Report to the General Assembly
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Report to the General Assembly The Department of Public Health’s Oversight Responsibilities relating to Scope of Practice Determinations: Scope of Practice Review Committee Report on Athletic Trainers Raul Pino, MD, MPH, Commissioner 02/01/2017 State of Connecticut Department of Public Health 410 Capitol Avenue P.O. Box 340308 Hartford, CT 06134-0308 State of Connecticut Department of Public Health Report to the General Assembly The Department of Public Health’s Oversight Responsibilities relating to Scope of Practice Determinations for Health Care Professions: Athletic Trainers Table of Contents Executive Summary ....................................................................................................................................... 3 Background ................................................................................................................................................... 5 Scope of Practice Request............................................................................................................................. 6 Impact Statements and Responses to Impact Statements ........................................................................... 7 Scope of Practice Review Committee Membership ..................................................................................... 8 Scope of Practice Review Committee Evaluation of Request ....................................................................... 9 Findings/Conclusions .................................................................................................................................. 17 Appendices Table of Contents ................................................................................................................... 20 P a g e |2 Executive Summary In accordance with Section 19a-16d of the Connecticut General Statutes, the Connecticut Athletic Trainers’ Association (CATA) submitted a scope of practice request to the Department of Public Health to update the scope of practice to allow athletic trainers to practice to the full extent of their education and training. Within the scope request, the CATA has proposed the following changes: Replace “athlete” with “physically active individual” Athletic trainers are the only healthcare profession whose practice act does not use the term patient or individual. Any injury an athletic trainer will be dealing with is still athletic in nature or comparable to an athletic injury. An athletic trainer would only be working with individuals who have been determined “otherwise healthy by a health care provider”. Removal of a time requirement (3x/wk.) in participation of sports and activities, pertaining to those an athletic trainer can treat The time constraint of three times per week may prohibit an athletic trainer from being on the sideline at youth sporting events. In addition, CT is the only state in the nation with a time constraint incorporated into the definition of the word athlete. Stricter guidelines as it pertains to standing orders and the athletic trainer’s direction from a licensed health care provider Standing orders would pertain to only athletes (in the traditional sense). Under the proposed changes, standing orders would have to be reviewed annually and will have to reflect best practices. Outside of the traditional athletic setting, standing orders will not be present, and athletic trainers would be required to immediately refer “physically active individuals”. The current practice act requires an athletic trainer to make a referral to a licensed healthcare provider for any athlete whose injury or illness have not improved within 4 days of onset and for those athletes who have physical or medical contraindications outside of an athletic trainer’s education and training. The CATA keeps this requirement in their scope of practice request. Inclusion of the ability of an athletic trainer to provide immediate and emergent care in an acute situation without standing orders (i.e. a road race) There may be cases in which an athletic trainer is working at an event without standing orders. This proposed change will allow the athletic trainer to provide immediate and acute care to help individuals until emergency medical services and transport arrive. P a g e |3 The CATA made the request for a scope of practice update due to the profession evolving and changes within their education. The current scope of practice was written in the 1990’s, passed by the General Assembly in 2000, and enacted by the Department of Public Health in 2006. At the time the practice act was passed, the educational requirements were being reviewed by the National Athletic Trainers Association Board of Certification (NATABOC) to ensure consistency of the educational process for athletic trainers. One major change by the NATABOC to the educational requirements was that all athletic trainers must graduate from an accredited program in order to sit for the Board of Certification examination. The accreditation requirement ensures athletic trainers have graduated from a program providing education that is meeting national standards established by a peer review board. According to the CATA, other states have updated their athletic training practice acts, or are in the process of updating their practice acts so an athletic trainer can practice to the full extent of their education and training. In Connecticut, athletic trainers practice under the direction of a healthcare provider who is licensed to practice medicine or surgery under chapter 370 of the general statutes, chiropractic under chapter 372 of the general statutes, podiatry under chapter 375 of the general statutes, or naturopathy under chapter 373 of the general statutes. It is the intent of the CATA’s proposal to keep this requirement in place and implement stricter requirements pertaining to standing orders and the athletic trainer’s direction from the healthcare provider mentioned above. CATA asserts the requested scope of practice changes will improve healthcare for the residents of Connecticut, lower healthcare costs, and improve patient outcomes through collaboration of the athletic trainer with other health care practitioners. The CATA developed this scope of practice request, being mindful of concerns of other healthcare groups, and states it has put in place safeguards to protect the public and address those concerns. The CATA asserts the athletic trainer brings a unique skill set and collaborative nature to a comprehensive wellness team. The CATA is not intending to replace or restrict any other healthcare provider through this scope of practice request. A scope of practice review committee was established to review and evaluate the request as well as subsequent written responses to the request and additional information that was gathered through the review process. The literature reviewed throughout the committee process focused on the educational changes and accreditation, standards of professional practice, and the potential to increase public access to healthcare while lowering costs. All members of the review committee agreed athletic trainers provide a valuable service to the athletic population, and an aspect of this request would increase the athlete population’s P a g e |4 access to health care, especially younger athletes who may be participating in sports that meet less than three times per week. However, members of the committee continued to express concerns about 1) replacing the term athlete with “physically active individual”, 2) the education and training an athletic trainer receives, and 3) the broadness of the scope of practice request. Background Connecticut General Statutes Section 19a-16d through 19a-16f provides health care professionals a process to submit a request to the Department of Public Health to revise or establish a scope of practice prior to consideration by the General Assembly. Under the provisions of this statute, persons or entities acting on behalf of a health care profession that may be directly impacted by a scope of practice request may submit a written impact statement to the Department of Public Health. The Commissioner of Public Health shall, within available appropriations, establish and appoint members to a scope of practice review committee for each timely scope of practice request received by the Department. Committees shall consist of the following members: 1. Two members recommended by the requestor to represent the health care profession making the scope of practice request; 2. Two members recommended by each person or entity that has submitted a written impact statement, to represent the health care profession(s) directly impacted by the scope of practice request; and 3. The Commissioner of Public Health or the commissioner’s designee, who shall serve as an ex-officio, non-voting member of the committee. Scope of practice review committees shall review and evaluate the scope of practice request, subsequent written responses to the request and any other information the committee deems relevant to the scope of practice request. Such review and evaluation shall include, but not be limited to, an assessment of any public health and safety risks that may be associated with the request, whether the request my enhance access to quality and affordable health care and whether the request enhances the ability of the profession to practice to the full extent of the profession’s education and training. Upon concluding its review and evaluation of the scope of practice request,