BILL ANALYSIS
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|SENATE RULES COMMITTEE | AB 1116|
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THIRD READING
Bill No: AB 1116
Author: Carter (D)
Amended: As introduced
Vote: 21
SEN. BUSINESS, PROF. & ECON. DEV. COMMITTEE : 9-1, 6/22/09
AYES: Negrete McLeod, Wyland, Aanestad, Corbett, Correa,
Florez, Oropeza, Romero, Yee
NOES: Walters
ASSEMBLY FLOOR : 62-9, 5/18/09 - See last page for vote
SUBJECT : Cosmetic surgery
SOURCE : Author
DIGEST : This bill enacts the Donda West Law, which
prohibits the performance of an elective cosmetic surgery
procedure on a patient unless, prior to surgery, the
patient has received a physical examination, and a written
clearance for the surgery, as specified.
ANALYSIS :
Existing Law
1.Establishes the Medical Board of California (MBC) under
the Department of Consumer Affairs (DCA), which licenses
physicians and surgeons and regulates their practice.
CONTINUED
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2.Requires specified disclosures to patients undergoing
procedures involving collagen injections, defined as any
substance derived from, or combined with, animal protein.
3.Requires MBC to adopt extraction and postoperative care
standards in regard to body liposuction procedures
performed by a physician and surgeon outside of a general
acute care hospital, and makes a violation of these
provisions a misdemeanor.
4.Requires a licensed dentist who wishes to perform
elective facial cosmetic surgery to apply and receive a
permit to perform elective facial cosmetic surgery from
the Dental Board of California and specifies requirements
for the performance of elective facial cosmetic surgery.
5.Establishes a credentialing committee, with specified
membership, to review the qualifications of each
applicant for a permit.
6.Establishes the Nursing Practice Act which provides for
the certification and regulation of nurses, nurse
practitioners and nurse-midwives by the Board of
Registered Nursing (BRN) and requires the BRN to
establish categories and standards for nurse
practitioners in consultation with specified health care
practitioners, including physicians and surgeons.
7.Defines the practice of nursing as those functions,
including basic health care, that help people cope with
difficulties in daily living that are associated with
their actual or potential health or illness problems, and
that require a substantial amount of scientific knowledge
or technical skill, as specified.
8.Provides for the regulation and licensing of physician
assistants by the Physician Assistant Committee of the
MBC and allows a physician assistant to perform medical
services, as specified, under the supervision of a
licensed physician and surgeon.
This bill:
1.Prohibits a licensed dentist who holds a permit to
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perform elective facial cosmetic surgery from performing
elective facial cosmetic surgery on a patient unless the
patient has received a physician examination by, and
written clearance for the procedure from either of the
following: (a) a licensed physician and surgeon, or (b)
a licensed dentist who holds a permit to perform elective
facial cosmetic surgery. Requires the physical
examination to include the taking of a complete medical
history. Specifies that a violation of these provisions
does not constitute a crime.
2.Prohibits a physician and surgeon from performing a
cosmetic surgery procedure on a patient unless prior to
surgery the patient has received a physical examination
and written clearance for the procedure from any of the
following: (a) the physician and surgeon who will be
performing the surgery, (b) another licensed physician
and surgeon, (c) a certified nurse practitioner, in
accordance with a certified nurse practitioner's scope of
practice, unless limited by protocols for a delegation
agreement, or (d) a licensed physician assistant, in
accordance with a licensed physician assistant's scope of
practice, as specified. Requires the physical
examination to include the taking of a complete medical
history. States that a violation of these provisions is
not a misdemeanor.
3.Defines cosmetic surgery as an elective surgery that is
performed to alter or reshape normal structures of the
body in order to improve the patient's appearance,
including, but not limited to, liposuction and elective
facial cosmetic surgery.
Background
Popularity of Plastic Surgery . According to the American
Society of Plastic Surgeons' (ASPS) web site, about 12.1
million cosmetic procedures were performed in 2008,
representing a $10.3 billion industry. ASPS indicate that
the top five surgical procedures were breast augmentation,
liposuction, nose reshaping, eyelid surgery, and tummy
tuck. Moreover, ASPS points out that there were 10.7
million minimally-invasive cosmetic procedures in 2008.
The top five minimally-invasive procedures were Botox,
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hyaluronic acid fillers, chemical peel, laser hair removal,
and microdermabrasion.
Prior Efforts Dealing with Cosmetic Surgery Practices . In
California, cosmetic surgery can be performed by any
licensed physician, from a plastic surgeon to a
pediatrician. Many physicians, who may or may not be
trained in cosmetic procedures, are conducting increasingly
complex procedures in settings outside of hospitals such as
outpatient surgery centers and doctors' offices. It is
also common for doctors performing complex cosmetic
surgeries to receive their only training from weekend
courses or instructional videos. Currently, there are no
uniform standards for physician training related to
cosmetic surgery, and the regulation of outpatient settings
in which these surgeries occurs need to be strengthened to
ensure public safety. The Legislature attempted to
regulate the practice of cosmetic surgery in previous years
with the introduction of several bills, including:
1. SB 1423 (Figueroa), Chapter 873, Statutes of 2008 .
Requires the MBC, in conjunction with the BRN, to
promulgate regulations on or before January 1, 2009 to
implement changes relating to the use of laser or intense
pulse light devices for cosmetic procedures by physicians
and surgeons, nurses, and physician assistants.
2. SB 835 (Figueroa), 1999-2000 Session . Would have enacted
the Cosmetic Surgery Patient Disclosure Act, which would
have required physicians who perform cosmetic surgery, as
defined, to provide the MBC with specified information,
including training, board certifications, and number of
procedures performed, and would have required the MBC to
make this information available to the public upon
request and post the information on the Internet. SB 835
was vetoed by then Governor Davis who indicated that the
methods prescribed by the bill were unduly burdensome.
3. SB 836 (Figueroa), Chapter 856, Statutes of 1999 .
Expanded and revised the prohibition against fraudulent
advertising by health practitioners.
4. SB 837 (Figueroa), 1999-2000 Session . Would have
required cosmetic surgery procedures to be performed in a
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licensed acute care hospital or in a licensed or
accredited outpatient surgery setting. AB 837 died in
the Assembly Appropriations Committee.
FISCAL EFFECT : Appropriation: No Fiscal Com.: No
Local: No
SUPPORT : (Verified 6/23/09)
California Academy of Physician Assistants
Medical Board of California
OPPOSITION : (Verified 6/23/09)
American Nurses Association/California
Department of Consumer Affairs
ARGUMENTS IN SUPPORT : According to the author's office,
this bill will better protect individuals who are not
physically fit from unnecessary bodily trauma that could
result from elective cosmetic surgery. The author's office
states that this bill is not directed at the many good
plastic surgeons who require their patients to have a
medical clearance before elective cosmetic surgery. The
author's office believes that explicitly requiring in law a
physical examination prior to surgery will reduce the risk
of complications, including death, during or after cosmetic
surgical procedures. The author's office states that this
bill comes from the author's constituent, Yolanda Anderson,
the winner of the Assembly Member's district-wide, "It
Ought to Be a Law" contest. Ms. Anderson is the niece of
Donda West, who died on November 10, 2007, due to
complications that resulted from cosmetic surgery.
According to the West family, a physical examination was
not performed prior to surgery. A January 10, 2008
Associated Press article, citing the Los Angeles County
Coroner's official report, states that Ms. West died from
pre-existing coronary artery disease and multiple
postoperative factors following surgery.
ARGUMENTS IN OPPOSITION : The American Nurse
Association/California opposes this bill, arguing that
cosmetic surgery should not be singled out for a greater
standard that other procedures. DCA indicates that this
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bill is unnecessary because no honest, law abiding dentist
or physician would perform cosmetic surgery on a patient
that is unfit for surgery. DCA also points out that a
practitioner who is willing to perform surgery on a patient
that cannot safely undergo the surgical procedures would
not be deterred by the provisions of this bill. Existing
law already provides for civil, administrative, and
criminal penalties for physicians who are negligent or
provide substandard care.
ASSEMBLY FLOOR :
AYES: Ammiano, Anderson, Arambula, Beall, Bill Berryhill,
Block, Blumenfield, Brownley, Buchanan, Caballero,
Charles Calderon, Carter, Chesbro, Conway, Cook, Coto,
Davis, De La Torre, De Leon, Emmerson, Evans, Feuer,
Fletcher, Fong, Fuentes, Furutani, Gaines, Galgiani,
Gilmore, Hall, Hayashi, Hernandez, Hill, Huber, Huffman,
Jeffries, Jones, Krekorian, Lieu, Bonnie Lowenthal, Ma,
Mendoza, Monning, Nava, Niello, Nielsen, John A. Perez,
V. Manuel Perez, Portantino, Ruskin, Salas, Skinner,
Smyth, Solorio, Audra Strickland, Torlakson, Torres,
Torrico, Tran, Villines, Yamada, Bass
NOES: Tom Berryhill, Blakeslee, Fuller, Garrick, Hagman,
Knight, Logue, Miller, Silva
NO VOTE RECORDED: Adams, DeVore, Duvall, Eng, Harkey,
Nestande, Price, Saldana, Swanson
JJA:cm 6/23/09 Senate Floor Analyses
SUPPORT/OPPOSITION: SEE ABOVE
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