BILL NUMBER: AB 1045 AMENDED
BILL TEXT
AMENDED IN SENATE AUGUST 5, 2002
AMENDED IN SENATE JUNE 17, 2002
AMENDED IN SENATE MAY 28, 2002
AMENDED IN ASSEMBLY MAY 15, 2001
AMENDED IN ASSEMBLY MAY 3, 2001
AMENDED IN ASSEMBLY MAY 1, 2001
INTRODUCED BY Assembly Member Firebaugh
FEBRUARY 23, 2001
An act to repeal and add Section 853 of, and to add Sections 854
and 855 to, the Business and Professions Code, relating to healing
arts.
LEGISLATIVE COUNSEL'S DIGEST
AB 1045, as amended, Firebaugh. Healing arts: practice.
Existing law provides for a Task Force on Culturally and
Linguistically Competent Physicians and Dentists in the Department of
Consumer Affairs. Pursuant to existing law there is a subcommittee
within the task force to examine the feasibility of a pilot program
allowing Mexican and Caribbean licensed physicians and dentists to
practice in nonprofit community health centers in medically
underserved areas. Existing law requires the subcommittee to report
to the task force by March 1, 2001, and requires the report to be
forwarded to the Legislature by April 1, 2001, with any additional
comments.
This bill would delete the provisions for the subcommittee.
The bill would create the Licensed Physicians and Dentists from
Mexico Pilot Program. The bill would set forth the program's
provisions related to eligibility, licensing, location, and hiring.
The bill would also provide for an evaluation of the program, and for
funding of administrative and evaluation costs by philanthropic
entities. The bill would authorize a 3-year nonrenewable license for
physician participants and a 3-year nonrenewable dental special
permit for participating dentists and would prohibit these medical
licenses and dental permits from being used as the standard for
issuing a license to practice medicine or dentistry in this state on
a permanent basis.
The bill would additionally specify certain requirements
international medical graduates are required to meet to participate
in a separate pilot program and to receive an applicant status
letter. The bill would provide the Medical Board of California
the authority to issue a license to practice medicine to an
international medical graduate participating in the program if
specified criteria are met.
The bill would provide that these programs shall only be
implemented if the necessary amount of nonstate funding is obtained.
Vote: majority. Appropriation: no. Fiscal committee: yes.
State-mandated local program: no.
THE PEOPLE OF THE STATE OF CALIFORNIA DO ENACT AS FOLLOWS:
SECTION 1. The 2000 United States Census determined the population
of California to be over 35 million people with approximately 11
million being Latino.
From July 1990 to July 1999, California's population increased by
approximately 4 million people. Approximately 61 percent of this
growth can be attributed to the growth in the Latino population. The
Latino population has increased at an average rate of 275,000
persons per year from 1990 to 1999. The Latino population is
estimated to have grown in virtually all counties over this period.
The United States General Accounting Office reports that the
United States Community Health Centers patients are comprised of 65
percent ethnic and racial minorities.
Title VI of the Civil Rights Act of 1964 requires any federally
funded health facility to ensure persons with limited English
proficiency may meaningfully access health care services. Persons
with limited english English
proficiency are often excluded from programs, experience delays or
denials of services, or receive care and services based on inaccurate
or incomplete information.
The Health Resources and Services Administration reports the
number of physicians in California grew 17 percent between 1989 and
1998.
The Health Resources and Services Administration found in 1998
that only 4 percent of active patient care physicians were Latino.
The Association of American Medical Colleges in 1998 found only
6.8 percent of all graduates from United States medical schools were
of an ethnic or racial minority group.
In 1999 only 11 percent of dentists in California were a member of
a racial or ethnic minority group with 5 percent being classified as
Asian or Pacific Islanders.
In 1996 only 4 percent of dentists in California were Latino.
According to the Institute of Medicine report requested by the
United States Congress, research evidence suggests that
provider-patient communication is directly linked to patient
satisfaction, adherence, and subsequently health outcomes. Thus,
when sociocultural differences between the patient and the provider
are not appreciated, explored, understood, or communicated in the
medical encounter, the result is patient dissatisfaction, poor
adherence, poorer health outcomes, and racial and ethnic disparities
in health care.
A Commonwealth Fund of New York study found that: (1) one-third
of Latinos said they had problems communicating with their doctors
with barriers to this poor communication including language, cultural
traditions, and sensitivity; (2) communication is essential to
quality health care; and (3) inadequate communication can lead to the
perception of inhumane health care service delivery.
The Summit on Immigration Needs & Contributions of the Bridging
Borders in the Silicon Valley Project found that approximately 50
percent of participants reported that having a provider that speaks
his or her language will improve the quality of health care services
they receive.
Only two states in the country have reported cultural competency
standards for care.
No states in the country have reported foreign language
competencies for physicians or dentists.
According to the Dallas Morning News, many immigrants travel to
Mexico to receive health care due to the cultural and language
barriers they encounter in the United States health care system.
According to the San Jose Mercury News, 65 percent of the membership
of the largest medical association in California reported that if
they were required to pay for medical interpreters, they would stop
seeing patients that required interpretation services.
According to the Journal of the American Medical Association, in
1999, one medical school had a separate course covering cultural
diversity, 109 medical schools included cultural diversity content as
part of a required course or clerkship, and 84 medical schools
included information on cultural beliefs or practices related to
death or dying in a required course or clerkship.
SEC. 2. Section 853 of the Business and Professions Code is
repealed.
SEC. 3. Section 853 is added to the Business and Professions Code,
to read:
853. (a) The Licensed Physicians and Dentists from Mexico Pilot
Program is hereby created. This program shall allow up to
150 85 licensed physicians specializing in
family practice, internal medicine, pediatrics, and obstetrics and
gynecology, and up to 100 licensed dentists from Mexico to practice
medicine or dentistry in California for a period not to exceed three
years.
(b) The Medical Board of California and the Dental Board of
California shall issue three-year nonrenewable licenses to practice
medicine or dentistry to licensed Mexican physicians and dentists,
within the limits set forth in subdivision (a), who satisfactorily
pass the specific requirements contained in this article.
(c) Physicians from Mexico eligible to participate in this program
shall comply with the following:
(1) Be licensed, certified or recertified, and in good standing in
their medical specialty in Mexico.
(2) Prior to leaving Mexico, each physician shall have completed
the following requirements:
(A) Passed the board review course with a score equivalent to
that registered by United States Participants when passing a board
review course for the United States certification examination in each
of his or her specialty areas and passed an interview examination
developed by the National Autonomous University of Mexico for each
specialty area. Family practitioners who shall include obstetrics
and gynecology in their practice, shall also be required to have
appropriately documented, as specified by United States standards, 50
live births. Mexican obstetricians and gynecologists shall be
fellows of the American College of Obstetrics and Gynecology.
(B) (i) Satisfactorily completed a six-month orientation program
that addressed medical protocol, community clinic history and
operations, medical administration, hospital operations and protocol,
medical ethics, the California medical delivery system, health
maintenance organizations and managed care practices, and
pharmacology differences.
(ii) Additionally, Mexican physicians shall be required to be
enrolled in English language acquisition classes until they obtain a
level of proficiency in English that is commensurate with the level
of English spoken at community clinics where they will practice.
(C) Representatives from the National Autonomous University of
Mexico (UNAM) in Mexico and an approved a
medical school in good standing or a facility
conducting an approved medical residency training program in
California , shall confer to develop a mutually
agreed upon distant learning program for the six-month orientation
program required pursuant to subparagraph (B).
(3) Upon satisfactory completion of the requirements in paragraphs
(1) and (2), and after having received their three-year
nonrenewable medical license, the Mexican physicians shall be
required to obtain 35 hours of continuing education credits, as
specified by the board, from an approved program.
(4) Upon satisfactory completion of the requirements in paragraphs
(1) to (3), inclusive, the applicant shall receive a three-year
nonrenewable license to work in nonprofit community health centers
and shall also be required to participate in a six-month externship
at his or her place of employment. This externship shall be
undertaken after the participant has received a license and is able
to practice medicine. The externship shall ensure that the
participant is complying with the established standards for quality
assurance of nonprofit community health centers and medical
practices. The externship shall be affiliated with a medical school
in good standing in California. Complaints against program
participants shall follow the same procedures contained in the
Medical Practice Act (Chapter 5 (commencing with Section 2000)).
(5) (A) Nonprofit community health centers employing Mexican
physicians shall be required to have medical quality assurance
protocols and either be accredited by the Joint Commission on
Accreditation of Health Care Organizations or have protocols similar
to those required by the Joint Commission on Accreditation of Health
Care Organizations. These protocols shall be submitted to the
Medical Board of California prior to the hiring of Mexican
physicians.
(B) In addition, after the program participant successfully
completes the six-month orientation program, a free standing health
care organization that has authority to provide medical quality
certification, including, but not limited to, health plans,
hospitals, and the Integrated Physician Association, shall be
responsible for ensuring and overseeing the compliance of nonprofit
community health centers medical quality assurance protocols,
conducting site visits when necessary, and developing any additional
protocols, surveys, or assessment tools to ensure that quality of
care standards through quality assurance protocols are being
appropriately followed by physicians participating in the program.
(C) Any funding necessary to implement these activities shall be
secured from nonprofit philanthropic entities.
(6) Participating hospitals shall have the authority to
establish criteria necessary to allow program participants
individuals participating in this three-year pilot
program to be granted hospital privileges in their facilities.
(d) (1) Dentists from Mexico eligible to participate in this
program shall comply with the following:
(A) Be graduates from the National Autonomous University of
Mexico Faculty Dental School (Facultad de Odontologia).
(B) Meet all criteria required for licensure in Mexico that is
required and being applied by the National Autonomous University of
Mexico School of Faculty Dentistry (Facultad de Odontologia),
including, but not limited to:
(i) A minimum grade point average.
(ii) A specified English language comprehension and conversational
level.
(iii) Passage of a general examination.
(iv) Passage of an oral interview.
(C) Enroll and complete an orientation program that focuses on the
following:
(i) Practical issues in pharmacology which shall be taught by an
instructor who is affiliated with a California dental school
approved by the Dental Board of California.
(ii) Practical issues and diagnosis in oral pathology which shall
be taught by an instructor who is affiliated with a California dental
school approved by the Dental Board of California.
(iii) Clinical applications which shall be taught by an instructor
who is affiliated with a California dental school approved by the
Dental Board of California.
(iii) Biomedical sciences which shall be taught by an instructor
who is affiliated with a California dental school approved by the
Dental Board of California.
(iv) Clinical history management which shall be taught by an
instructor who is affiliated with a California dental school
approved by the Dental Board of California.
(v) Special patient care which shall be taught by an instructor
who is affiliated with a California dental school approved by the
Dental Board of California.
(vi) Sedation techniques which shall be taught by an instructor
who is affiliated with a California dental school approved by the
Dental Board of California.
(vii) Introduction to health care systems in California.
(viii) Introduction to community clinic operations.
(2) Upon satisfactory completion to a competency level of the
requirements in paragraph (1), dentists participating in the program
shall be eligible to obtain employment in a nonprofit community
health center pursuant to subdivision (f) within the structure of an
extramural dental program for a period not to exceed three years.
(3) Dentists participating in the program shall be required to
complete the necessary continuing education units required by the
Dental Practice Act (Chapter 4 (commencing with Section 1600)).
(4) The program shall accept 125 participating dentists. The
first 100 dentists shall be active program participants and the
remaining 25 dentists shall be placed on an alternate list. If an
active program participant leaves the program for any reason, a
participating dentist from the alternate list shall be chosen to fill
the vacancy. Only active program participants shall be required to
complete the orientation program specified in subparagraph (C) of
paragraph (1) of this subdivision.
(5) (A) Additionally, an extramural dental facility may be
identified, qualified, and approved by the board as an adjunct to,
and an extension of, the clinical and laboratory departments of an
approved dental school.
(B) As used in this subdivision, "extramural dental facility"
includes, but is not limited to, any clinical facility linked to an
approved dental school for the purposes of monitoring or overseeing
the work of a dentist licensed in Mexico participating in this
program and that is employed by an approved dental school for
instruction in dentistry which exists outside or beyond the walls,
boundaries, or precincts of the primary campus of the approved dental
school, and in which dental services are rendered. These facilities
shall include nonprofit community heath centers.
(C) Dental services provided to the public in these facilities
shall constitute a part of the dental education program.
(D) Approved dental schools shall register extramural dental
facilities with the board. This registration shall be accompanied by
information supplied by the dental school pertaining to faculty
supervision, scope of treatment to be rendered, arrangements for
postoperative care, the name and location of the facility, the date
operations shall commence at the facility, and a description of the
equipment and facilities available. This information shall be
supplemented with a copy of the agreement between the approved dental
school and the affiliated institution establishing the contractual
relationship. Any change in the information initially provided to
the board shall be communicated to the board.
(6) The program shall also include issues dealing with program
operations, and shall be developed in consultation by representatives
of community clinics, approved dental schools, and the Universidad
Nacional Autonoma de Mexico Facultad de Odontologia.
(e) Nonprofit community health centers that employ participants
shall be responsible for ensuring that participants are enrolled in
local English-language instruction programs and that the participants
attain English-language fluency at a level that would allow the
participants to serve the English-speaking patient population when
necessary and have the literacy level to communicate with appropriate
hospital staff when necessary.
(f) Physicians and dentists from Mexico having met the applicable
requirements set forth in subdivisions (c) and (d) shall be placed in
a pool of candidates who are eligible to be recruited for employment
by nonprofit community health centers in California, including, but
not limited to, those located in the Counties of Ventura, Los
Angeles, San Bernardino, Imperial, Monterey, San Benito, Sacramento,
San Joaquin, Santa Cruz, Yuba, Orange, Colusa, Glenn, Sutter, Kern,
Tulare, Fresno, Stanislaus, San Luis Obispo, and San Diego.
(g) Nonprofit community health centers in the counties listed in
subdivision (f) shall apply to the Medical Board of California and
the Dental Board of California to hire eligible applicants who shall
then be required to complete a six-month externship that includes
working in the nonprofit community health center and a corresponding
hospital. Once enrolled in this externship, and upon payment of the
required fees, the Medical Board of California shall issue a
three-year nonrenewable license to practice medicine and the Dental
Board of California shall issue a three-year nonrenewable dental
special permit to practice dentistry. A licensee or permitholder
shall practice only in the nonprofit community health center that
offered him or her employment and the corresponding hospital. This
three-year nonrenewable license or permit shall be deemed to be a
license permit in good standing pursuant to the provisions of this
chapter for the purpose of participation and reimbursement in all
federal, state, and local health programs, including managed care
organizations and health maintenance organizations.
(h) The three-year nonrenewable license or permit shall terminate
upon notice by certified mail, return receipt requested, to the
licensee's or permitholder's address of record, if, in the Medical
Board of California or Dental Board of California's sole discretion,
it has determined that either:
(1) The license or permit was issued by mistake.
(2) A complaint has been received by either board against the
licensee or permitholder that warrants terminating the license or
permit pending an investigation and resolution of the complaint.
(i) All applicable employment benefits, salary, and policies
provided by nonprofit community health centers to their current
employees shall be provided to medical and dental practitioners from
Mexico participating in this pilot program. This shall include
nonprofit community health centers providing malpractice insurance
coverage.
(j) Beginning 12 months after this pilot program has commenced, an
evaluation of the program shall be undertaken with funds provided
from philanthropic foundations. The evaluation shall be conducted
jointly by one medical school and one dental school in California and
the National Autonomous University of Mexico. This evaluation shall
include, but not be limited to, the following issues and concerns:
(1) Quality of care provided by doctors and dentists licensed
under this pilot program.
(2) Adaptability of these licensed practitioners to California
medical and dental standards.
(3) Impact on working and administrative environment in nonprofit
community health centers and impact on interpersonal relations with
medical licensed counterparts in health centers.
(4) Response and approval by patients.
(5) Impact on cultural and linguistic services.
(6) Increases in medical encounters provided by participating
practitioners to limited English-speaking patient populations and
increases in the number of limited English-speaking patients seeking
health care services from nonprofit community health centers.
(7) Recommendations on whether the program should be continued,
expanded, altered, or terminated.
(8) Progress reports on available data listed shall be provided to
the Legislature on achievable time intervals beginning the second
year of implementation of this pilot program. An interim final
report shall be issued three months before termination of this pilot.
A final report shall be submitted to the Legislature at the time of
termination of this pilot program on all of the above data. The
final report shall reflect and include how other initiatives
concerning the development of culturally and linguistically competent
medical and dental providers within California and the United States
is are impacting communities in need of
these health care providers.
(9) The Director of Health Services (DHS) along with any
voluntarily participating funding philanthropic foundations shall
select the California medical and dental schools and work with the
National Autonomous University of Mexico (UNAM) to conduct the
evaluation of this pilot program.
(k) Costs for administering this pilot program shall be secured
from philanthropic entities.
(l) Program applicants shall be responsible for working with the
governments of Mexico and the United States in order to obtain the
necessary three-year visa required for program participation.
SEC. 4. Section 854 is added to the Business and Professions Code,
to read:
854. Criteria for issuing three-year nonrenewable medical
licenses and dental permits under this article shall not be utilized
at any time as the standard for issuing a license to practice
medicine or a permit to practice dentistry in California on a
permanent basis.
SEC. 5. Section 855 is added to the Business and Professions Code,
to read:
855. (a) Up to 70 international medical graduates who have passed
their United States medical license examination on the first attempt
and who have been working in the medical field in the capacity
of a medical assistant, a nurse practitioner, a nurse-midwife, a
physician assistant, a dental hygienist, or a quality assurance and
peer review specialist for not less than three years, shall be
selected to participate in a pilot program. Preference shall be
given to international medical graduates who are residents of
California, have experience working in communities whose language is
other than English and whose culture is not from the dominant
society, and have a proven level of literacy in the foreign language
of a medically underserved community.
(b) If there are not 70 international medical graduates who meet
the criteria of subdivision (a), the remaining openings may be filled
by participants who have passed the United States medical license
examination on two or more attempts, have been working in the medical
field in the capacity of a medical assistant, a nurse
practitioner, a nurse-midwife, a physician assistant, a dental
hygienist, or a quality assurance and peer review specialist
for not less than three years, and who pass an additional test to be
determined by the medical facility and the medical school
participating in the pilot program. Preference shall be given to
international medical graduates who are residents of California, have
experience working in communities whose language is other than
English and whose culture is not from the dominant society, and have
a proven level of literacy in the foreign language of a medically
underserved community.
(c) An international medical graduate shall not be eligible for
this program if he or she has graduated from a school that has not
been approved by the Division of Licensing of the Medical Board of
California.
(d) Upon selection for the pilot program, participants may submit
an application to the International Medical Graduate Liaison of the
Medical Board of California's Division of Licensing, with the
appropriate fee, to initiate the medical licensing review process,
providing the participant time to remediate any deficiency during the
three-year international medical graduates pilot program.
(e) All program participants shall be required to have the foreign
language fluency and the cultural knowledge necessary to serve the
non-English-speaking community at the nonprofit community health
center where they practice.
(f) The Medical Board of California shall issue an applicant
status letter to participating and qualifying international medical
graduates.
(g) International medical graduates shall be required to
participate and satisfactorily complete a six-month orientation
program that will address medical protocol, community clinic history
and operations, medical administration, hospital operations and
protocol, medical ethics, the California medical delivery system,
health maintenance organizations and managed care practices, and
pharmacology differences. International medical graduates who have
passed the Educational Commission for Foreign Medical Graduates
(ECFMG) language exam shall not be required to be enrolled in English
language classes. However, if a participating international medical
graduate has not passed the ECFMG language exam, he or she shall be
enrolled in English language acquisition classes until he or she
obtains a level of English language proficiency equivalent to the
ECFMG language exam.
(h) (1) Upon satisfactorily completing the orientation program and
the one-year residency training program, international medical
graduates shall be selected by nonprofit community health centers to
work in nonprofit community health centers and disproportionate share
hospitals whose service area includes areas
include federally designated Health Professional Shortage
Areas, Dental Professional Shortage Areas, Medically Underserved
Areas, and Medically Underserved Populations for a period not to
exceed three years.
(2) There shall be two residency programs operated under the
auspices of an approved a medical
school in good standing , with one in southern California
and one in northern California. These residency programs shall be in
family practice, internal medicine, or obstetrics and gynecology.
(3) After successfully completing the one-year residency program,
the training institution for the one-year residency program for
international medical graduates may transfer the program participant
into an approved residency program.
(i) (1) All program participants shall be required to satisfy the
medical curriculum requirements of Section 2089, the clinical
instruction requirements of Section 2089.5 , and the
examination requirements of Section 2170 prior to being admitted into
an approved residency program.
(2) Those international medical graduates who are transferred into
an approved residency program shall be required to work in nonprofit
community health centers or disproportionate share hospitals whose
service areas includes include
federally designated Health Professional Shortage Areas, Dental
Professional Shortage Area Areas ,
Medically Underserved Area Areas , and
Medically Underserved Populations for not less than three years after
being fully licensed.
(j) The applicant status letter shall be deemed a license in good
standing pursuant to the provisions of this article for the purpose
of participation and reimbursement in all federal, state, and local
health programs, including managed care organizations and health
maintenance organizations.
(k) (1) The Director of General Medical Education or an
equivalent position in the training institution of the one-year
residency program for international medical graduates shall have the
authority to make a recommendation to the Medical Board of California
for the full medical licensure of an international medical graduate
who has successfully completed the one-year residency program if the
director believes, based on
the performance and competency of international medical
graduate, that the international medical graduate should be fully
licensed.
(2) After reviewing the recommendation for full licensure from the
director, the Medical Board of California shall have the authority
to issue a permanent license to practice medicine in this state to
the international medical graduate.
(l) If an international medical graduate desires to secure a
permanent license to practice medicine from the board, he or she
shall, among other things, be required to be admitted into an
approved residency program.
SEC. 6. The programs in Sections 853 and 855 of the Business and
Professions Code shall be implemented only if the necessary amount of
nonstate resources are obtained. General Fund moneys shall not be
used for these programs. ____
CORRECTIONS Text -- Pages 2 and 4. ____