BILL ANALYSIS
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THIRD READING
Bill No: AB 1116
Author: Carter (D)
Amended: 9/3/09 in Senate
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, within 30 days prior to the
elective facial procedure, and confirmed as up-to-date on
the day of the procedure, the patient has received an
appropriate physical examination, and a written clearance
for the surgery, as specified.
Senate Floor Amendments of 9/3/09 revise the previous floor
amendments of 8/19/09 by providing that a physical
examination must be performed on a patient within 30 days
prior to an elective facial cosmetic surgery, and confirmed
as up-to-date on the day of the procedure.
CONTINUED
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Senate Floor Amendments of 8/19/09 clarify that the
physical examination must be received within 48 hours prior
to surgery, which would include the taking of an
appropriate medical history.
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.
2.Requires specified disclosures to patients undergoing
procedures involving collagen injections, defined as any
substance derived from, or combined with, animal protein.
3.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.
4.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.
5.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.
This bill:
1.Prohibits a licensed dentist who holds a permit to
perform elective facial cosmetic surgery from performing
elective facial cosmetic surgery on a patient unless the
patient has received, within 30 days prior to the
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elective facial cosmetic surgery and confirmed as
up-to-date on the day of the procedure, an appropriate
physical examination, 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 an appropriate medical history. Specifies
that an appropriate medical history and physical
examination done the day of the procedure is presumed to
be in compliance with the bill. 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 the
patient has received, within 30 days prior to the
elective facial cosmetic surgery and confirmed as
up-to-date on the day of the procedure, an appropriate
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 an appropriate medical history within 30 days prior to
the elective facial cosmetic surgery and confirmed as
up-to-date on the day of the procedure. 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
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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,
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.
FISCAL EFFECT : Appropriation: No Fiscal Com.: No
Local: No
SUPPORT : (Verified 8/20/09)
California Academy of Physician Assistants
Medical Board of California
OPPOSITION : (Verified 8/20/09)
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
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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
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
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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 9/4/09 Senate Floor Analyses
SUPPORT/OPPOSITION: SEE ABOVE
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