BILL ANALYSIS Ó
------------------------------------------------------------
|SENATE RULES COMMITTEE | AB 655|
|Office of Senate Floor Analyses | |
|1020 N Street, Suite 524 | |
|(916) 651-1520 Fax: (916) | |
|327-4478 | |
------------------------------------------------------------
THIRD READING
Bill No: AB 655
Author: Hayashi (D)
Amended: 7/6/11 in Senate
Vote: 21
SENATE BUSINESS, PROF & ECON DEVELOP COMM : 9-0, 06/13/11
AYES: Price, Emmerson, Corbett, Correa, Hernandez, Negrete
McLeod, Vargas, Walters, Wyland
SENATE JUDICIARY COMMITTEE : 4-0, 06/28/11
AYES: Evans, Blakeslee, Corbett, Leno
NO VOTE RECORDED: Harman
ASSEMBLY FLOOR : 70-0, 05/12/11 - See last page for vote
SUBJECT : Healing arts: peer review
SOURCE : California Medical Association
DIGEST : This bill requires a peer review body to produce
relevant peer review information about a physician and
surgeon that was subject to peer review for a medical
disciplinary cause or reason.
Senate Floor Amendments of 7/6/11 require that all relevant
peer review information produced pursuant to this bill be
made available to a licentiate by the requesting peer
review body in accordance with specified hearing
requirements.
CONTINUED
AB 655
Page
2
ANALYSIS : Existing law:
1.Establishes the Medical Board of California (MBC) to
license, regulate and discipline physicians and surgeons
in California and states that the protection of the
public is the highest priority of the MBC in exercising
its functions.
2.Provides for the professional review of specified healing
arts licentiates by a peer review body, as defined.
3.Defines a licentiate, for purposes of item #2 above, as a
physician and surgeon, doctor of podiatric medicine,
clinical psychologist, marriage and family therapist,
clinical social worker, or dentist.
4.Requires an 805 report to be filed by the chief of staff,
chief executive officer, medical director, or
administrator of any peer review body and the chief
executive officer or administrator of a health facility
or clinic, as defined, with the relevant agency having
regulatory jurisdiction over a licentiate under the
following:
A. Within 15 days after the effective date of any of
the following that occur as a result of an action of a
peer review body:
A licentiate's application for staff privileges
or membership is denied or rejected for a medical
disciplinary cause or reason.
A licentiate's membership, staff privileges, or
employment is terminated or revoked for a medical
disciplinary cause or reason.
Restrictions are imposed, or voluntarily
accepted, on staff privileges, membership, or
employment for a cumulative total of 30 days or more
for any 12-month period, for a medical disciplinary
cause or reason.
A. Within 15 days if a licentiate does any of the
following based on information indicating medical
CONTINUED
AB 655
Page
3
disciplinary cause or reason:
Resigns or takes a leave of absence from
membership, staff, or employment.
Withdraws or abandons an application for staff
privileges or membership.
Withdraws or abandons the request for renewal
of privileges or membership.
1. Requires also for an 805 report to be filed within 15
days after the imposition of a summary suspension of
staff privileges, membership, or employment, if the
summary suspension remains in effect for over 14 days.
2. Requires a copy of the 805 report, and a notice
advising the licentiate of his or her right to submit
additional statements or other information, as
specified, to be sent by the peer review body to the
licentiate named in the report.
3. Indicates that the reporting required under Section
805 does not act as a waiver of confidentiality of
medical records and committee reports. Requires that
the information reported or disclosed be kept
confidential, as specified.
4. Requires, prior to granting or renewing staff
privileges for any physician and surgeon, psychologist,
podiatrist or dentist, any licensed health care
facility, health care service plan or medical care
foundation, or the medical staff of an institution, to
request a report from the MBC, the Board of Psychology,
the Osteopathic Medical Board of California, or the
Dental Board of California to determine if any 805
report has been made, indicating that the applying
physician and surgeon, psychologist, podiatrist or
dentist has been denied staff privileges, been removed
from medical staff, or had his or her staff privileges
restricted as provided in Section 805. Prohibits
providing any report in the following circumstances:
5. If the denial, removal, or restriction was imposed
CONTINUED
AB 655
Page
4
solely because of the failure to complete medical
records.
6. If the MBC found the information reported is without
merit.
7. If a period of three years has elapsed since the
report was submitted.
8. Provides that peer review action may only be taken
against the licentiate by the peer review body if
certain procedures and rules are followed including
written notice to the licentiate of the proposed
action, an opportunity for a hearing with full
procedural rights, including discovery, examination of
witnesses, formal record of the proceedings and written
findings.
This bill:
1.Finds and declares that the sharing of information
between peer review bodies is essential to protect the
public health.
2.Requires a peer review body, upon receipt of reasonable
processing costs, to respond to the request of another
peer review body and produce relevant peer review
information about a licentiate that was subject to peer
review by the responding peer review body for a medical
disciplinary cause or reason. Requires that all relevant
peer review information produced pursuant to this bill be
made available to a licentiate by the requesting peer
review body in accordance with specified hearing
requirements.
3.Requires the responding peer review body to determine the
manner by which to produce the information specified in
#2 above and may elect to do so through: 1) a written
summary of relevant peer review information, or 2) a
relevant peer review record.
4.Provides that relevant peer review information or peer
review record includes, but is not limited to,
CONTINUED
AB 655
Page
5
allegations and findings, explanatory or exculpatory
information submitted by a licentiate, any conclusions
made, or actions taken, and the reasons for those
actions, to the extent not prohibited by state or federal
law. Prohibits the information from identifying any
other person, except the licentiate.
5.Indicates that the information produced by a peer review
body shall be used solely for peer review purposes and
shall not be subject to discovery, as specified.
6.States that the responding peer review body acting in
good faith is not subject to civil or criminal liability
for providing information to the requesting peer review
body pursuant to this bill.
7.Entitles the peer review body responding to the request
to all confidentiality protections and privileges
provided by law as to the information disclosed.
8.Requires the following prior to the release of any
information pursuant to this bill:
A. The requesting peer review body shall, upon
request, sign a mutually agreeable peer review sharing
agreement with the responding peer review body.
Requires the requesting peer review body to indemnify
the responding peer review body for any and all
claims, demands, liabilities, losses, damages, costs,
and expenses, including reasonable attorney's fees,
resulting in any manner, directly or indirectly, from
the receiving peer review body's improper release or
disclosure of information that is shared.
B. The licentiate under review by the peer review body
requesting information pursuant to this section shall,
upon request, release the responding peer review body,
its members, and the health care entity for which the
responding peer review body conducts peer reviews,
from liability for the disclosure of information.
1.Provides that the responding peer review body is not
obligated to produce the relevant peer review information
unless both of the following conditions are met:
CONTINUED
AB 655
Page
6
A. The licentiate provides a release, as specified in
#8 above that is acceptable to the responding peer
review body.
B. The requesting peer review body signs a mutually
agreeable peer review sharing agreement, as specified
in #8 above with the responding peer review body.
Background
In peer review, physicians evaluate their colleagues'
practice 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, 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.
Recognizing that peer review is necessary to maintain and
improve quality medical care, Congress, in 1986, enacted
the Health Care Quality Improvement Act (HCQIA.) HCQIA
established standards for hospital peer review committees,
provided immunity for those who participate in peer review,
and created the National Practitioner Data Bank (NPDB).
The NPDB is a confidential repository of information
related to the professional competence and conduct of
CONTINUED
AB 655
Page
7
physicians, dentists, and other health care practitioners.
Credentialing bodies are required to check the NPDB
database before granting privileges to physicians or
re-appointing them. Entities such as hospitals,
professional societies, state boards, and plaintiffs'
attorneys are given access to the NPDB. In enacting the
NPDB, the United States Congress intended to improve the
quality of health care by encouraging State licensing
boards, hospitals, and other health care entities, and
professional societies to identify and discipline those who
engage in unprofessional behavior; and to restrict the
ability of incompetent physicians, dentists, and other
health care practitioners to move from State to State
without disclosure or discovery of previous medical
malpractice payment and adverse action history. The NPDB
is a central repository of information about: (1)
Malpractice payments made for the benefit of physicians,
dentists, and other health care practitioners; (2)
licensure actions taken by State medical boards and State
boards of dentistry against physicians and dentists; (3)
professional review actions primarily taken against
physicians and dentists by hospitals and other health care
entities, including health maintenance organizations, group
practices, and professional societies; (4) actions taken by
the Drug Enforcement Administration, and (5)
Medicare/Medicaid Exclusions.
According to the MBC, it received 138 805 reports in
2007-2008 from hospitals/clinics (74), health care service
plans (17), and medical group/employers (47). Out of all
of these reports, one accusation was filed, 92 cases are
pending disposition and 45 cases were closed. The number
of 805 reports varies from year to year, but it appears
that when adjusted to the number of physicians and surgeons
licensed and living in California, or the number of people
living in California, the trend shows a downward direction.
FISCAL EFFECT : Appropriation: No Fiscal Com.: No
Local: No
SUPPORT : (Verified 7/6/11)
California Medical Association (source)
California Hospital Association
CONTINUED
AB 655
Page
8
ASSEMBLY FLOOR : 70-0, 05/12/11
AYES: Achadjian, Allen, Ammiano, Atkins, Beall, Bill
Berryhill, Block, Blumenfield, Bonilla, Bradford,
Brownley, Buchanan, Butler, Charles Calderon, Campos,
Carter, Chesbro, Cook, Davis, Dickinson, Donnelly, Eng,
Feuer, Fletcher, Fong, Fuentes, Furutani, Beth Gaines,
Galgiani, Gatto, Gordon, Grove, Hagman, Halderman, Hall,
Harkey, Hayashi, Hill, Huber, Hueso, Huffman, Jeffries,
Jones, Knight, Lara, Logue, Ma, Mansoor, Mendoza, Miller,
Monning, Morrell, Nestande, Nielsen, Norby, Olsen, Pan,
Perea, V. Manuel Pérez, Silva, Skinner, Smyth, Solorio,
Swanson, Valadao, Wagner, Wieckowski, Williams, Yamada,
John A. Pérez
NO VOTE RECORDED: Alejo, Cedillo, Conway, Garrick, Gorell,
Roger Hernández, Bonnie Lowenthal, Mitchell, Portantino,
Torres
JJA:nl 7/6/11 Senate Floor Analyses
SUPPORT/OPPOSITION: SEE ABOVE
**** END ****
CONTINUED