BILL NUMBER: AB 1360 INTRODUCED
BILL TEXT
INTRODUCED BY Assembly Member Swanson
FEBRUARY 18, 2011
An act to amend Section 2401 of the Business and Professions Code,
relating to healing arts.
LEGISLATIVE COUNSEL'S DIGEST
AB 1360, as introduced, Swanson. Physicians and surgeons:
employment.
Existing law, the Medical Practice Act, restricts the employment
of licensed physicians and surgeons and podiatrists by a corporation
or other artificial legal entity, subject to specified exemptions.
Existing law established, until January 1, 2011, a pilot project to
allow qualified district hospitals that, among other things, provide
more than 50% of patient days to the care of Medicare, Medi-Cal, and
uninsured patients, to employ a physician and surgeon, if the
hospital does not interfere with, control, or otherwise direct the
professional judgment of the physician and surgeon. The pilot project
authorized the direct employment of a total of 20 physicians and
surgeons by those hospitals to provide medically necessary services
in rural and medically underserved communities.
This bill would authorize a health care district, as defined, and
a clinic owned or operated by a health care district, as specified,
to employ physicians and surgeons if the health care district's
service area includes a Medically Underserved Area (MUA) or a
Medically Underserved Population (MUP), or has been federally
designated as a Health Professional Shortage Area (HPSA); the
district board conducts a public hearing and adopts a formal
resolution declaring the need for the district to recruit and
directly employ one or more physicians and surgeons; and the
executive officer of the district provides specified documentation to
the Medical Board of California. Upon receipt of that documentation,
the bill would require the Medical Board of California to approve
the employment of up to 5 primary or specialty care physicians and
surgeons by the district, and, upon receipt of additional
documentation after that employment, to approve an additional 5
primary or specialty care physicians and surgeons. The bill would
provide that a district may, until December 31, 2022, enter into,
renew, or extend any employment contract with a physician and surgeon
for up to 10 years. The bill would require the Office of Statewide
Health Planning and Development, in consultation with the State
Department of Public Health and the Medical Board of California, to
report to the Legislature by June 1, 2020, with regard to the
efficacy of the employment of physicians and surgeons by health care
districts, as specified.
Vote: majority. Appropriation: no. Fiscal committee: yes.
State-mandated local program: no.
THE PEOPLE OF THE STATE OF CALIFORNIA DO ENACT AS FOLLOWS:
SECTION 1. Section 2401 of the Business and Professions Code is
amended to read:
2401. (a) Notwithstanding Section 2400, a clinic operated
primarily for the purpose of medical education by a public or private
nonprofit university medical school, which is approved by the
Division of Licensing board or the
Osteopathic Medical Board of California, may charge for professional
services rendered to teaching patients by licensees who hold academic
appointments on the faculty of the university, if the charges are
approved by the physician and surgeon in whose name the charges are
made.
(b) Notwithstanding Section 2400, a clinic operated under
subdivision (p) of Section 1206 of the Health and Safety Code may
employ licensees and charge for professional services rendered by
those licensees. However, the clinic shall not interfere with,
control, or otherwise direct the professional judgment of a physician
and surgeon in a manner prohibited by Section 2400 or any other
provision of law.
(c) Notwithstanding Section 2400, a narcotic treatment program
operated under Section 11876 of the Health and Safety Code and
regulated by the State Department of Alcohol and Drug Programs, may
employ licensees and charge for professional services rendered by
those licensees. However, the narcotic treatment program shall not
interfere with, control, or otherwise direct the professional
judgment of a physician and surgeon in a manner prohibited by Section
2400 or any other provision of law.
(d) (1) Notwithstanding Section 2400, a
hospital owned and operated by a health care
district operated pursuant to Division 23 (commencing with
Section 32000) of the Health and Safety Code may employ a
licensee pursuant to Section 2401.1, and physicians
and surgeons, and may charge for professional services rendered
by the licensee, a physician and surgeon,
if the physician and surgeon in whose name the charges are made
approves the charges . However, the hospital shall not
interfere with, control, or otherwise direct the physician
and surgeon's professional judgment in a manner prohibited
by Section 2400 or any other provision of law. , and
if all of the following conditions are met:
(A) The service area of the health care district includes a
Medically Underserved Area (MUA) or a Medically Underserved
Population (MUP), as defined in Section 127928 of the Health and
Safety Code, or has been federally designated as a Health
Professional Shortage Area (HPSA).
(B) The district board conducts a public hearing and adopts a
formal resolution declaring that a need exists for the district to
recruit and directly employ one or more physicians and surgeons to
serve unmet community need.
(C) The resolution shall include all of the following findings and
declarations:
(i) Patients living within the community have been forced to seek
care outside of the community, or have faced extensive delays in
access to care, due to the lack of physicians and surgeons.
(ii) The communities served by the district lack sufficient
numbers of physicians and surgeons to meet community need or have
lost or are threatened with the impending loss of one or more
physicians and surgeons due to retirement, planned relocation, or
other reasons.
(iii) The district has been actively working to recruit one or
more physicians and surgeons to address unmet community need, or to
fill an impending vacancy, for a minimum of 12 consecutive months,
beginning July 1, 2010, without success.
(iv) The direct employment of one or more physicians and surgeons
by the district is necessary in order to augment or preserve access
to essential medical care in the communities served by the district.
(D) The resolution shall also do the following:
(i) Direct the district's executive officer to begin actively
recruiting one or more physicians and surgeons, up to the limits
specified in this chapter, as district employees.
(ii) Prohibit the executive officer from actively recruiting a
physician and surgeon who is currently employed by a federally
qualified health center, rural health center, or other community
clinic not affiliated with the district.
(E) Upon adoption of the resolution by the district board, the
executive officer shall submit an application to the Medical Board of
California certifying the district's inability to recruit one or
more physicians and surgeons, including all relevant documentation,
certifying that the inability to recruit primary or specialty care
physicians and surgeons has negatively impacted patient care in the
community, and certifying that the employment of physicians and
surgeons by the district would meet a critical, unmet need in the
community based upon a number of factors, including, but not limited
to, the number of patients referred for care outside of the
community, the number of patients who experienced delays in
treatment, the length of treatment delays, and negative patient
outcomes.
(2) Upon receipt and review of the application, adopted
resolution, and all relevant documentation of the district's
inability to recruit a physician and surgeon as specified in
subparagraph (E) of paragraph (1), the Medical Board of California
shall approve and authorize the employment of up to five primary or
specialty care physicians and surgeons by the district.
(3) Upon receipt and review of subsequent documentation of the
need for additional primary or specialty care physicians and surgeons
by the district, the Medical Board of California shall approve and
authorize the employment of up to five additional primary or
specialty care physicians and surgeons by the district.
(4) Employment contracts with physicians and surgeons issued
pursuant to this subdivision shall be for a period of not more than
10 years, but may be renewed or extended. Districts may enter into,
renew, or extend employment contracts with physicians and surgeons
pursuant to this subdivision until December 31, 2022.
(5) The Office of Statewide Health Planning and Development, in
consultation with the State Department of Public Health and the
Medical Board of California, shall conduct an efficacy study of the
program under this subdivision to evaluate improvement in physician
and surgeon recruitment and retention in the districts participating
in the program, impacts on physician and surgeon and health care
access in the communities served by these districts, impacts on
patient outcomes, degree of patient and participating physician and
surgeon satisfaction, and impacts on the independence and autonomy of
medical decisionmaking by employed physicians and surgeons. This
study shall be completed and its results reported to the Legislature
no later than June 1, 2020.
(6) This subdivision applies to health care districts and to any
clinic owned or operated by a health care district, provided the
health care district meets the criteria of, and ensures compliance
with, the requirements of this subdivision.
(e) A health care district authorized to employ physicians and
surgeons pursuant to subdivision (d) shall not interfere with,
control, or otherwise direct a physician and surgeon's professional
judgment in a manner prohibited by Section 2400 or any other
provision of law. Violation of this prohibition is punishable as a
violation of Section 2052, by a fine not exceeding ten thousand
dollars ($10,000), by imprisonment in the state prison, by
imprisonment in a county jail not exceeding one year, or by both the
fine and either imprisonment. This subdivision is declaratory of
existing law, and, as such, does not create a new crime or expand the
scope of any existing crime.
(f) Nothing in subdivision (d) shall be construed to affect a
primary care clinic licensed pursuant to subdivision (a) of Section
1204 of the Health and Safety Code.
(g) (1) The report to be submitted pursuant to paragraph (5) of
subdivision (d) shall be submitted in compliance with Section 9795 of
the Government Code.
(2) The requirement for submitting the report imposed under
paragraph (5) of subdivision (d) shall become inoperative on June 1,
2024, pursuant to Section 10231.5 of the Government Code.