BILL NUMBER: AB 801 CHAPTERED
BILL TEXT
CHAPTER 510
FILED WITH SECRETARY OF STATE SEPTEMBER 25, 2003
APPROVED BY GOVERNOR SEPTEMBER 24, 2003
PASSED THE ASSEMBLY SEPTEMBER 9, 2003
PASSED THE SENATE SEPTEMBER 8, 2003
AMENDED IN SENATE SEPTEMBER 3, 2003
AMENDED IN SENATE AUGUST 18, 2003
AMENDED IN SENATE JUNE 30, 2003
AMENDED IN ASSEMBLY MAY 8, 2003
INTRODUCED BY Assembly Member Diaz
(Principal coauthors: Assembly Members Firebaugh and Maldonado)
(Coauthors: Assembly Members Koretz, Leiber, and Yee)
FEBRUARY 20, 2003
An act to amend Section 853 of, and to add Article 10.5
(commencing with Section 2198) to Chapter 5 of Division 2 of, the
Business and Professions Code, relating to the healing arts.
LEGISLATIVE COUNSEL'S DIGEST
AB 801, Diaz. Dentists and physicians and surgeons.
(1) Existing law, the Licensed Physicians and Dentists from Mexico
Pilot Program, allows licensed physicians and dentists from Mexico
to practice medicine or dentistry in California for a period not to
exceed 3 years. The program establishes requirements for the
participants in the program.
This bill would revise the requirements applicable to the dentists
who participate in the program.
(2) Existing law requires the Division of Licensing of the Medical
Board of California to establish continuing medical education
requirements for physicians and surgeons and to administer other
specified programs.
This bill would enact the Cultural and Linguistic Competency of
Physicians Act of 2003 where local medical societies of the
California Medical Association, while monitored by the division,
would operate a voluntary competency program for physicians. The
program would develop educational classes to teach foreign languages
to interested physicians and would offer classes designed to teach
physician participants about cultural practices and beliefs that
impact health care. The bill would require the formation of a
workgroup to examine and recommend whether successful participating
physicians receive credit for the program and to evaluate the
program. The bill would require funding of the program by fees
charged to physicians who elect to take the educational classes and
by any other funds secured by local medical societies.
THE PEOPLE OF THE STATE OF CALIFORNIA DO ENACT AS FOLLOWS:
SECTION 1. The Legislature finds and declares all of the
following:
(a) According to the 2000 United States Census, from July 1990 to
July 1999, inclusive, 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.
(b) 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 proficiency are often excluded from
programs, experience delays or denial of services, or receive care
and services based on inaccurate or incomplete information.
(c) The Association of American Medical Colleges in 1998 found
only 6.8 percent of all graduates from the United States medical
schools were of an ethnic or racial minority group.
(d) 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 and subsequent healthy outcomes for patients. 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, poor outcomes, and racial and ethnic disparities in health
care.
(e) The Summit on Immigration Needs and 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.
SEC. 2. Section 853 of the Business and Professions Code is
amended to read:
853. (a) The Licensed Physicians and Dentists from Mexico Pilot
Program is hereby created. This program shall allow up to 30
licensed physicians specializing in family practice, internal
medicine, pediatrics, and obstetrics and gynecology, and up to 30
licensed dentists from Mexico to practice medicine or dentistry in
California for a period not to exceed three years. The program shall
also maintain an alternate list of program participants.
(b) The Medical Board of California shall issue three-year
nonrenewable licenses to practice medicine to licensed Mexican
physicians and the Dental Board of California shall issue three-year
nonrenewable permits to practice dentistry to licensed Mexican
dentists.
(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. This certification or
recertification shall be performed, as appropriate, by the Consejo
Mexicano de Ginocologia y Obstetricia, A.C., the Consejo Mexicano de
Certificacion en Medicina Familiar, A.C., the Consejo Mexicano de
Medicina Interna, A.C., or the Consejo Mexicano de Certificacion en
Pediatria, A.C.
(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 applicants 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 (UNAM) 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 in good standing of the American College of Obstetricians and
Gynecologists.
(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. This orientation program shall be approved
by the Medical Board of California to ensure that it contains the
requisite subject matter and meets appropriate California law and
medical standards where applicable.
(ii) Additionally, Mexican physicians participating in the program
shall be required to be enrolled in adult English as a Second
Language (ESL) classes that focus on both verbal and written subject
matter. Each physician participating in the program shall have
transcripts sent to the Medical Board of California from the
appropriate Mexican university showing enrollment and satisfactory
completion of these classes.
(C) Representatives from the National Autonomous University of
Mexico (UNAM) in Mexico and 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
continuing education pursuant to Section 2190 of the Business and
Professions Code. Each physician shall obtain an average of 25
continuing education units per year for a total of 75 units for a
full three years of program participation.
(4) Upon satisfactory completion of the requirements in paragraphs
(1) and (2), 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) After arriving in California, Mexican physicians participating
in the program shall be required to be enrolled in adult English as
a Second Language (ESL) classes at institutions approved by the
Bureau of Private Post Secondary and Vocational Education or
accredited by the Western Association of Schools and Colleges. These
classes shall focus on verbal and written subject matter to assist a
physician in obtaining a level of proficiency in English that is
commensurate with the level of English spoken at community clinics
where he or she will practice. The community clinic employing a
physician shall submit documentation confirming approval of an ESL
program to the Medical Board of California for verification.
Transcripts of satisfactory completion of the ESL classes shall be
submitted to the Medical Board of California as proof of compliance
with this provision.
(6) (A) Nonprofit community health centers employing Mexican
physicians in the program 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 externship 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.
(7) Participating hospitals shall have the authority to establish
criteria necessary to allow individuals participating in this
three-year pilot program to be granted hospital privileges in their
facilities.
(8) The Medical Board of California shall provide oversight review
of both the implementation of this program and the evaluation
required pursuant to subdivision (j). The Board shall consult with
the medical schools applying for funding to implement and evaluate
this program, executive and medical directors of nonprofit community
health centers wanting to employ program participants, and hospital
administrators who will have these participants practicing in their
hospital, as it conducts its oversight responsibilities of this
program and evaluation. Any funding necessary for the implementation
of this program, including the evaluation and oversight functions,
shall be secured from nonprofit philanthropic entities.
Implementation of this program may not proceed unless appropriate
funding is secured from nonprofit philanthropic entities. The
Medical Board of California shall report to the Legislature every
January during which the program is operational regarding the status
of the program and the ability of the program to secure the funding
necessary to carry out its required provisions. Notwithstanding
Section 11005 of the Government Code, the board may accept funds from
nonprofit philanthropic entities. The board shall, upon
appropriation in the annual Budget Act, expend funds received from
nonprofit philanthropic entities for this program.
(d) (1) Dentists from Mexico eligible to participate in this
program shall comply with the following requirements or the
requirements contained in paragraph (2):
(A) Be graduates from the National Autonomous University of Mexico
School of Faculty Dentistry (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 that 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 that shall
be taught by an instructor who is affiliated with a California dental
school approved by the Dental Board of California.
(iii) Clinical applications that shall be taught by an instructor
who is affiliated with a California dental school approved by the
Dental Board of California.
(iv) Biomedical sciences that shall be taught by an instructor who
is affiliated with a California dental school approved by the Dental
Board of California.
(v) Clinical history management that shall be taught by an
instructor who is affiliated with a California dental school approved
by the Dental Board of California.
(vi) Special patient care that shall be taught by an instructor
who is affiliated with a California dental school approved by the
Dental Board of California.
(vii) Sedation techniques that shall be taught by an instructor
who is affiliated with a California dental school approved by the
Dental Board of California.
(viii) Infection control guidelines which shall be taught by an
instructor who is affiliated with a California dental school approved
by the Dental Board of California.
(ix) Introduction to health care systems in California.
(x) Introduction to community clinic operations.
(2) (A) Graduate within the three-year period prior to enrollment
in the program, from a foreign dental school that has received
provisional approval or certification by November of 2003 from the
Dental Board of California under the Foreign Dental School Approval
Program.
(B) Enroll and satisfactorily complete an orientation program that
focuses on the health care system and community clinic operations in
California.
(C) Enroll and satisfactorily complete a course taught by an
approved foreign dental school on the infection control guidelines
adopted by the Dental Board of California.
(3) Upon satisfactory completion to a competency level of the
requirements in paragraph (1) or (2), 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.
(4) 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)).
(5) The program shall accept 30 participating dentists. The
program shall also maintain an alternate list of program applicants.
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).
(6) (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 that 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 health 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.
(7) 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 National
Autonomous University of Mexico School of Faculty Dentistry (Facultad
de Odontologia).
(8) The Dental Board of California shall provide oversight review
of the implementation of this program and the evaluation required
pursuant to subdivision (j). The Dental Board shall consult with
dental schools in California that have applied for funding to
implement and evaluate this program and executive and dental
directors of nonprofit community health centers wanting to employ
program participants, as it conducts its oversight responsibilities
of this program and evaluation. Implementation of this program may
not proceed unless appropriate funding is secured from nonprofit
philanthropic entities. The Dental Board of California shall report
to the Legislature every January during which the program is
operational regarding the status of the program and the ability of
the program to secure the funding necessary to carry out its required
provisions. Notwithstanding Section 11005 of the Government Code,
the board may accept funds from nonprofit philanthropic entities.
(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. The
Medical Board of California shall ensure that all Mexican physicians
participating in this program have satisfactorily met the
requirements set forth in subdivision (c) prior to placement at a
nonprofit community health center.
(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. For purposes of this program,
the fee for a three-year nonrenewable license to practice medicine
shall be nine hundred dollars ($900) and the fee for a three-year
nonrenewable dental permit shall be five hundred forty-eight dollars
($548). 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 or 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 in consultation with
the Medical Board of California and the Dental Board of California.
If the evaluation required pursuant to this section does not begin
within 15 months after the pilot project has commenced, the
evaluation may be performed by an independent consultant selected by
the Director of the Department of Consumer Affairs. 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
program. 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
are impacting communities in need of these health care providers.
(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. 3. Article 10.5 (commencing with Section 2198) is added to
Chapter 5 of Division 2 of the Business and Professions Code, to
read:
Article 10.5. Cultural and Linguistic Competency of Physicians
Act of 2003
2198. (a) This article shall be known and may be cited as the
Cultural and Linguistic Competency of Physicians Act of 2003. The
cultural and linguistic physician competency program is hereby
established and shall be operated by local medical societies of the
California Medical Association and shall be monitored by the Division
of Licensing.
(b) This program shall be a voluntary program for all interested
physicians. As a primary objective, the program shall consist of
educational classes which shall be designed to teach physicians the
following:
(1) A foreign language at the level of proficiency that initially
improves their ability to communicate with non-English speaking
patients.
(2) A foreign language at the level of proficiency that eventually
enables direct communication with the non-English speaking patients.
(3) Cultural beliefs and practices that may impact patient health
care practices and allow physicians to incorporate this knowledge in
the diagnosis and treatment of patients who are not from the
predominate culture in California.
(c) The program shall operate through local medical societies and
shall be developed to address the ethnic language minority groups of
interest to local medical societies.
(d) In dealing with Spanish language and cultural practices of
Mexican immigrant communities, the cultural and linguistic training
program shall be developed with direct input from physician groups in
Mexico who serve the same immigrant population in Mexico. A similar
approach may be used for any of the languages and cultures that are
taught by the program or appropriate ethnic medical societies may be
consulted for the development of these programs.
(e) Training programs shall be based and developed on the
established knowledge of providers already serving target populations
and shall be formulated in collaboration with the California Medical
Association, the Division of Licensing, and other California-based
ethnic medical societies.
(f) Programs shall include standards that identify the degree of
competency for participants who successfully complete independent
parts of the course of instruction.
(g) Programs shall seek accreditation by the Accreditation Council
for Continuing Medical Education.
(h) The Division of Licensing shall convene a workgroup including,
but not limited to, representatives of affected patient populations,
medical societies engaged in program delivery, and community clinics
to perform the following functions:
(1) Evaluation of the progress made in the achievement of the
intent of this article.
(2) Determination of the means by which achievement of the intent
of this article can be enhanced.
(3) Evaluation of the reasonableness and the consistency of the
standards developed by those entities delivering the program.
(4) Determination and recommendation of the credit to be given to
participants who successfully complete the identified programs.
Factors to be considered in this determination shall include, at a
minimum, compliance with requirements for continuing medical
education and eligibility for increased rates of reimbursement under
Medi-Cal, the Healthy Families Program, and health maintenance
organization contracts.
(i) Funding shall be provided by fees charged to physicians who
elect to take these educational classes and any other funds that
local medical societies may secure for this purpose.
(j) A survey for language minority patients shall be developed and
distributed by local medical societies, to measure the degree of
satisfaction with physicians who have taken the educational classes
on cultural and linguistic competency provided under this section.
Local medical societies shall also develop an evaluation survey
for physicians to assess the
quality of educational or training programs on cultural and
linguistic competency. This information shall be shared with the
workgroup established by the Division of Licensing.
2198.1. For purposes of this article, "cultural and linguistic
competency" means cultural and linguistic abilities that can be
incorporated into therapeutic and medical evaluation and treatment,
including, but not limited to, the following:
(a) Direct communication in the patient-client primary language.
(b) Understanding and applying the roles that culture, ethnicity,
and race play in diagnosis, treatment, and clinical care.
(c) Awareness of how the health care providers and patients
attitudes, values, and beliefs influence and impact professional and
patient relations.