guidelines generally used in the United States:

1. Post-nominal letters are typically listed in the following order:
   • Academic Degrees—listed lowest to highest (e.g., MBA, DAOM);
   • Honorary degrees;
   • Professional licenses (e.g, LAc)—listed from highest to lowest importance (as you determine) or alphabetically;
   • Professional certifications;
   • Professional associations and affiliations.
2. List only the highest degree earned in a particular discipline (e.g., ‘Jane Doe, DAOM, LAc’; not ‘Jane Doe, MSTCM, DAOM, LAc’).
3. If a doctoral post-nominal is used (e.g., DAOM), don’t use ‘Dr.’ prior to your name; this is redundant. It’s ‘Jane Doe, DAOM, LAc,’ not ‘Dr. Jane Doe, DAOM, LAc.’
4. Generally, no more than three post-nominals are listed unless you have a compelling reason to list more.

Additionally, current regulation, SB 628, and California Attorney General Opinion No. 87–103 all clearly indicate that a California licensed acupuncturist may not use the title ‘doctor’ or the abbreviation ‘Dr.’ without also indicating the type of license or degree that authorizes this use. For example, ‘Dr. Jane Doe’ and ‘Dr. Jane Doe, LAc’ are not permissible as they do not also indicate the doctoral license or degree. ‘Dr. Jane Doe, DAOM, LAc’ or ‘Dr. Jane Doe, MD, LAc’ are permitted (assuming, of course, that you hold a DAOM degree or MD license respectively); however, as we noted above, the prefix of ‘Dr.’ is not typically used concurrently with doctoral post-nominal letters (e.g., DAOM or MD).

California Attorney General Opinion No. 87–103 makes clear that using the initials ‘OMD’ or the title ‘Oriental Medical Doctor’ without further information that removes the implication that the individual is a physician or surgeon. For example, ‘Jane Doe, OMD’ is not permissible; ‘Jane Doe, OMD, LAc’ is permissible assuming that the OMD degree was granted by an accredited or approved institution as explained above.

Finally, all of the restrictions on the use of doctoral titles apply equally to written and spoken communications in connection with the practice of acupuncture. The law does not make a distintion between the two.

Comments & Feedback

As always, we welcome and appreciate feedback. You may send comments to info@csomaonline.org or contact CSOMA toll-free at 800.477

Alert ─ California’s State Bill 628 Must Not Pass

According to Senator Leland Yee’s website, “Since 2003, Dr. Yee has one of the best track records in getting his bills passed and signed into law. In fact, he has successfully passed 133 pieces of legislation, of which 100 have been chaptered into law.” With a track record like that, he would be the person to go to to call in a political favor. California State Bill 628 just may be that favor.

While the stated topic is Acupuncture Regulation, the bill is actually aimed at TCM traumatologists, a field that has nothing to do with the specialty of Traditional Chinese Medicine (TCM). Because all acupuncture laws are already in place, and the bill’s actual stipulated topic is traumatologists, the bill’s topic should be TCM Traumatologist Regulation, which would be far less misleading.

How will this bill benefit California residents if it is allowed to pass without including any set standards for traumatologists? One benefit for the TCM traumatologists committee is that the bill places jurisdiction under the California Acupuncture Board (CAB). That means required money including debts related to TCM traumatologists can be paid by the CAB. This is hardly fair to acupuncturists who have nothing to do with this new field, yet are expected to pay TCM traumatologists’ unspecified expenses. The committee deciding on a job description and regulations will be formed in March 2012, and a short two months later the board shall start issuing certificates to the applicants that they see as fit. To go a step further, the committee could decide to base the traumatologists’ job description and regulations solely on a certain applicant’s resume since two months worth of applications would have been collected before the committee ever even meets.

Most people will not know the time frame open to apply (January to December 2012) and will miss the opportunity to become certified as TCM traumatologists; however, the opportunity to become certified is long enough for a special interest group to send in a person with a plan against alternative health care to become certified. This person will be functioning under the CAB’s jurisdiction; therefore, any incident could potentially ruin acupuncture’s reputation in California.

Although a job description is lacking, the monies related to TCM traumatologists certification is spelled out thoroughly. Applicants originally only had to pay $75. Now it’s been changed to $200. Those who fail to renew their certificate after five years will have three years to renew before they risk losing their certificate. Of course, a delinquency fine of $25 and the renewal fee must be paid in order to reinstate certification. Aside from the applicant being eighteen years of age and the monies involved being clearly stated, why are the time frame and physicians to be on the committee the only two clear stipulations made for the whole bill when an explanation of what TCM traumatologists do is absent?

One wonders about the motivation behind this bill. Basically, after this bill passes, a committee can make up the rules to make this bill anything they want. Further, there are inconsistencies, like requesting an annual renewal fee. Previously written into the bill, renewal was set at every five years, not annually. The renewal cost used to be $75 and now that’s been crossed out changed to $100. There’s no word about a refund for those who are not issued a certificate although applying to be a TCM traumatologist. The bill contradicts itself by saying that one can only apply for a certificate in 2012, yet in section 4967, it states, “A person who fails to renew his or her license or certificate within three years after its expiration may not renew it, and it may not be restored, reissued, or reinstated thereafter, but that person may apply for and obtain a new license or certificate if he or she meets all of the following requirements.” New licenses supposedly are not to be given out after December 15, 2012, yet you can “obtain a new license.”

In section 4967(d) of SB 628, it states, “The board may provide for the waiver or refund of all or any part of an examination fee in those cases in which a license to practice acupuncture is issued without an examination pursuant to this section.” TCM traumatologists are not mentioned at all. Regulations around acupuncture testing are already in place. Furthermore, no one is permitted to practice acupuncture without a license except interns within a school setting under the watchful eye of a licensed acupuncturist who is also a teacher. A license is only given after an exam is passed. Two places referring to a written examination for TCM traumatologists have been crossed out of the bill. There’s no affiliation between the two professions. SB 628 discusses acupuncturists and TCM traumatologists separately the whole way through.

How is 4967(d) connected to TCM traumatologists? Yee may as well have written, “Drivers must drive thirty-five in a thirty-five mile per hour zone.” It’s already a law and not connected to TCM traumatologists in any discernable way. Each section is filled with a lot of writing and still doesn’t clarify the job description of a TCM traumatologist. A big question arises, why bring up acupuncturists at all when the bill relates only to TCM traumatologists specifically? Acupuncturists already have rules, regulations, and laws governing their actions in detail. This bill should leave them out of it. Most likely the only reason Yee is mentioning acupuncturists is to make readers of the bill believe in an affiliation between the two professions when none exists.

One has to ask who benefits from the passing of SB 628, especially when there are no educational or certification standards in place. Senator Leland Yee allegedly thought this bill up by himself, working without any special interest group’s influence. This should be easy enough to find out. If interested, we could look up campaign donors to Senator Yee and see if this group is listed, or wait until SB628 passes and see if a donor ends up on the committee.

The California Assembly Committee on Business, Professions, and Consumer Protection will be presented with this bill on July 5, 2011.

http://dist08.casen.govoffice.com/index.asp?Type=B_Basic&SEC={20BBA5EO-F400-4A31-802C-C4416989696D}

www.csomaonline.org/files/public/CSOMA_SB628_position_20110607.pdf

www.csomaonline.org/i4a/pages/index.cfm?pageid=3466

www.leginfo.ca.gov/cgi-bin/postquery?bill_number=sb_628&sess=CUR

www.leginfo.ca.gov/pub/11-12/bill/sen/sb_0601-0650/sb_628_bill_20110531_amended_sen_v95.html

Warning: Acupuncture in California May Be in Jeopardy

Despite the fact that California’s State Bill 628 is flawed and nonsensical, it will be heard by the California Assembly Committee on July 5, 2011. This much is clear, however. The legality and reputation of acupuncture as a safe healing modality may be in jeopardy.

If it passes, SB 628 will create a new category of providers called Traditional Chinese Medicine (TCM) traumatologists. While these traumatologists will be under the jurisdiction of the California Acupuncture Board (CAB) and will appear to be affiliated with TCM, nothing could be further from the truth. TCM has nothing at all to do with this new field and being a licensed acupuncturist isn’t even a requirement.

California’s professionals are required to prove they are educated by earning degree credits and passing exams in their fields. TCM traumatologists don’t have to prove education in TCM traumatology because no standards exist.

Acupuncturists have a clear scope of practice outlined for anyone to inquire about, but the committee who will decide what these TCM traumatologists can and cannot do, will not be formed until March, 2012. Furthermore, four physicians or surgeons are to be in charge of the committee of six. Since no physicians will be applying for a position as a traumatologist, it makes little sense that they make up the committee. This makes as much sense as a committee of nurses choosing a school’s teachers.

The bill states that when manipulation techniques are to be done, a physician must be present to observe. Firstly, the use of manipulation techniques implies this new field should be affiliated with chiropractic care rather than TCM. Secondly, a practitioner is to call a doctor to come over and observe each time a traumatologist does a manipulation technique. Why be certified if it means Intern status for the traumatologist’s whole career?

Those who are licensed acupuncturists had to pass a grueling written test. TCM traumatologists, on the other hand, will not take an exam at all despite the CAB being responsible for their actions. Presently, acupuncturists are required to take fifty hours of continuing education within every two year renewal period. Conversely, TCM traumatologists only have to wait five years, pay, and reapply.

Acupuncture testing for licensing occurs every year and is ongoing. With TCM trauamatologists, applications for certification are only to be accepted from January 1, 2012 to December 15, 2012. If TCM traumatologist certification is so legitimate, why only have certification possible for one time only, and for such a short time? The average person wouldn’t even know about the opportunity to get certified. Further, according to this bill, the CAB is required to accept the applications of all those who are seeking certification as long as they meet the criteria─criteria that the committee can establish after reading resumes.

As it says on the California State Oriental Medical Association’s (CSOMA) website, “SB 628, as amended on May 31, 2011, could harm the reputation of licensed acupuncturists, by association, if TCM traumatologists engage in unethical or negligent practice.” Could this be the real intent behind this bill? CSOMA goes on to say, “The bill appears to be focused upon satisfying the needs of a special interest group that is unable or unwilling to obtain licensing or certification through existing means.” Senator Leland Yee supposedly thought this bill up by himself, working without any special interest group’s influence.

Currently, all we know is who will not benefit: the CAB and California residents. If this bill passes, this much is clear: through association, the legality and reputation of acupuncture as a safe healing modality in California may be in jeopardy.

For your opposition to have been recorded in the committee analysis, you had to have faxed the committee consultant Joanna Gin before close of business on Tuesday, June 28, 2011 at 916.319.3306.

http://dist08.casen.govoffice.com/index.asp?Type=B_Basic&SEC={20BBA5EO-F400-4A31-802C-C4416989696D}

www.csomaonline.org/files/public/CSOMA_SB628_position_20110607.pdf

www.csomaonline.org/i4a/pages/index.cfm?pageid=3466www.leginfo.ca.gov/cgi-bin/postquery?bill_number=sb_628&sess=CUR

www.leginfo.ca.gov/pub/11-12/bill/sen/sb_0601-0650/sb_628_bill_20110531_amended_sen_v95.html

ALERT: In June 2012, the They tried again with SB 1488.  It was voted down 6-3.  They're going to keep trying to pass this kind of absurd legislation, so look out!

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