BILL ANALYSIS
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|Hearing Date:June 27, 2005 |Bill No:AB |
| |1195 |
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SENATE COMMITTEE ON BUSINESS, PROFESSIONS AND ECONOMIC
DEVELOPMENT
Senator Liz Figueroa, Chair
Bill No: AB 1195Author:Coto
As Amended:June 21, 2005 Fiscal: Yes
SUBJECT: Continuing education: cultural and linguistic
competency.
SUMMARY: Would require all Continuing Medical Education
(CME) courses, except as specified, to contain curriculum
pertaining to cultural and linguistic competency in the
practice of medicine by July 1, 2006.
Existing law:
1)Requires a physician to complete a minimum of 100 hours
of approved CME requirements during a four-year period in
order to be eligible for licensure renewal.
2)Allows physicians to fulfill education requirements in
California State Medical Board (Board) approved subject
areas in order to maintain or improve quality of patient
care. One of those areas includes educational activities
that improve the physician-patient relationship.
3)Requires physicians and surgeons to complete a one-time
requirement of 12 credit hours in the subjects of pain
management and the treatment of terminally ill and dying
patients.
4)Requires general internists and family physicians who
have a patient population of which 25 percent are 65
years of age or older to complete at least 20 percent of
all mandatory continuing education hours in the field of
older patient care.
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5)Establishes a voluntary program for interested physicians
and surgeons to learn a foreign language and cultural
beliefs that may impact patient care practices.
This bill:
1)Would require all CME courses to contain curriculum that
includes cultural and linguistic competency in the
practice of medicine by July 1, 2006.
2)Would exempt from the above requirement any continuing
medical education course solely dedicated to research of
other issues that do not include direct patient care.
3)CME courses would be required to address at least one of
the following topics:
a) Applying linguistic skills to communicate
effectively with the target population.
b) Utilizing cultural information to establish
therapeutic relationships.
c) Eliciting and incorporating pertinent cultural data
in diagnosis and treatment.
d) Understanding and applying cultural and ethnic data
to the process of clinical care.
e) Reviewing relevant federal and state laws and
regulations regarding linguistic access.
4)Defines "cultural competency" as a set of integrated
attitudes, knowledge, and skills that enable a physician
and surgeon to care effectively for patients from diverse
cultures, groups, and communities.
5)Defines "linguistic competency" as the ability of the
physician and surgeon to provide patients who do not
speak English or have limited ability to speak English,
direct communication in the patient's primary language.
FISCAL EFFECT: According to the Assembly Appropriations
Committee, this bill would impose minor absorbable costs on
the Board to add a check box to the renewal form for
self-verification of the continuing education requirement.
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The Board's operating costs are funded from physician
licensing fees deposited in the Medical Board Contingency
Fund.
COMMENTS:
1.Purpose. According to the Author, current law pertaining
to CME does not contain cultural or linguistic training
requirements. The Author points to the 2003 findings of
the Task Force on Culturally and Linguistically Competent
Physicians and Dentists, who reported that "because
health care providers frequently do not understand unique
cultural beliefs about health care that consumers hold,
and do not consider culture when developing a treatment
plan, many consumers are given treatment regimes that
they will not follow." The Author states that
instruction in cultural and linguistic competency will
help address the problems of racial, ethnic, linguistic,
and gender-based disparities found in medical treatment.
2.Background. Existing law requires physicians to complete
at least 25 CME hours per year. Physicians generally
have flexibility in determining which approved CME course
will best improve the quality of care to their patients.
There are two exceptions: (1) California licensed
physicians are required to take a one-time 12 credit-hour
CME course on pain management and the treatment of
terminally ill and dying patients. (2) Physicians with a
population of which more than 25 percent of the patients
are at least 65 years of age, are required to complete at
least 20 percent of their mandatory CME in the field of
geriatric medicine or the care for older patients.
3.Prior Related Legislation. AB 801 (Diaz, Chapter 510,
Statutes of 2003) established the Cultural and Linguistic
Competency Program. This voluntary program is designed
to provide foreign language instruction and classes to
instruct physicians, surgeons and dentists about cultural
practices and beliefs that impact health care. The Board
is responsible for implementing the program and for
reporting to the Legislature every year regarding its
status.
AB 2394 (Firebaugh, Chapter 802, Statutes of 2000)
established the Task Force on Culturally and
Linguistically Competent Physicians and Dentists. The 37
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members of the Task Force included representatives from
community clinics, advocacy groups, the statewide dental
and medical associations, state government (including the
Board), and others. The Task Force was charged with
meeting to come up with a report to the Legislature
making recommendations on ways to improve access to
culturally and linguistically appropriate care.
4.Task Force Findings. The Task Force on Culturally and
Linguistically Competent Physicians and Dentists released
its report in 2003. The Task Force developed a Working
Group on Continuing Education and Cultural Competency
Certification, which recommended, among other actions,
the development of a continuing education program on
cultural and linguistic competency to improve patient
quality of care. The Working Group "did not recommend
mandatory continuing education and certification, but
decided that the acquisition of additional language and
cultural education skills should be up to the individual
professional. This issue of mandatory versus voluntary
continuing education and certification for physicians,
dentists, and other allied health professionals generated
significant debate within the Task Force as a whole."
The Task Force also established a Working Group on
Cultural Competency Standards, which recommended, among
other actions, "the establishment of a new task force or
the continuation of the current task force to further
develop, implement, and oversee any proposed
recommendations received and adopted by the current task
force and/or any action items which result from
additional recommendations of the new task force."
5.Arguments in Support. This bill is sponsored by the
National Council of La Raza (NCRL ), which argues that
cultural and linguistic competency skills are essential
for providing quality health care to California's diverse
patient population. NCLR cites a 2002 body of research:
"What Health Care Consumers Need to Know about Racial and
Ethnic Disparities in Healthcare" from the Institute of
Medicine, which found that minorities do not receive the
same quality of medical care in comparison with
non-minorities despite similar health plans.
Lieutenant Governor Cruz Bustamante writes that the
Institute of Medicine study "suggests that the principle
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causes for these discrepancies are associated with
communication barriers that result from cultural and
language differences." Proponents further argue that
providing culturally and linguistically competent health
care services reduces risk and costs, improves care, and
ensures informed consent.
The California Pan-Ethnic Health Network adds that AB
1195 "will improve the quality of care delivered to 53%
of Californians who are people of color, and the 40% who
speak a language other than English at home."
6.Arguments in Opposition. The American College of
Obstetricians and Gynecologists District IX (ACOG-IX)
argues that mandating specific CME topics is
counterproductive and potentially harmful. ACOG-IX
explains that decisions related to the content of CME
hours are left to individual physicians because their
required knowledge varies significantly depending on each
physician's specialty and particular practice. ACOG-IX
further states that extensive efforts to deal with the
issue of cultural and linguistic competencies are being
undertaken by the California Endowment, the California
Medical Association, as well as by the CMA Foundation and
the Medical Board. ACOG-IX believes that the Legislature
is not the proper forum for setting the specific agenda
for CME.
The California Orthopaedic Association (COA) maintains
that the provisions of AB 1195 will prove to be
particularly problematic for physicians attempting to
complete nationally-accredited courses given in other
states, which may or may not include the new California
requirements. Further, all curriculum will need to be
rewritten to comply with AB 1195.
The California Academy of Family Physicians argues that
"however worthy the aim of AB 1195, and the aim is very
worthy, CAFP believes that CME works best if each
physician can choose which courses best suit the needs of
his or her particular patients, specialty, or practice
model. Furthermore, AB 1195 would set a precedent for
ceding more and more control of the CME curriculum to the
political process. We simply don't believe such a change
is appropriate, as we believe the curriculum is best
developed within the profession, in direct response to
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needs of patients and research and developments within
the field."
7.Author's Amendments. The Author plans to offer
amendments in Committee that would require CME courses to
dedicate no less than one-fourth of the course to
cultural and linguistic competency. Cultural competency
components would be recommended to include applying
linguistic skills to communicate effectively with the
target population, utilizing cultural information to
establish therapeutic relationships, eliciting and
incorporating pertinent cultural data in diagnosis and
treatment, and understanding and applying cultural and
ethnic data to the process of clinical care.
SUPPORT AND OPPOSITION:
Support:
National Council of La Raza (Sponsor)
Asian Americans for Civil Rights and Equality
Asian Pacific American Legal Center of Southern California
California Immigrant Welfare Collaborative
California Pan-Ethnic Health Network
Community Child Care Council of Santa Clara County, Inc.
Lieutenant Governor, Cruz M. Bustamante
Opposition:
American College of Obstetricians and Gynecologists
California Academy of Family Physicians
California Orthopaedic Association
Kaiser Permanente Medical Care Program
Consultant:Laura Metune