BILL ANALYSIS                                                                                                                                                                                                    



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          SENATE THIRD READING
          SB 700 (Negrete McLeod)
          As Amended  January 26, 2010
          Majority vote 

           SENATE VOTE  :35-0  
           
           BUSINESS & PROFESSIONS     11-0 APPROPRIATIONS      17-0        
           
           ----------------------------------------------------------------- 
          |Ayes:|Hayashi, Emmerson,        |Ayes:|Fuentes, Conway,          |
          |     |Conway, Eng, Hernandez,   |     |Bradford,                 |
          |     |Hill, Ma, Nava, Niello,   |     |Charles Calderon, Coto,   |
          |     |Ruskin, Smyth             |     |Davis,                    |
          |     |                          |     |De Leon, Gatto, Hall,     |
          |     |                          |     |Harkey, Miller, Nielsen,  |
          |     |                          |     |Norby, Skinner, Solorio,  |
          |     |                          |     |Torlakson, Torrico        |
           ----------------------------------------------------------------- 

           SUMMARY  :   Makes various changes to the physician peer review  
          process.  Specifically,  this bill  :   


          1)Requires specified health-related boards' licensee central  
            files to include disciplinary information reported pursuant to  
            Section 805.01 and 805, including any exculpatory or  
            explanatory statements submitted by the licentiate.  



          2)Requires the central file to include a statement from a court,  
            if in its final judgment the court determined that the peer  
            review resulting in the 805 report was conducted in bad faith.  




          3)Requires the Medical Board of California (MBC), the  
            Osteopathic Medical Board of California (OMB), and the  
            California Board of Podiatric Medicine (CBPM) to disclose  
            information regarding enforcement actions taken against a  
            former licensee by their respective board or by another state  
            or jurisdiction.  Such enforcement actions, for both current  








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            and former licensees, shall include any summaries of hospital  
            disciplinary actions that result in the termination or  
            revocation of a licensee's staff privileges for medical  
            disciplinary cause or reason, unless a court finds, in a final  
            judgment, that the peer review resulting in the disciplinary  
            action was conducted in bad faith and the licensee notifies  
            the board of that finding.  In addition, any exculpatory or  
            explanatory statements submitted by the licentiate  
            electronically shall be disclosed. 



          4)Revises the definition of peer review to mean both of the  
            following:

           

             a)   A process in which a peer review body reviews the basic  
               qualifications, staff privileges, employment, medical  
               outcomes, or professional conduct of licentiates to make  
               recommendations for quality improvement and education, if  
               necessary, in order to do either or both of the following:



               i)     Determine whether a licentiate may practice or  
                 continue to practice in a health care facility, clinic,  
                 or other setting providing medical services, and, if so,  
                 to determine the parameters of that practice; and,



               ii)    Assess and improve the quality of care rendered in a  
                 health care facility, clinic, or other setting providing  
                 medical services.



             b)   Other activities of a peer review body, as specified.



          5)Requires the specified authority of a medical or professional  
            staff, peer review body, or licensed health care facility or  








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            clinic where the licentiate is employed or has staff  
            privileges or membership or where the licentiate applied for  
            staff privileges or membership, or sought the renewal thereof  
            (Chief), to file an 805 report with the relevant agency within  
            15 days after the licentiate takes the following actions after  
            receiving notice of a pending investigation initiated for a  
            medical disciplinary cause or reason or after receiving notice  
            that his or her application for membership or staff privileges  
            is denied or will be denied for a medical disciplinary cause  
            or reason: 



             a)   Resigns or takes a leave of absence from membership,  
               staff privileges, or employment;



             b)   Withdraws or abandons his or her application for staff  
               privileges or membership; or,



             c)   Withdraws or abandons his or her request for renewal of  
               staff privileges or membership. 



          6)Requires notice sent to a licensee indicating that information  
            submitted electronically will be publicly disclosed to those  
            who request the information. 



          7)Requires the Chief to file a report (805.01 report)with the  
            relevant agency within 15 days after a peer review body makes  
            a final decision or recommendation regarding a disciplinary  
            action, as specified, resulting in a final proposed action to  
            be taken against a licentiate based on the peer review body's  
            determination that any of the following acts may have  
            occurred, regardless of whether a hearing is held pursuant to  
            Section 809.2:










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             a)   Incompetence, or gross or repeated deviation from the  
               standard of care involving death or serious bodily injury  
               to one or more patients, such that the physician and  
               surgeon poses a risk to patient safety;



             b)   Drug or alcohol abuse by a physician and surgeon  
               involving death or serious bodily injury to a patient;



             c)   Repeated acts of clearly excessive prescribing,  
               furnishing, or administering of controlled substances or  
               repeated acts of prescribing, dispensing, or furnishing of  
               controlled substances without a good faith effort prior  
               examination of the patient and a medical reason.  However,  
               in no event shall a physician and surgeon prescribing,  
               furnishing, or administering controlled substances for  
               intractable pain, consistent with lawful prescribing, be  
               reported for excessive prescribing and prompt review of the  
               applicability of these provisions shall be made in any  
               complaint that may implicate these provisions; or,



             d)   Sexual misconduct with one or more patients during a  
               course of treatment or an examination. 



          8)Authorizes the relevant agency, including MBC, OMBC, and DBC  
            to inspect and copy the following documents in the record of  
            any formal investigation required to be reported pursuant to  
            805 or 805.01:



             a)   Any statement of charges;



             b)   Any document, medical chart, or exhibit;








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             c)   Any opinions, findings, or conclusions; and,



             d)   Any certified copy of medical records, as permitted by  
               applicable law. 



          9)Requires the 805.01 report and related information to be kept  
            confidential and not be subject to discovery, except that the  
            information may be reviewed in certain limited circumstances  
            and may be disclosed in any subsequent disciplinary hearing  
            conducted pursuant to the Administrative Procedure Act.



          10)Does not require a peer review body to make a 805.01 report  
            if it does not make a final decision or recommendation  
            regarding the disciplinary action to be taken against a  
            licentiate based on their determination that any of the above  
            mentioned acts may have occurred. 



          11)Requires MBC to furnish a copy of an 805 report and any  
            additional exculpatory or explanatory information submitted  
            electronically to the board by the licensee upon request made  
            by a health facility, as specified.  Prohibits MBC from  
            sending a copy if a court finds, in a final judgment, that the  
            peer review resulting in the report was conducted in bad faith  
            and the licensee who is the subject of the report notifies the  
            board of that finding.



          12)Requires a peer review body, within 15 days of initiating a  
            formal investigation of a physician and surgeon's ability to  
            practice medicine safely based upon information indicating  
            that the physician and surgeon may be suffering from a  
            disabling mental or physical condition that poses a threat to  








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            patient care, report to the MBC executive director (ED) name  
            of the physician and surgeon under investigation and the  
            general nature of the investigation.  Requires a peer review  
            body that has made this report to also notify the MBC ED when  
            it has completed or closed an investigation.



          13)Requires the MBC ED, upon receipt of the above report, to  
            contact the peer review body that made the report within 60  
            days in order to determine the status of the peer review  
            body's investigation.  Requires the MBC ED contact the peer  
            review body periodically thereafter to monitor the progress of  
            the investigation. At any time, if the MBC ED determines that  
            the progress of the investigation is not adequate to protect  
            the public, the MBC ED shall notify the MBC chief of  
            enforcement (CE), who shall promptly conduct an investigation  
            of the matter. Concurrently with notifying the CE, the MBC ED  
            shall notify the reporting peer review body and the chief  
            executive officer or an equivalent officer of the hospital of  
            its decision to refer the case for investigation by the CE.   
            Information received pursuant to this report is deemed  
            confidential, and if the peer review body closes the  
            investigation and determines there is no need for further  
            action to protect the public, the MBC ED shall purge and  
            destroy all records, unless the MBC ED has referred the matter  
            to the CE. 



          14)Defines "formal investigation" for the purpose of the above  
            report only, as an investigation ordered by the peer review  
            body's medical executive committee or its equivalent, based  
            upon information indicating that the physician and surgeon may  
            be suffering from a disabling mental or physical condition  
            that poses a threat to patient care. "Formal investigation"  
            does not include the usual activities of the well-being or  
            assistance committee or the usual quality assessment and  
            improvement activities undertaken by the medical staff of a  
            health facility in compliance with the licensing and  
            certification requirements for health facilities, or  
            preliminary deliberations or inquiries of the executive  
            committee to determine whether to order a formal  
            investigation.








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          15)Requires MBC to post on its Internet Web site any hospital  
            disciplinary actions that resulted in the termination or  
            revocation of a licensee's hospital staff privileges for a  
            medical disciplinary cause or reason, and a link to any  
            additional explanatory or exculpatory information submitted  
            electronically by the licensee.  This information and any  
            felony convictions reported to MBC after January 3, 1991 shall  
            not be removed from the Web site after 10 years. 



          16)Requires that if a court finds that peer review resulting in  
            a hospital disciplinary action was conducted in bad faith and  
            the licensee notifies the board of that finding, the  
            information concerning that hospital disciplinary action is to  
            be immediately removed from MBC's Internet Web site. 



          17)Requires MBC to post on the Internet a factsheet that  
            explains and provides information on the 805 reporting  
            requirements.



          18)Defines "usual activities" of the well-being or assistance  
            committee as activities to assist medical staff members who  
            may be impaired by chemical dependency or mental illness to  
            obtain necessary evaluation and rehabilitation services that  
            do not result in referral to the medical executive committee.



          19)Defines "formal investigation" as an investigation performed  
            by a peer review body based on an allegation that specified  
            acts occurred.



          20)Makes technical changes.









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           FISCAL EFFECT  : According to the Assembly Appropriations  
          Committee, no direct fiscal impact to the healing arts boards  
          addressed by this bill to continue oversight of medical  
          professionals in California. 

           COMMENTS  :  In peer review, physicians evaluate their colleagues'  
          work to determine compliance with the standard of care.  Peer  
          reviews are intended to detect incompetent or unprofessional  
          physicians early, and terminate, suspend, or limit their  
          practice if necessary.  Peer review is triggered by a wide  
          variety of events including patient injury, disruptive conduct,  
          substance abuse, or other medical staff complaints.  A peer  
          review committee investigates the allegation, comes to a  
          decision regarding the physician's conduct, and takes  
          appropriate remedial actions.  However, some suspect that there  
          is reluctance among physicians to serve on peer review  
          committees due to the risk of involvement in related future  
          litigation, including medical malpractice lawsuits against a  
          physician under review.  In addition, there has been rising  
          concern relating to "sham peer review."  Sham peer review is the  
          use of the peer review system to discredit, harass, discipline,  
          or otherwise negatively affect a physician's ability to practice  
          medicine or exercise professional judgment for a non-medical or  
          patient safety related reason.  Other criticisms of peer review  
          include over legalization of the process, lack of transparency  
          in the system, and burdensome human and financial toll peer  
          review brings not only to the hospital but also to a physician  
          under review.  

          The MBC is responsible for regulating and licensing physicians  
          in California.  The MBC revokes, suspends, or limits the  
          practice of any physicians and surgeons.  In exercising  
          regulatory authority over physicians and surgeons, the MBC's  
          highest priority is the protection of the public.  Currently,  
          the MBC regulates 125,612 physicians and surgeons, of which  
          97,878 reside in California.  The MBC investigates complaints  
          against physicians and surgeons and adopts final decisions in  
          disciplinary matters.


          Analysis Prepared by  :    Sarah Huchel / B. & P. / (916) 319-3301  











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