File No. 568

Senate, April 18, 2011

The Committee on Public Health reported through SEN. GERRATANA of the 6th Dist., Chairperson of the Committee on the part of the Senate, that the substitute bill ought to pass.

AN ACT CONCERNING THE PRACTICE OF ATHLETIC TRAINING.

Be it enacted by the Senate and House of Representatives in General Assembly convened:

Section 1. Section 20-65f of the general statutes is repealed and the following is substituted in lieu thereof (Effective October 1, 2011):

As used in this chapter:

(1) "Athletic training" means (A) the application or provision, with the consent and under the direction of a health care provider, of [(A) principles, methods and procedures of evaluation, prevention, treatment and rehabilitation of athletic injuries sustained by athletes] (i) risk management and injury prevention services, (ii) clinical evaluation and assessment services, (iii) treatment services, and (iv) rehabilitation and intervention services for emergency, acute and chronic athletic injuries, (B) the application or provision of (i) appropriate preventative and supportive devices, temporary splinting, [and] bracing and casting, (ii) physical modalities of heat, cold, light, electric stimulation, massage, [water, electric stimulation, sound,] aquatic therapy, sound, therapeutic exercise, and [exercise equipment,] (iii) other modalities as prescribed by a health care provider, (C) the organization and administration of athletic training programs, [and] (D) education and counseling to athletes, coaches, medical personnel and [athletic communities] the community in the area of the prevention and care of athletic injuries, and (E) wellness care services that are developed and applied in the treatment of asymptomatic clients. [For purposes of this subdivision, "health]

(2) "Health care provider" means a person licensed to practice medicine or surgery under chapter 370, chiropractic under chapter 372, podiatry under chapter 375 or natureopathy under chapter 373;

[(2)] (3) "Athletic injury" means any [injury] clinical condition sustained [by an athlete as a result of such athlete's participation in exercises, sports, games or recreation] as a result of an individual's participation in activities requiring strength, agility, flexibility, range of motion, speed or stamina, or any comparable [injury] clinical condition that prevents such [athlete] individual from participating in [any] such activities, or a clinical condition for which athletic training services are an appropriate course of treatment as determined by a health care provider;

[(3) "Athlete" means any person who is a member of any professional, amateur, school or other sports team, or is a regular participant in sports or recreational activities, including, but not limited to, training and practice activities, that require strength, agility, flexibility, range of motion, speed or stamina. For purposes of this subdivision, "regular" means not less than three times per week;]

(4) "Wellness care" means services related to injury prevention, conditioning, strength training and fitness;

[(4) "Standing orders" means written protocols, recommendations and guidelines for treatment and care, furnished and signed by a health care provider specified under subdivision (1) of this section, to be followed in the practice of athletic training that may include, but not be limited to, (A) appropriate treatments for specific athletic injuries, (B) athletic injuries or other conditions requiring immediate referral to a licensed health care provider, and (C) appropriate conditions for the immediate referral to a licensed health care provider of injured athletes of a specified age or age group;]

(5) "With the consent and under the direction of a health care provider" means the issuance of written standing orders that (A) provide protocols, recommendations or guidelines for the treatment and care of individuals participating in professional, amateur or school sports or recreational activities, (B) are furnished by a health care provider, and (C) are followed in the practice of athletic training while under the oversight of a health care provider;

(6) "Written standing orders" means written protocols, recommendations or guidelines for the treatment and care of individuals that (A) are furnished by a health care provider, (B) are followed by an athletic trainer while under the oversight of such health care provider, (C) are periodically reviewed by the health care provider and the athletic trainer, and (D) may be renewed annually. Written standing orders include, but are not limited to, appropriate treatments for (i) specific injuries, (ii) injuries or other medical conditions requiring immediate referral to a health care provider, (iii) conditions necessitating the immediate referral to a health care provider of individuals of a certain specified age or age group, and (iv) treatment and management of traumatic brain injuries;

(7) "Oversight" includes, but is not limited to, (A) continuous availability of direct communication either in person or by radio, telephone or other mode of telecommunication between a health care provider and an athletic trainer, (B) a health care provider's active and regular review of the athletic trainer's activities to ensure that such provider's directions are being implemented and to support the athletic trainer in the performance of his or her services, (C) a health care provider's personal review of the athletic trainer's services on a regular basis in order to ensure quality patient care, (D) delineation by a health care provider of a predetermined plan for emergency situations, and (E) designation of an alternate health care provider to provide oversight to the athletic trainer in the place of a supervising health care provider; and

[(5)] (8) "Commissioner" means the Commissioner of Public Health.

Sec. 2. Section 20-65h of the general statutes is repealed and the following is substituted in lieu thereof (Effective October 1, 2011):

(a) Each person who practices athletic training [under standing orders] with the consent and under the direction of a health care provider shall make a written or oral referral to a [licensed] health care provider of any [athlete] individual who has an athletic injury whose symptoms have not improved for a period of four days from the day of onset, or who has any physical or medical condition that would constitute a medical contraindication for athletic training or that may require evaluation or treatment beyond the scope of athletic training. [The injuries or conditions requiring a referral under this subsection shall include, but not be limited to, suspected medical emergencies or illnesses, physical or mental illness and significant tissue or neurological pathologies.]

(b) Each person who practices athletic training, but [not under standing orders] who does so without the specific consent and direction of a health care provider, may perform an initial evaluation and temporary splinting and bracing of any [athlete] individual with an athletic injury and shall, without delay, make a written or oral referral of such [athlete] individual to a [licensed] health care provider. The limitations on the practice of athletic training set forth in this subsection shall not apply in the case of any [athlete] individual that is referred to such person by a [licensed] health care provider, provided such practice shall be limited to the scope of such referral.

Sec. 3. Section 20-65i of the general statutes is repealed and the following is substituted in lieu thereof (Effective October 1, 2011):

A license to practice athletic training shall not be required of: (1) A practitioner who is licensed or certified by a state agency and is performing services within the scope of practice for which such person is licensed or certified; (2) a student [intern or trainee] pursuing a course of study in athletic training, provided the activities of such student [intern or trainee] are performed under the supervision of a person licensed to practice athletic training and the student [intern or trainee] is given the title of ["athletic trainer intern"] "athletic training student", or similar [designation] title as designated by the Commission on Accreditation of Athletic Training Education or its successor organization; (3) a person employed or volunteering as a coach of amateur sports who provides first aid for athletic injuries to athletes being coached by such person; (4) a person who furnishes assistance in an emergency; or (5) a person who acts as an athletic trainer in this state for less than thirty days per calendar year and who is licensed as an athletic trainer by another state or is certified by the Board of Certification, Inc., or its successor organization.

Sec. 4. Section 20-65j of the general statutes is repealed and the following is substituted in lieu thereof (Effective October 1, 2011):

(a) Except as provided in [subsections (b) and (c)] subsection (b) of this section, an applicant for a license to practice athletic training shall have: (1) A baccalaureate degree from a regionally accredited institution of higher education, or from an institution of higher learning located outside of the United States that is legally chartered to grant postsecondary degrees in the country in which such institution is located; and (2) current certification as an athletic trainer by the Board of Certification, Inc., or its successor organization.

(b) An applicant for licensure to practice athletic training by endorsement shall present evidence satisfactory to the commissioner (1) of licensure or certification as an athletic trainer, or as a person entitled to perform similar services under a different designation, in another state having requirements for practicing in such capacity that are substantially similar to or higher than the requirements in force in this state, and (2) that there is no disciplinary action or unresolved complaint pending against such applicant.

[(c) Prior to April 30, 2007, the commissioner shall grant a license as an athletic trainer to any applicant who presents evidence satisfactory to the commissioner of (1) the continuous providing of services as an athletic trainer since October 1, 1979, or (2) certification as an athletic trainer by the Board of Certification, Inc., or its successor organization.]

The following Fiscal Impact Statement and Bill Analysis are prepared for the benefit of the members of the General Assembly, solely for purposes of information, summarization and explanation and do not represent the intent of the General Assembly or either chamber thereof for any purpose. In general, fiscal impacts are based upon a variety of informational sources, including the analyst's professional knowledge. Whenever applicable, agency data is consulted as part of the analysis, however final products do not necessarily reflect an assessment from any specific department.

OFA Fiscal Note

State Impact: None

Municipal Impact: None

Explanation

The bill, which revises certain athletic training-related statutes, does not result in a fiscal impact to the Department of Public Health.

The Out Years

State Impact: None

Municipal Impact: None

OLR Bill Analysis

sSB 1051

AN ACT CONCERNING THE PRACTICE OF ATHLETIC TRAINING.

SUMMARY:

This bill expands the scope of practice of athletic training by allowing athletic trainers to (1) serve individuals other than athletes and (2) provide more services to such individuals directly, without the consent and direction of a health care provider. It also (1) redefines “working with consent and under the direction of a health care provider” and “standing orders,” (2) broadens the definition of “athletic injury,” and (3) clarifies the licensure exemption for athletic training students. And it makes technical changes.

EFFECTIVE DATE: October 1, 2011

ATHLETIC TRAINERS

Scope of Practice

Under current law, athletic trainers work only with athletes who suffer injuries while exercising or participating in sports or recreational activities. It defines an “athlete” as someone who participates at least three times a week in sports or recreational activities, including training and practice, or is a member of a sports team.

The bill allows an athletic trainer to serve anyone, not just athletes and provide more services to individuals. It eliminates the definition of athlete and redefines “athletic training” to mean applying or providing, with the consent and under the direction of a health care provider, (1) risk management and injury prevention service; (2) clinical evaluation and assessment services; (3) treatment services; and (4) rehabilitation and intervention services for emergency, acute, and chronic health injuries. (By law, “health care provider” means a licensed physician, chiropractor, podiatrist, or naturopath.)

The bill also allows an athletic trainer to perform the following without the consent and direction of a health care provider to apply or provide: (1) appropriate preventive and supportive devices, temporary splinting, bracing, and casting and (2) physical modalities of health, cold, light, electric stimulation, massage, aquatic therapy, sound, and therapeutic exercise. Under the bill, an athletic trainer can perform other modalities as prescribed by a health care provider.

The bill allows athletic trainers, without the consent and direction of a health care provider, to (1) organize and administer athletic training programs; (2) provide education and counseling in the community, not just to athletes, coaches, and medical personnel as under current law; and (3) provide wellness care services developed and applied in the treating asymptomatic clients. “Wellness care” means services related to injury prevention, conditioning, strength training, and fitness.

The bill broadens the definition of “athletic injury” to mean any clinical condition, not just an injury, sustained as a result of an individual's (not just an athlete's) participation in activities requiring strength, agility, flexibility, range of motion, speed or stamina, or any comparable clinical condition (1) that prevents the individual from participating in such activities or (2) for which athletic training services are appropriate as determined by a health care provider.

Standing Orders

Under current law, an athletic trainer practicing under standing orders from a licensed physician, podiatrist, naturopath, or chiropractor must make a written or oral referral to the provider if an athlete's symptoms do not improve within four days. Trainers must also refer when (1) athletic training methods are contraindicated for an athlete's physical or mental condition or (2) an athlete's condition requires evaluation and treatment beyond the scope of athletic training. “Standing orders” are written protocols, recommendations, and guidelines for treatment and care in athletic training practices. The may include appropriate treatments for specific athletic injuries, injuries and conditions that require immediate referral, and appropriate conditions for immediate referral by various age groups.

Under current law, athletic trainers who are not practicing under standing orders may only perform initial evaluations or temporarily splint or brace an injured athlete. They must refer injured athletes to a provider without delay.

Under the bill, an athletic trainer who formerly practiced under standing orders is now considered to be practicing “with the consent and under the direction of a health care provider.” The bill defines this as practicing under written standing orders that (1) have protocols, recommendations, or guidelines for treating and caring for individuals participating in professional, amateur, or school sports or recreational activities; (2) are furnished by a health care provider; and (3) are followed in athletic training practice while under a provider's oversight.

It defines “written standing orders” as written protocols, recommendations, or guidelines for the care and treatment of individuals that (1) are furnished by the provider, (2) are followed by an athletic trainer while under the provider's oversight, (3) are periodically reviewed by the provider and trainer, and (4) may be renewed annually.

The bill defines “oversight” as

1. the availability of continuous direct communication, either in person, or by radio, telephone, or other mode between a trainer and provider;

2. a provider's active and regular review of the trainer's activities to ensure that his or her directions are being implemented and to support the trainer's performance;

3. a provider's regular personnel review of the trainer's services to ensure quality care;

4. delineation by a provider of a predetermined plan for emergency situations; and

5. designation of an alternative provider to provide oversight in place of the supervising provider.

Under the bill, those athletic trainers who practice without the specific consent of the provider (i.e. not practicing under standing orders under current law), can continue to perform an initial evaluation and provide temporary splinting and bracing , but of any individual, not just an athlete. As under current law, the trainer must make a written or oral referral without delay.

Licensure Exemption for Athletic Training Students

Under current law, a student intern or trainee in an athletic training program, identified as an “athletic trainer intern,” and supervised by a licensed athletic trainer does not need an athletic trainer's license. The bill revises this exemption by calling the person an “athletic training student” or similar title as designated by the Commission on Accreditation of Athletic Training Education or its successor.

COMMITTEE ACTION

Public Health Committee

Joint Favorable Substitute