BILL ANALYSIS
SB 820
Page 1
Date of Hearing: July 7, 2009
ASSEMBLY COMMITTEE ON BUSINESS AND PROFESSIONS
Mary Hayashi, Chair
SB 820 (Negrete McLeod) - As Amended: July 6, 2009
SENATE VOTE : (Vote not relevant)
SUBJECT : Healing arts.
SUMMARY : Makes various changes related to disciplinary
reporting by specified healing arts boards, including adding to
the central file if a court finds that a peer review was held in
bad faith and the filing of an additional report under certain
circumstances, as specified. Specifically, this bill :
1)Requires a licensee's respective regulatory board (Board), as
specified, to include in a central file:
a) A finding from a court if the court determines that the
peer review resulting in the disciplinary report (805
report) was conducted in bad faith and the licensee who is
the subject of the report notifies the Board of that
finding;
b) Any additional exculpatory or explanatory statements
regarding an 805 report submitted by a licensee; and,
c) Information reported pursuant to an 805.01 report, as
specified.
2)Requires the Medical Board of California (MBC), the
Osteopathic Medical Board of California (OMBC), and the
California Board of Podiatric Medicine (CBPM), to disclose to
an inquiring member of the public information regarding any
enforcement actions taken against a former or current
licensee, and requires MBC, OMBC, and CBPM to provide to each
current and former licensee a copy of the text of any proposed
public disclosure prior to its release, as specified.
3)Requires the MBC, OMBC, and CBPM to disclose to an inquiring
member of the public summaries of any hospital disciplinary
actions resulting in the termination or revocation of a former
or current licensee's staff privileges for medical
disciplinary cause or reason, unless a court finds that the
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peer review resulting in the disciplinary action was conducted
in bad faith and the licensee notifies the Board of that
finding.
4)Requires a chief of staff of a medical or professional staff
or other chief executive officer (CEO), medical director, or
administrator of any peer review body and the CEO or
administrator of any licensed health care facility or clinic
[all, respectively, "Director"] to file an 805 report with the
relevant agency within 15 days after the effective date on
which certain events, as specified, are imposed on a
licentiate as a result of an action of a peer review body.
5)Requires the Director of a facility in which a licentiate is
employed, has staff privileges, or membership or where the
licentiate applied for staff privileges, membership, or
employment, or sought the renewal thereof, to file an 805
report with the relevant agency within 15 days if the
licentiate does any of the following 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, staff privileges, or employment 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
membership, staff privileges, or employment; or,
c) Withdraws or abandons his or her request for renewal of
membership, staff privileges, or employment.
6)Requires 805 reports be maintained, submitted, and distributed
electronically, but permits an 805 report and the notice
advising the licentiate of his or her right to submit
additional statements or other information to be sent
electronically or otherwise.
7)Defines the following terms:
a) "Formal investigation" means an investigation performed
by a peer review body based on an allegation that an act,
as specified has occurred; and,
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b) "Peer review" means 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, to determine whether the
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.
8)Requires the chief of staff of a medical or professional staff
or other CEO, medical director, or administrator of any peer
review body and the CEO or administrator of any licensed
health care facility or clinic to file a report (805.01
report), following formal investigation of the licentiate,
with the relevant agency within 15 days after a peer review
body makes a final decision or recommendation regarding a
disciplinary action, that any of the following acts may have
occurred, regardless of whether a specified hearing is held:
a) Gross negligence, incompetence, or repeated negligent
acts that involve death or serious bodily injury to one or
more patients, such that the physician and surgeon
represents a danger to the public;
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 good faith effort prior
examination of the patient and medical reason therefore.
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.
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9)Requires the licentiate to receive a notice of the proposed
action, as specified, which also must include a notice
advising the licentiate of the right to submit additional
explanatory or exculpatory statements.
10)Authorizes the relevant agency to inspect and copy the
following documents in the record of any formal investigation
pursuant to the 805.01 report:
a) Any statement of charges;
b) Any document, medical chart, or exhibit;
c) Any opinions, findings, or conclusions; and,
d) Certified medical records.
11)Requires that the 805.01 report and any related information,
as specified, be kept confidential and not subject to
discovery, except as specified.
12)States that the 805.01 report shall be filed in addition to
any other report required by law.
13)Authorizes MBC, OMBC, and the Dental Board of California
(DBC) to inspect and copy certified copies of medical records
in the record of any disciplinary proceedings resulting in
action that is required to be reported, as specified.
14)Requires, upon a request made by, or on behalf of, specified
institutions seeking information related to granting or
renewing staff privileges for any physician and surgeon,
psychologist, podiatrist, or dentist, the Board to provide a
copy of an 805 report and any additional information submitted
to the Board by a licensee unless a court finds 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.
15)Requires the MBC to post on its Internet Web site a link to
any additional explanatory or exculpatory information
submitted electronically by the licentiate.
16)States that if a licensee's hospital staff privileges are
restored and the licensee notifies MBC, the information
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pertaining to the termination or revocation of those
privileges shall remain posted on MBC's Internet Web Site for
10 years from the date of restoration of those privileges,
except for information relating to:
a) A felony conviction; or,
b) A hospital disciplinary action resulting in termination
or revocation of a licensee's staff privileges for a
medical disciplinary cause or reason which must remain
posted, unless a court finds that the peer review resulting
in the disciplinary action was conducted in bad faith and
the licensee notifies MBC of that fact, in which case the
information shall be removed immediately.
17)Requires MBC to post on its Internet Web site a fact sheet
explaining and providing information on 805 reporting
requirements.
EXISTING LAW :
1)Provides for the professional review of specified healing arts
licentiates through a peer review process. Existing law
defines the term "peer review body" as including a medical or
professional staff of any health care facility or clinic
licensed by the State Department of Public Health.
2)Requires specified persons to file a 805 report with a Board
within 15 days after a specified action is taken against a
person licensed by that Board. Existing law provides various
due process rights for licentiates who are the subject of a
final proposed disciplinary action of a peer review body,
including authorizing a licentiate to request a hearing
concerning that action.
3)Requires the MBC to maintain an 805 report for a period of
three years after receipt.
4)Authorizes MBC, OMBC, and DBC to inspect and copy certain
documents in the record of any disciplinary proceeding
resulting in action that is required to be reported in an 805
report.
5)Requires specified healing arts boards to maintain a central
file of their licensees containing, among other things,
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disciplinary information reported through 805 reports.
6)Requires MBC, OMBC, and CBPM to disclose an 805 report to
specified health care entities and to disclose certain
hospital disciplinary actions to inquiring members of the
public. Existing law also requires the MBC to post hospital
disciplinary actions regarding its licensees on its Internet
Web site.
FISCAL EFFECT : Unknown
COMMENTS :
Purpose of this bill . According to the author's office, "SB 820
attempts to improve the physician peer review process by
providing the Medical Board of California needed critical
information for regulatory oversight of physicians to further
enhance its public protection mandate.
"This bill is necessary to ensure that the current peer review
process continues to protect the public from incompetent
physicians. Given the indispensable nature of health care, high
quality patient care is vital. Patients expect their treating
physicians or other medical professionals to be competent and
qualified, and physicians who fail to meet established
professional standards must be discovered, reviewed and
disciplined if necessary in a timely manner. Physician peer
review is one of the regimes used to ensure that quality of care
is delivered while minimizing medical errors and managing
patient risks."
Background . 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
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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.
REGISTERED SUPPORT / OPPOSITION :
Support
None on file.
Opposition
None on file.
Analysis Prepared by : Sarah Huchel / B. & P. / (916) 319-3301