Athletic trainers enter ‘scope of practice’ debate

California is the only state in the nation that doesn’t regulate athletic trainers. That could soon change if a bill sponsored by Assemblymember Dr. Akilah Weber and the California Athletic Trainers’ Association becomes law.

Weber’s measure, Assembly Bill 796, seeks to regulate the athletic training profession in California by establishing the Athletic Trainer Registration Committee within the Medical Board of California.

The bill would require athletic trainers to be registered – but not licensed – with the state in order to practice in California. (Registration is a lesser form of regulation than licensure.) Under the bill’s definitions, an athletic trainer could include a sports medical specialist present at an athletic event, like a National Football League game, but also something someone seemingly disconnected from athletics like a person hired to oversee workers on a production line.

“I see the importance of athletic trainers as they are an integral part of our health care team for our athletes,” said Weber, a physician, during a recent press conference about the bill. “In fact, we have all witnessed the importance of athletic trainers. A few months ago, we watched an athletic trainer, Denny Kellington, save the life of Buffalo Bills Safety Damar Hamlin when he collapsed on the field during an NFL game.”

Weber’s bill is in contrast to a growing trend around the nation to embrace less-restrictive occupational licensing requirements, in part to bolster job opportunities for their residents.

A 2015 report by the Obama Administration found that there’s growing evidence that licensing requirements, while protecting consumers, can also raise the price of goods and services and restrict employment opportunities, particularly for lower-income individuals.

The bill would require athletic trainers to be registered – but not licensed – with the state in order to practice in California.

Her bill attempts to address concerns about overly restrictive occupational licensing by including a “sunset” provision that would allow for the assessment of the necessity and effectiveness of the new committee at an unspecified future date. Nick Harvey, the governmental affairs chair for the California Athletic Trainers’ Association, noted that sunset provisions, while common in California bills, aren’t as common in legislation that only seeks to require professional registration, not licensure.

“We definitely have been working and listening to the opposition,” Weber said in an interview with Capitol Weekly.

Weber said she is “definitely open to improving other things” in the bill as well, adding that as a mother of two athletes she was surprised that California doesn’t regulate athletic trainers.

“We regulate everything!” she said.

Opponents, however, contend the bill is completely unnecessary and overly broad.

AB 796 opponents, which include the California Nurses Association, the California Physical Therapy Association, the California Academy of Physician Associates, the Occupational Therapy Association of California and the United Nurses Association of California/Union of Health Care Professionals, say that not only is there no athletic training crisis in California that needs addressing, but that the bill is so broad that it allows anyone registered under the proposed Athletic Training Practice Act to work with nearly any patient for nearly any physical condition.

“It’s way too broad,” said Chris Reed, chair of the California Physical Therapy Association’s Government Affairs Committee. “Can we just narrow this down to the kind of person you’d expect an athletic trainer to work with?”

Weber, for her part, says she “doesn’t understand” the opposition’s arguments, because athletic trainers have no regulation now in California and therefore can essentially do whatever they want, without supervision.

Reed said opponents are also concerned about athletic trainers’ oversight by physicians as described by the bill. He said the legislation allows athletic trainers to provide “medical services,” not just athletic training.

“I’m not sure that’s protecting the public in the way we’re intending to protect the public,” he said, “or in the way licensure is intended to protect the public.”

Weber, for her part, says she “doesn’t understand” the opposition’s arguments, because athletic trainers have no regulation now in California and therefore can essentially do whatever they want, without supervision. “It’s the wild west,” she said.

AB 796 passed out of the Assembly Committee on Arts, Entertainment, Sports and Tourism on a 5-0 vote on April 11, and passed out of the Assembly Committee on Business and Professions on a 13-0 vote on April 25.

According to the B&P committee’s bill analysis, 125 total California cases have been closed by the Board of Certification for the Athletic Trainer, a private, national, non-profit credentialing agency for entry-level athletic trainers incorporated in 1989. None of the cases were closed for harm to patients; 16 were closed for alcohol-related convictions. Most of the others were for regulatory violations.

Still, the bill boasts dozens of supporters, including the American Medical Society for Sports Medicine and the California Coaches Association; the National Football League as well as the San Francisco 49ers, Los Angeles Chargers and Los Angeles Rams; and several California colleges and universities, like Azusa Pacific University, Cal State Fullerton, Cypress College, San Jose State Athletics and UC San Francisco.

The bill now awaits further action in the Assembly Committee on Appropriations.

Brian Joseph is a former statehouse reporter for the Sacramento Bee and Orange County Register