Senate Jt Leg Business — 2026-03-24

Good morning, everybody. Welcome to the third and final Sunset Review oversight hearing, which is once again being held jointly by the Assembly Business and Professions Committee and the Senate Committee on Business, Professions and Economic Development. Today we will be hearing from five entities responsible for overseeing regulated professionals in California. The Respiratory Care Board, the California Council for Interior Design, the Speech Language Pathology and Audiology and Hearing Aid Dispensers Board, the Board of Occupational Therapy, and the Board of Naturopathic Medicine. For each portion of today's hearing, we will begin by hearing from representatives of the entity under review. Next, we will open the discussion up for questions or comments from committee members. Finally, we will invite other interested stakeholders here in the room to provide public comment. Speakers will be limited to a maximum of two minutes per organization. In the interest of time, additional speakers making substantially similar comments will be asked to simply provide their name and state their alignment with prior testimony. I am looking forward to a productive discussion today and would like to thank committee staff for all their hard work throughout this process. Before we begin. I will. I take that back. We are just going to begin. So today's hearing will begin with representatives of the Respiratory care. Good morning. Today's hearing will begin with representatives of the Respiratory Care Board. Testifying today is Ricardo Guzman, Board President, and Christina Molina, Executive Officer. And we are ready whenever you are. Come on up. Thanks so much.

Thank you, President Guzman. Good morning, Chair Berman and members of the Committee. My name is Ray Hernandez and I am the Vice President of the Respiratory Care Board and serve as Chair of the Board's Professional Qualifications Committee. This year marks my 40th year of being a respiratory care practitioner and a native of California. I've been a licensed respiratory care practitioner for 40 years. As stated, I've worked in the hospital setting caring for neonatal and pediatric patients and have been an educator and administrator for the community college system for the past 20 years. The professional Qualifications Committee is responsible for reviewing and developing requirements related to education, continuing education, and professional ethics for licensure. In carrying out this work, we closely monitor advancements in health care, emerging technologies, and evolving care delivery models to ensure our standards remain current and most importantly, continue to protect patients receiving respiratory care services. In this role, I've had the opportunity to help lead several of the Board's recent initiatives aligned with the Strategic Plan, most notably the assessment of whether a Bachelor's degree should be incorporated into the Respiratory Care act to ensure licensees are prepared to meet the increasing complexity of patient care and to further strengthen consumer protection. As another recent example of the Committee's work included a public meeting where we heard testimony and subsequently issued updated guidance on suctioning practices under our Basic Tasks Regulation, an effort aimed at reducing ambiguity, reinforcing appropriate clinical boundaries, and ensuring care is delivered appropriately and safely in healthcare settings and throughout the community. I look forward to answering any questions of the Committee's work, including our assessment of the entry level, educational requirements and other consumer protection focused initiatives. I'm now going to hand it over to Christine Molina, who's our Executive Officer.

Thank you very much for the presentation. I'm going to kick it over to my colleague, Assemblymember Addis, and then colleagues. Please just get my attention if anyone else has any other questions.

Thank you for that question. We've been exploring having meetings with our board open to the public. And we started that back in June of 2021. So this hasn't been something that's all of a sudden this is where we need to go. And it really started with our national professional organization, the American association for Respiratory Care. And back in 2015, they started all the work with first looking at where the profession had been, where it is currently and where it is going. So that was really our starting point. And both our national professional organization and our state professional organization have created vision statements of moving towards a bachelor's degree. So I start with that just to say that's our starting point. And In June of 2021, we started with some board study sessions and really looking at and providing the board an opportunity to see where the profession has been and where we think it's going. And with that, doing some case studies with other healthcare professions such as nursing and physical therapy in particular, to look at those models. And we know for nursing that's always been a big conversation and there have been many different opinions about where that profession is going. So just to say we are looking at the whole landscape. So first and foremost, we understand the need to get people into workforce as soon as possible and be able to serve the public. We know that as we've been moving forward and with my background at the community college level, one of the things that the state legislature has done, which has been awesome, is that they've approved baccalaureate degrees which were originally intended for nursing. And that hasn't come to fruition. Our hope is that it will because they deserve that pathway as well. But that that has launched and we as respiratory care board have been proactive in supporting community college programs to develop a baccalaureate degree. And at this current level, it's a plus two program. I say that lightly because really plus two is a misnomer. At the associate level, students, by the time they complete all of their coursework, they've already accumulated for an associate of science degree, approximately 100 units on average. For an associate of science. There are a few programs across the state that are of applied science which have less general ed and less preparation. But when we look at that associate degree, it's really not too far from a bachelor's already. And one of the things that we saw is we saw that it might take maybe 6 to 12 months more for somebody to complete all of that coursework and have the added skill training and have the added general education that's needed for excellent communication skills and assessment skills. So again, looking at all of that, we did that as a board and engaged in dialogue, did focus groups, surveys to the public, gained feedback. And so all of that is moving towards that piece. Now, I know your question was, what's going to happen with the workforce if it's instituted? And right now this is a really great opportunity. In looking at the workforce in particular for respiratory care, we see that we're meeting the needs. Is that correct, Christine?

Okay. And so should this enact and move forward, it's really a good opportunity. Okay. And so in looking at that, one of the things that our professional qualifications committee also did was we created a plan and a timeline to help with all of that. So it's as streamless as possible. One other note I want to just bring right now with the bachelor's degree is the unintended consequence to that for our profession, and I would say most of the workforce professions that have completed a baccalaureate degree or instituting, that is, it is added, at least for our pathway, it's added 20 plus more units to complete a bachelor's degree. Because once you finish your associate, many of the units that our profession has acquired do not count towards the bachelor's. And for external accreditation, higher education, they require a minimum of 40 units of upper division work. And our associate degrees already, if you look at a second year for respiratory care, most of that coursework, while it's not classified as upper division, it could easily translate to upper division. And by streamlining that process, while it may add just a little more work in terms of time, it really strengthens the process and reduces the total accumulation of units. And I know that's a discussion the legislature has been looking at in terms of 60 units for an associate degree, no more. 120 units for a bachelor's degree, no more. So this would actually help with that.

And I appreciate that clarification. So I think I have two comments to that. The first one is we know in underserved areas for all healthcare providers, it's difficult so not to negate. Well, what does that do for respiratory care? I would say, you know, I think in terms of the data we can get that for you. And I would say the quotes we made were statewide and so it doesn't disaggregate for the underserved communities. I grew up in Fresno and while it is a metropolitan area, it is underserved in general. And I go back there and I see that as well. So I would say two responses to that. One is, again, the legislature has done an excellent job with providing access to education at the community college level. So I think the Respiratory Care Board can continue to work to do two things. One is to provide that access and ensure that the current educational opportunities remain for both public and private. And then the second is to advocate for more programs in underserved areas. And I think that that would be something we could do actively. The second piece I think is important to share with you is, is at a national level, our profession has been looking at increasing the level of education to a bachelor's degree because currently we do not get reimbursed directly for our services. And part of the struggle is that we're classified as a technician because our level of education maintains us at that level. If we can get to a bachelor's degree, then there is the opportunity to go to CMS and advocate to a greater degree to get reimbursed directly. And that I think then proves for respiratory care practitioners then to start serving underserved areas directly.

One last question. It's really the same line on your current caps, or excuse me, on your initial licensing fees versus moving those to your renewal fees. It looks like you're looking at letting go of initial fees and moving that to annual fees and just how that might affect rural areas. If that's expected to help folks get into the profession.

Thank you.

Thank you so much. Rattus, any additional questions or comments from colleagues? Seeing none. A lot of the questions that I had have. I'm going to try to model for everyone. A lot of the questions that I had have already been answered. I want to align my kind of concerns or questions around the bachelor's degree issue with Assembly Member Addis. You know, obviously we want to make sure that our health care professionals are properly qualified. I have concern kind of philosophically. I think as a society we've increased requirements too much and you know, require bachelor's degrees for things that probably don't need bachelor's degrees. I don't know that that applies in this specific instance. That's more a broader kind of philosophical societal trend that I don't think has necessarily benefited anyone. But just keep that in mind as you're doing this analysis and you know, making sure that we're not exacerbating healthcare access challenges in rural areas, not make sure that we're not unnecessarily creating additional barriers to people entering the profession. Because we, you know, we want to be diligent, we want to be responsible, but we don't want to be unnecessarily burdensome. One quick question I have has to do with issue number one around fees. And I noticed in your report that current law requires you to maintain a fund no more than six months in reserves while most other DCA entities have a Runway of two years. Has this kind of anomalous six month cap made it hard to budget?

Thank you for that. And then I know you spoke to the continuing or the analysis and I guess the work that's gone into the LVN issues, just look forward to continued updates on that as that progresses. Yes, with that going to open it up to members of the public. If members of the public will come forward to the microphone that we have at the front. And just a reminder that you have two minutes per organization. And in the interest of time, if they're. If someone else has already kind of said what you were planning to say, please just say I align myself with those comments. Please. Go ahead. Give us one sec.

Perfect.

Thank you very much.

Thank you very much.

Thank you.

Thank you for this opportunity and good morning. My name is Marianne Vozcana and I'm a registered nurse and I have owned and operated a Congregate Living Health Facility or clif, as are sometimes referred to in the Los angeles area since 2012 cliffs are home and community based settings for individuals with chronic disabilities who want to live their lives in the communities and lead lives that are as normal and independent as possible. Many of our residents attend school, participate in community events and even maintain employment. I want to thank the Respiratory Care Board today for working with Cliffs and our association to exempt most CLIFs from the basic respiratory care tasks and services. We appreciate the board recognizing the current regulation does not fit the current CLIF model.

We respectfully want to ask that all Cliffs be exempted from this regulation so that we can continue providing safe, appropriate care while allowing our residents to remain integrated in their communities. Thank you for your time and consideration.

Good morning.

also own and operate a congregate living

continue to work with you in the

facilities with more beds into this carving out process. Thank you very much.

Hi, my name's Court Green.

care that our committee person was referring to.

Good morning everyone.

I'm a nurse practitioner and I would like to thank the board for giving exemptions to Cliffs congregate living health facilities. And I also lead a group of nurses who run a congregate living health facility here in Sacramento. I work in a local trauma medical center and we took care of patients

in the hospital for years because there's too few congregate living health facilities in this area. So thank you for allowing us to for LVNs to take care of those

And just like my colleague has said, please allow other all cliffs to to

Thank you.

Good morning.

I also own and operate congregate living

as you mentioned is severely underserved.

that you guys are able to give us that leniency with the licensed vocational nurses being able to practice even in the larger facilities. Thank you very much for your time.

Good morning Respiratory Care Board. Thank you for your commitment to the safety and protection of medically fragile Californians. The right to breathe and the ability to breathe is something all of us take for granted, but we all need to have access to. And what has happened for the last four decades is LVMS has helped that continue for medically fragile children like Eliza here for decades. And it's not just vent and trach which she does have, but it's also suctioning, it's also putting on immediate oxygen after a seizure just to stabilize what we're asking here, and we're so grateful for, the respiratory Care Board is creating a pathway of skilled nursing oversight and training from an employer based setting. And we look forward to building that with you so that kids like Eliza from 0 to 100 can remain in their communities and thriving. And thank you for protecting that right.

Good morning chair and the board, it's an honor to speak with you and thank you so much for everything you're doing to resolve this matter. Eliza is a 10 year old. She's my daughter. She's a fourth grader at Mickey Cox Elementary. She's had the trach since two months old old. She was born with a spontaneous genetic disorder called Pfeiffer syndrome. So her lungs are totally fine, but her nasal passages are fused so trach was necessary. We have met so many nurses, 50, 60 within, you know, in 10 years of Eliza's life. And we have Learned from the LVNs how to take care of Eliza and they've been excellent. They're trained, they know how to do a breathing treatment, they know how to suction the trach, they know how to take turn on the vent. It's not like they're changing the settings on the vent. And there are plenty of checks and balances from the valet, children's home care. The respiratory therapist does come out to the house and checks the vent every month. So it's not like LVNs cannot push the button to turn on the vent at night to give her that air. And Eliza does go to school and she has one on one nurse, LVN nurse. And if lvn cannot section the trachea and she cannot go to school, what would that be? Would that mean that she has to live in the hospital? Because we cannot, we need help at home, we need nursing help at home to have that respite. But Eliza is a joyful little girl. She loves life, she loves her friends at school. And in October, and when everything came down and we couldn't have a nurse at home and we couldn't take Eliza to Loretta's little miracles, that was hard. That was very hard. So we thank you so much for everything you're doing and hearing us out as parents and we're representing other families too. So thank you. We appreciate your attention to this. Thank you.

Greetings to the committee and to the respiratory care board.

He couldn't be here today because he

Thank you.

Is that better?

All right.

Thank you, Chair Members of the committee. My name is Rose Wiebe. I'm the executive officer of the California Council for Interior Design Certification. Thank you for the opportunity to appear before you today and for the careful review of our sunset review report. For more than 35 years, California has made a deliberate policy choice to regulate interior design through a title act. CCIDC fulfills that role by establishing and enforcing standards for education, experience and examination that ensure certified interior designers are competent to perform work impacting public health, safety and welfare. CCIDC operates as a self funded, efficient and transparent organization with open meetings, public participation and ongoing legislative oversight. Through the sunset review process, the program is appropriately scaled to the statutory purpose and continues to function as intended. CCIDC certification framework is working. It protects the public, it establishes competency standards and should be continued. The legislature has consistently applied the same standard in evaluating if there has been demonstrated harm to the public that justifies additional regulation. The record shows that there is no pattern of consumer harm associated with interior design practice under the current framework. Complaints are minimal and none have involved any threats to public health, safety or welfare. At the same time, certified interior designers are required to demonstrate competency through the education experience and the passage of the IDEX exam. The only California examination that's comprehensive, California specific, and tests not only on building codes and regulations, but design standards, professional practice, business practices and ethics, accessibility and life safety requirements. The examination is developed and continuously updated by a comprehensive team of subject matter experts, including collaboration with the International Code Council, which is the council that develops the actual codes and it is independently validated and administered by psychometricians and using standards that are consistent with state regulatory expectations. With respect to stamp acceptance, the evidence shows that it's not a systemic issue, but one of inconsistent interpretation that can be addressed through statutory clarification and outreach rather than regulatory change. Finally, on the question of licensure, CCIDC's position is clear. Licensure is a significant regulatory expansion and it should only be considered the sunrise review process that standard has not been met. Licensure would create barriers to entry for a large portion of the existing workforce, increasing cost and restricting access to the profession without a demonstrated public protection benefit. CCIDC also notes that recent licensure proposals were developed without any consultation with the entity responsible for administering the current framework. Engagement with CCIDC is important to ensure that proposals reflect how the system operates in practice and the impacts on both practitioners and the public. In closing, CCIDC is a program that is working well, working as intended. It is effective, proportionate, transparent and aligned with legislative intent. There is no demonstrated need to replace it. CCIDC respectfully recommends continuation of the program and ongoing review through the sunset review process. I thank you and I'm happy to answer any questions.

thanks so much Mr. Chair. Appreciate the testimony here today. I want to play devil's advocate for a moment. According to this background white paper we have here, I just want to quote while the phrase interior design is commonly associated with decorative services focused exclusively on visual elements such as furniture arrangements arrangements or wall colors, CIDs utilize considerable technical knowledge to ensure that indoor spaces are safe and functional in addition to aesthetically pleasing. You noted that the current system's working minimal complaints. What would you say to this idea that, you know, according to this white paper, that they are obviously, you know, functionally serving to provide safety? Not just what I think the average Californian thinks of an interior designer not having CCIDC to have enforcement authority, for example, for when things do go wrong, not having consistent training, not having competency standards? What would you say to the question that an overhaul of the system is needed and we need more compliance because of the safety aspect and not Just a voluntary compliance, as is other elements of what we do and how we regulate. These businesses are different professions. Why? Can you dig a little bit deeper for me and sort of explain why? Just because, for example, we get a lot of these sort of. We know a lot of these complaints, for example, are sometimes unreported in a sort of voluntary system. So there's no real way to track certain issues if it's a. If it's voluntary. I'm just wondering if you can speak to some of those.

But how if it's a voluntary system, if we're not, how are we track. You know, we're only tracking it based on the complaints that you get.

And when you have these complaints, since they're, you know, CCIDC notes that they don't have enforcement authority when. Or ability to issue fines or et cetera. When you do have these complaints come up, what is the remedy if there is no enforcement authority?

But it's a voluntary certification.

Okay.

So currently in California, there's over 8,500 interior designers practicing. And that's from statistics that we've pulled from the labor board. Out of that, approximately 1700 are certified under the voluntary system. There's still an additional group of people that have been practicing for decades.

Correct. Have been practicing for decades without proven public harm. There have not been lawsuits. There have not been issues. You know, we've seen, like fires in warehouses that have occurred do not occur because of interior designers. That's not who created those. So if there were public harm, it would be reported, and there's not been any public harm reported.

There's no. There's 8500 total. Of that, 1700 are certified.

And under the current licensing proposal that's out there, approximately 600 would qualify under that. So it'd be even less than what's certified.

It's really. You know, there's some. I'm sure people here that can explain their situation, but there's other avenues that they're taking that work for them. And without proven consumer harm, we don't understand why it would need to be more regulated.

But currently, the vast majority of the industry in California is not certified.

they don't see the need for that,

In my experience, relying on individuals to determine if they should be certified or not usually isn't conducive with, you know, making sure that we have set standards for safety reasons. So that's just sort of my only concern. But Mr. Chair, I'll just wrap up by saying would love to learn more and perhaps set up a meeting outside the committee.

If I could just quickly add, you know, we do have requirements for certification. There are educational requirements, there's our work experience requirements, and there is examination requirements.

Enforceable to become certified, yes.

But it's not that you're not required to be certified, correct?

Okay, thank you.

Thank you. Mr. Chair, given that only a portion of your certified interior designers hold the commercial designation, can you provide empirical evidence on what percentage that represents and demonstrate whether this designation has resulted in consistent acceptance of plans by local jurisdictions without additional license sign off, and if not, what problem the designation has actually solved?

Well, you said something that they all came together, but it wasn't meant to solve the problem.

So just so I'm understanding, even with this education, if you have an interior designer do this project, you're still going to have to seek other approvals from an architect before there's sign off on the plan.

Okay, so then what's. What you said there was 16 project denials. What are things denied for?

So I would argue though, that licensure in this particular case would clear up that ambiguity that you're talking about, that there's not consistency and you do have these projects kicked back. But how many of your currently certified interior designers hold the commercial designation? And what percentage of your total certificate holders does that represent?

Okay, I can't do quick math.

And that doesn't mean that if you're just a CID and not a commercial CID that you cannot submit commercial stamped drawings. That's just an identifier to the building departments that you have the experience, et cetera, in commercial work. It doesn't deny you, it doesn't bar you from, from doing that. But if I can just add, even with licensure, there is no guarantee Your plans are going to be accepted. Every building department is its own jurisdiction and they have the ability to deny drawings. Regardless if you're licensed, regardless if you're a cid, regardless if you're the general public, they have the ability to, you know, to do that. So it's not a guarantee. Licensure is not a guarantee that your drawings are going to get accepted. Even if you're an architect, even if you're a structural engineer, you have to meet requirements.

Sure.

Yes, but that stamp is different than my mom's PE engineering stamp.

Do me a favor and let the assembly comments. Thank you very much.

You.

Meaning if they were new to apply or they were already a CID and

Correct.

certified currently if they didn't meet the minimum education and experience requirements?

So it's a minimum. It's a combination of six years of education. And it's minimum of 40 core units plus the additional. If you have, it's on a scale kind of similar to the architect's board. If you have 40 core units, then you need to have an additional four years of experience. If it's 60, it's three and three. So it goes on. It's on a scale of 44 years, 63 years, 80. And that's in core units, not in the other things. It has to be specific to interior design for those units.

Thank you very much. Turn it over to Vice Chair Johnson.

Good morning. I'm going to keep it brief. Some of my questions.

I have a quick statement and then a follow up. So I'm seeking to understand, and the

And I think what I'm worried and

or the accountability for that a state

So I'm not sure that I understand the model correctly.

looking to understand that and then for some follow up. I come from local government, so I'm very familiar with some of these challenges

Can you give me evidence that has led to consistent acceptance of these plans by local jurisdictions without requiring any additional

Certainly I think that we're only able to report on what is reported to us of the 16 that we have. But on the other hand, we don't have reporting of people not having it accepted. Does that make sense? So for us, we can only report on what we've been told we have not gotten any numbers, any substantial numbers, any valid numbers of people that are not having plans accepted elsewhere. So we continuously work with the International Code Council, with the building officials to do the educating, and we don't have. There's no concrete numbers in opposition to what we have.

Again, we can't report on what we have and we don't have. So, yes, obviously that we don't have that information.

Yeah. I really would like to see that

There's a need for it, and that the certification is helpful versus hurtful. Like as far as if they're needing an additional someone to sign off.

I don't understand that being helpful.

Yeah.

willing to hold so for additional conversation outside of this. Okay, thank you.

I need.

Hi. Thank you.

I'm looking over the backgrounder, and I'm

the ED salary that it's recommended.

So what is the current compensation?

Okay.

Thank you.

Certainly we went to 100% Zoom meetings when Covid happened and then we found that our participation remained so significantly much higher than when we were holding it in different parts of the state. We're talking from having maybe five to 15 people attend a meeting when they were held across the state versus close to 100 people when we held it on Zoom. So we felt like that was we were reaching more people. We were able to reach more people if we held them that way. But we're happy to review what the Bagley King law says and make adjustments as according as necessary.

Good morning. My name is Janice Plessis and I am an allied professional practitioner with asid. I'm the current chapter president for NKBA here in Sacramento. And I'm also sit on the board for clcid, which is the California Legislative Coalition for Interior Designers. I am not a certified interior designer, but I'm here on behalf of to support the CCIDC because I think their function is very important. I think the system as a voluntary system has been working for decades. And many of us make a decision somewhere along the way that we want to go into residential versus commercial design. But as you know, things change and I do some amount of work that has, has been and continues to be in the commercial realm, whether it's in hospitality, clubhouses, that kind of thing, as well as residential design. Residential design. We also submit plans and we have to put them before the same building officials. They have to meet the same requirements. And we work with contractors, architects. And I think that this is a very nuanced thing. The thing that is disturbing to me is bifurcating interior design into two separate practices. Residential versus commercial. And we all have to know different things at different periods of time. I've gone more into commercial because there was no residential work. Now things are more residentially focused primarily because of COVID and so I'm doing more residential work. So it's been allowed me to have a great deal of flexibility being associated with these other design associations, especially asid. I still have to maintain a certain amount of professional standards. I have to have a certain amount of education and I still have to continue that education. And I also foster that. Foster that as being a chapter president for our local NKBA chapter. So I appreciate you considering keeping things as they are. There is no, in my estimation, public harm, public safety and so issue. So I would encourage you to consider keeping things like there.

Thank you.

My name is Linda Panettone. I'm past president of clcid which is the California Legislative Coalition for Interior Design. I have supported CCIDC for the last 25 plus years, promote their professionalism and what they stand for. I think it's important that all designers have provide the certification and that they are able to know the codes for California. And the IDEXX is one that promotes codes both for residential and commercial and the flexibility of being able to choose which way you want to go. As an interior designer, I've done a little bit of both over my years. But I'm also certified through NKBA and NARI which is the remodeling association. I do permit ready plans for residential at this time in my career. I support what CID has done over the years and I hope you will support them also.

Hi folks.

Thank you very much.

to meet other small businesses where they

meant I had to close my doors

Thank you.

I am an interior designer. Certified interior designer with a commercial designation. I am also serving as the president of the California Legislative Coalition for Interior Designers. And I want to let you know I practice in Los Angeles. I have my own small firm, and with my commercial designation stamp, I'm able to pull permits across the state in

I'm holding here a set of plans by a fellow certified interior designer on the 16th floor of a project on K Street a few blocks from here. So the system does work. If there are any questions that you all have about our ability to practice independently of other design professionals, I would love to continue that conversation with you. Thank you.

Hello, and thank you to the committee and the chairs for your time today.

Oliver and I'm interior designer at DEFCON Construction in Silicon Valley. I'm an ncidq holder and 2025 emerging leader for IIDA, Northern California. I grew up in Louisiana with both my parents in the design industry there. Having a license as an interior designer is normal. I dreamed of a day, of one day, having my own practice here in California. I realized that CCIDC misrepresents their certification as a license, saying things like hundreds of thousands of permits are pulled by CIDs every year or that the CID

These statements confuse practitioners like me from

the failed structure of a private board in California. I need my state to support me as an emerging professional. Instead, all I found is confusion. I strongly encourage the committee to determine if CCIDC is serving in the best interest of the public and young practitioners like me. Thank you again for your time.

Have you hit the button.

Okay.

Okay. Thank you. Good morning, Chairman Berman and joint committee members. My name is Gilda Dominguez and I'm a California licensed and nationally certified speech language pathologist and chair of the Speech Language Pathology and Audiology and Hearing Dispensers Board. Here with me today is Board Vice Chair Amy White, Doctor of Audiology and California Licensed Audiologist and Charisse Burns, Executive Officer of our Board. We want to thank the Joint Committee for the opportunity to speak with you today about the significant improvements the Board has made over the last four years. Our Three Professions as you have read, the Board serves to protect consumers and the public by licensing and regulating the professions of speech, language pathology, audiology and hearing aid, dispensing three separate and distinct professions with their own scope of practice. The Board's licensees provide speech and hearing services to California consumers of all ages from newborn hearing screenings and public school children receiving speech therapy and cognitive services to adults receiving post stroke rehabilitation care and senior citizens suffering from hearing loss receiving hearing screenings and hearing aid fitting services. The Board sets entry level licensing standards including education, examination and professional experience requirements as appropriate and ensures that licensees meet minimum qualifications to deliver appropriate speech and hearing health services. This is critical due to the potential harm to consumers of all ages. There is a growing need for these professions. The Board's licensing population continues to grow and is now over 44,500 individuals and entities nationally. The need for speech and hearing professionals is expected to grow anywhere between 9 to 18% by 2034, with the California growth rate expected to be even higher. Factors contributing to the demand include special education services in California's public schools, hearing loss detection via the newborn hearing screening program, and the aging population that will experience hearing loss, suffer strokes, cognitive decline and other debilitating illnesses. This increased consumer demand for speech and hearing services will make the Board's role even more critical to ensure the safety and efficacy of these professions over time. I'd like to share some of the Board's accomplishments since the last sunset review. The Board's most significant achievement since our last set review was a successful completion of our Board's modernization project for initial licensure applications, which provided applicants with a streamlined and user friendly licensure process that allows them to submit their application and payment online as well as check the status of their license application remediate deficiencies through the application system. This project also allowed the Board to review, streamline and automate many internal staff processes leading to a 71% reduction in application processing times within two years of implementation. Overall enhanced staff efficiency and increased workload capacity of approximately 32%. The streamlining of the application process and staff workload has enabled the Board to successfully meet the continued increase in application workload over the past four years. The Board hopes to be able to engage in a business modernization project for its enforcement and administrative functions in the future and is ready and willing to initiate this work once Board and departmental resources allow. Since the last sunset review, the Board has also been able to obtain additional staffing for its enforcement unit through the budgetary process, which enabled the Board to start ongoing continuing education audits of 5% of its licensees. The Board began ongoing continuing education audits in fiscal year 20242025 and has completed 249 audits since that time and is in the process of completing an additional 135 audits by the end of this fiscal year. Currently, the average failure rate for the continuing education audits is about 28%, resulting in the Board spending considerable time educating licensees regarding the Board's requirements as well as engaging in the Board citation and fine process for violation of these requirements. Both the Board Vice Chair, Executive Officer and I have provide educational opportunities with groups of licensees to help educate licensees on the Board's requirements. We strongly believe that the Board's educational efforts will result in a reduction of continuing education audit failures over the next few years. On the regulatory side, the Board continues to work on updating its regulatory framework. Since our last sunset, we have successfully strengthened supervision requirements for both speech language pathology assistance and required professional development licensees, updating continuing education requirements for licensees and enacted additional consumer protection measures against false, fraudulent, misleading and deceptive advertising practices in hearing aid sales. There is a need for the Board Overall. The Board has shown itself to be a good steward of its limited resources, successfully leading a small but mighty team of public servants to achieve the most effective administration possible over the mission critical responsibilities of the Board. We continue to do everything in our power to create efficiencies and cost savings where we can while strongly enforcing the Board's laws and regulations to protect California consumers of speech and hearing services. To that end, we strongly urge the Joint Committee to recommend the continued regulation of the practices of speech language pathology, audiology and hearing aid dispensing by the Board. We are pleased to take any questions at this time.

No.

Yes, I'd like to take that one. So I've been an audiologist for almost 20 years, working in a variety of environments, owning my own private practice, working in major healthcare settings, working at the va, working in university settings. So I can speak to having help in the clinic from different levels of support. So the audiology practice committee and then the full board discussed this issue and is very supportive of the creation of this audiology assistant license type. We currently have an audiology Aiden category that is not licensed and has led to, you know, limited use by audiologists due to those individuals not having significant education or training and therefore not being able to be unsupervised in any way to assist in the clinic. So I see many people wearing glasses here. So audiologists, you know, a lot of people don't really understand what an audiologist's clinic might look like or operate like, but it's unlike an optometry office right now. When you go to get your eyes checked, you generally will see an optometric assistant to do the screenings and the general annual type of tests. Then you will meet with the optometrist who will create your prescription and create the plan. Make sure that there's no medical need for you to continue on to an ophthalmologist or other medical professional, and then they'll send you out to the optician who will fit your prescription. Make sure everything is comfortable, and you may go back and see them a few times. So those support staff, those support assistants that are educated and trained, is what audiology really needs. Currently, the audiologist sees the patient for all of that from start to finish. So every patient encounter is probably about an hour on average. So if you can imagine, the load of patients that can get through an audiologist's door in a day is much smaller than what an optometrist, for example, can handle. We know that the demand for audiology services is there. We have a lack of access. There's only 2,500 audiologists in this state for 39 million residents. We know 65% of adults over the age of 70 have hearing loss. And we know that over 1,000 babies are identified every year in California with having hearing loss. So the demand on audiologists to take care of people in the state is quite high. Having an actual trained category of an assistance would really help the audiologist pump through more patients and serve more constituents and patients throughout California. The California Academy of Audiology also submitted a survey they did recently in the last month, here stating that 88% of respondents did state that they would hire an audiology assistant and on average most of them anticipate hiring three of them. So if you do the math, that equates to over 6,000 audiology assistants of potential demand. So it does look like the demand is there for this licensee category and that audiologists throughout the state believe it would be helpful.

Thank you for the additional context. Appreciate it. See no additional questions. We're going to open up to members of the public. Folks, just as a reminder, you've got two minutes each.

pathologist assistants, audiologists, students and other related professionals.

We support the continued licensing and regulation by the Board.

leadership for collaboration, ongoing proactive communication.

were included in the report.

you heard the President speak to this. The online licensing system has really had

having people be able to get submit,

to initial licensing applications.

procedures and the remaining projects which include

these changes and really appreciate the additional flexibility including the increase of the hours that can be accrued via self study.

of meetings, board meetings, that's really made

So for these reasons we appreciate and

support not only its continuation, but providing with the resources necessary to continue to make some of those business improvement and other projects.

Thank you very much.

Thank you very much.

Thank you very much. Seeing no additional members of the public wishing to speak on this item. That'll wrap up this part of it. Thank you for the presentation and answering some of the questions. Appreciate it. Looking forward to future conversations. The next item. The next item on our Agenda today is the Board of Occupational Therapy. Testifying today is Christine Wheatlessbach, board Vice President, and Austin Porter, executive Officer. Come on up, and we're ready when you are.

Thank you. Any opening comments or here for questions?

Great Appreciate you being here. Open it up to colleagues for any questions or comments that folks might have. We're a calm group today, or at least now. So one quick question I have. I understand that the Board is seeking some new fee authority during the course of this sunset. Can you talk a little bit about what specific cost pressures have most affected the Board's budget and if there are other fees that might be able to be offset?

Great. Thank you for the very thorough answer. I think with that we'll open up to members of the public to see if any folks have any comments. Please come on up. As a reminder, you have two minutes.

All right, thank you very Much. See no additional questions from members of the public. That'll wrap up this section of our sunset hearing. Thank you very much for the presentation and answering the questions.

Thanks. The final item on our agenda today is the board of Naturopathic Medicine. Testifying today is Dr. Dara Thompson, board president. And Rebecca Mitchell, executive officer. And we're ready whenever you are. Take your time. Hi. You bet. And just hit the little microphone buttons in front of you.

Perfectly.

Great. And if you just bring the microphone. Yeah. A little bit closer. There you go.

That's perfect.

I'm actually a little, like, vertically challenged.

All right. I'm Dr. Dara Thompson. I am the president of the California Board of Naturopathic Medicine. I am a native Californian, and I've been a naturopathic doctor for 24 years. I have been licensed in California since 2005, and I've been on the board since 2015. I practice currently in San Rafael, California, and San Francisco, where I have a broad reaching practice that treats a lot of different demographic groups. I just really, really love naturopathic medicine. I'm passionate about what we're doing for people and also very, very passionate about protecting the consumers of California. As board president, it is my foremost responsibility, shared by all board members, to provide public protection. Our mission is to ensure that consumers are safe from individuals who violate the Naturopathic Doctors act, either licensed individuals who violate their practice act or unlicensed individuals practicing outside of their scope. As our sunset review details, the distinction between those two groups is critical, and many complaints we receive come from consumers who believe that they are seeing a licensed naturopathic doctor only to learn later that they are being treated by an unregulated individual. California's naturopathic doctors are rigorously educated in accredited doctoral level programs and held to the highest professional and ethical standards. They serve communities across the state, including a little over 85% practicing in underserved areas, and they play a meaningful role in California's health care landscape. However, limitations in the current statutes create confusion for consumers, restrict Safe and appropriate practice for licensed providers and under undermine our ability to enforce against unlicensed activity. The Board is committed to transparent accountability and thoughtful regulation that keeps the public safe while supporting a modern, well functioning health care system. We welcome the opportunity to work collaboratively with the legislature on solutions that strengthen consumer protection, clarify statutory authority, and enhance the oversight of both licensed and unlicensed practice. Thank you so much for your consideration and your partnership in advancing public safety. We're happy to answer any of your questions.

All right.

Perfect.

Sorry.

Thank you both very much. Opening up the colleagues for any questions or comments. Seeing none the presentation was that thorough.

One question I'll ask has to do with sustainability. You're one of the smallest boards in terms of the number of licensees with a little over a thousand naturopathic doctors. Do you think this presents a concern for the long term sustainability of your fund condition? And are there any opportunities to grow the number of licensees under your jurisdiction as an alternative to simply raising fees?

Gotcha.

members of the public.

Thank you.

Sean, Good morning chair members. George Tories with the California Medical Association. Just wanted to flag a few issues that we have with the report. And on the front end, I want to say really appreciate everyone here today and and the reaching out from the board and all the interested stakeholders in this over the last few months. Really appreciate that dialogue and look forward to continuing that. First up for us is issue number three. CMA has concerns with replacing the physician member of the board with another professional or public member. The board in their sunset report noted that a physician's participation is essential to ensure that medical standards are appropriately considered and upheld in the advisory committee's reviews and recommendations. In the absence of a second appointed physician, the sole physician member has to serve on both advisory committees that require physician and surgeon representation. Next up is issue number 11. CMA opposes the proposal to expand naturopathic doctors scope of practice to include prescribing medications, including controlled substances administering vaccines and performing office procedures as a means to address the declining number of licensees. Issue number 12, CMA is surprised to read the board did not receive any complaints relating to COVID 19 vaccines while naturopathic doctors had this authority during the pandemic emergency. CMA has concerns about including vaccine administration in the scope of practice without physician supervision for vaccination. And then lastly, issue number 14, CMA has concerns with authorizing naturopathic doctors to provide documentation for workers compensation and for the dmp.

Thank you very much.

Thank you.

I'm Christine Issel and I'm a reflexologist and also administrative director of the California

Natural Practitioners. Our organization represents a thousand practitioners across the field of alternative and complementary health care throughout California. As you're aware, in 2001 the legislature enacted the Alternative and Complementary Health Care act, codified Business and Professional Code 2053.5 and 2053.6. The law establishes three health care three key protections. First, it protects the right of California to seek and receive complementary and alternative health care services from unlicensed practitioners, provided that the required disclosure and safeguards are followed by the practitioner. Second, it protects the right of the practitioner to provide these services so long as they comply with the statute's transparency and consumer protection requirements. Third, it establishes a clear structure that has successfully functioned for over 25 years. Within the existing framework and that the statute is working as designed. Granting the Naturopathic Medicine Board authority or oversight over unlicensed complementary therapies would contradict both the language and the legislative intent of the Alternative and Complementary Health Care Act. It would also create redundant regulations and serves neither the public nor the practitioners operating fully under the existing statute. Therefore, the Naturopathic Medicine Board's jurisdiction should remain limited to its licensees, not to the unlicensed practitioner.

Good morning. I am Susie Dannette Brown. I represent the Reflexology association of California, a 501c3 organization established in 1992 to represent reflexologists. Reflexology is a non invasive practice that maps the body through the feet, hands and outer ears using specialized manual technique to stimulate neural pathways to promote relaxation and support optimal body function. Our field maintains its own national testing agency with a psychometrically valid examination along with established state, national and international professional organizations. Educational standards are overseen by the National Council of Reflexology Educators. In California, reflexologists practice lawfully under the Alternative and Complementary Health Care Act. Business and professional code sections 2053.5 and 2053.6. The statute provides safeguards while preserving public access to complementary care. Importantly, it predates the Neuropathic Doctors act and operates independently of it. Our concern is that the California Board of Naturopathic Medicine has begun attempting to regulate alternative and complementary health care practices that fall outside its statutory authority. We stand in solidarity with other practitioners, including naturopaths. We do not seek regulation under this board. The legislation legislature has already established a clear framework through the Medical Practice Act. We respectfully urge that you to adopt the proposed amendments to clarify the board's authority, protect established practitioners and prevent further regulatory overreach. Thank you for your time.

Hello. My name is William Truong. I'm a law student at the University of San Diego. Once again speaking on behalf of the Consumer Protection Policy Center. While we support retention of the board, we have several recommendations that we urge the committee to consider. The naturopathic medicine profession wields significant control over the board and its decision making, which is a concern when the Board unduly protects the interests of its licensees over public protection. Over the previous sunset cycle, the Board has disciplined a shockingly low number of licensees, with only two licensees disciplined out of 276 investigations. Additionally, we are concerned that the Board's quick average times for completing investigations, which were as low as 18 days at one point, suggests its investigative process may not be sufficiently thorough. Accordingly, we recommend that the Board's composition be restructured to three naturopathic doctor members, one physician or surgeon member, and five public members. We also recommend that each advisory committee within the Board should have at least one public member. Additionally, we recommend that the Legislature reject the Board's recommendations made in section 10, issue 3 of the Census Review reports. First, we oppose the Board's request to eliminate the requirement for NDs to have supervisory protocol agreement with a physician to furnish drugs because eliminating it would remove oversight and increase the risk of medication related errors. Second, we believe that the standardized protocol for administering vaccinations should be maintained because various studies show higher rates of vaccine hesitancy among NDs, meaning granting them independent access to vaccinations could pose risks to public safety and dird. We believe that NDS should be denied authority to perform searching. We've included more information in our letter to the Committee. Thank you for your time and consideration.

Good morning. Thank you for your time today and your time on such a thorough analysis. I'm Dr. Meredith Bowell. I'm here on behalf of the California Naturopathic Doctors association in support of SB 1303 and the Board of Naturopathic Medicine. I specifically want to emphasize the issue of title protection. It is exhausting to continually have to have conversations with patients, prospective patients, and in just general conversations about the differences between what I do as a licensed naturopathic doctor with the ability to practice medicine and those that are not licensed and cannot practice medicine. I previously practiced in Washington State. I did not have to have these conversations. It was not an issue because naturopath is a protected term there and reserved for licensed naturopathic doctors. I also want to be clear that this is not an attack on those that aren't licensed. We do sympathize in some way because the work that they do that some of these other practitioners talk to are meaningful in their own way. But the issue is it's often conflated with the practice of medicine and that is something that kind of needs to be delineated a little bit more. And that is what the practice or the Title protection would do for us. We want to protect the integrity of what it means to practice naturopathic medicine. And that would come with the protection of the term naturopath in all of its iterations. It's really too confusing otherwise and ultimately an issue of consumer safety, as we've discussed. Thanks for your time.

Good morning.

So I'm going to say me too,

We fall under the Medical Board of California. What we're seeing now is an attempt

duplicate and expand existing authority.

its original intent and maintain the integrity.

Thank you, Honorable Chair Berman, Members of the joint session. My name is Mark Murad. Hey. I serve as a president of California Naturopathic Association. For over three decades, our association has represented naturopaths, traditional naturopaths, and naturopathic practitioners across California. We are here today to respectfully raise concerns regarding the proposed expansion of authority by the California Board of Naturopathic Medicine. We fully support the legislature's commitment to public protection. However, we believe existing California law already provides a clear and effective framework. Since 2001, the Alternative and Complementary Health Care act has allowed these practices to operate lawfully while ensuring that any harm or negligence is addressed through the courts. Our concern is not with regulation, regulation itself, but with jurisdictional overreach. The board's current proposals would extend authority beyond licensed naturopathic doctors to include educational content, wellness guidance, and practitioners who are not under its statutory authority. This risks creating confusion, limiting lawful practice and expanding enforcement beyond what the legislature originally intended. When the Natural Doctors act was enacted, it was understood that licensure would not be used to eliminate or restrict the broader practice of naturopathy. We believe it is important to reaffirm that boundary. We respectfully ask the legislator to clarify that the board's authority applies only to licensed naturopathic doctors. Preserve the legal protections established under lawfully and safely working California Senate Bill SB577. Ensure that lawful, alternative and complementary health care practices remain protected. This approach maintains public safety while respecting existing law and long standing practice in California. Thank you for your time and consideration. Thank you.

Thank you. See no additional members of the public that will complete this section of today's hearing. Thank you very much. Appreciate it. And that completes the hearing. So thank you very much. I want to just emphasize thanks to staff for all the amazing work that they've done on all these sunset reports and the boards and councils working with us and more conversations to come. Thanks so much.