California Legislature—2013–14 Regular Session

Assembly Bill No. 496

Introduced by Assembly Member Gordon

February 20, 2013

An act to amend Sections 852, 2198, and 2198.1 of the Business and Professions Code, relating to medicine.

LEGISLATIVE COUNSEL’S DIGEST

AB 496, as introduced, Gordon. Medicine: sexual orientation, gender identity, and gender expression.

Existing law creates the Task Force on Culturally and Linguistically Competent Physicians and Dentists and requires the Director of Consumer Affairs, in consultation with the Director of Health Care Services, to appoint as task force members, among other people, California licensed physicians and dentists that provide health services to members of language and ethnic minority groups and representatives of organizations that advocate on behalf of, or provide health services to, members of language and ethnic minority groups. Existing law required the task force to report its findings to the Legislature and appropriate licensing boards by January 1, 2003.

This bill would require the licensed task force members and advocate task force members to instead provide health services to, or advocate on behalf of, members of language and ethnic minority groups and lesbian, gay, bisexual, and transgender groups. The bill would require the task force to report its findings to the Legislature and appropriate licensing boards by January 1, 2016.

Existing law, the Cultural and Linguistic Competency of Physicians Act of 2003, establishes the cultural and linguistic physician competency program which is operated by local medical societies of the California Medical Association and is monitored by the Medical Board of California. That voluntary program consists of educational classes for all interested physicians and is designed to teach foreign language and cultural beliefs and practices that may impact patient health care practices and allow physicians to incorporate this knowledge in the diagnosis and treatment of patients who are not from the predominate culture in California. Existing law also defines “cultural and linguistic competency” for the purposes of those provisions as understanding and applying the roles that culture, ethnicity, and race play in diagnosis, treatment, and clinical care.

This bill would additionally require the program to address lesbian, gay, bisexual, and transgender groups of interest to local medical societies. The bill would require the training programs to be formulated in collaboration with California-based lesbian, gay, bisexual, and transgender medical societies. The bill would also redefine the term “cultural and linguistic competency” and understanding and applying the roles that culture, ethnicity, race, sexual orientation, gender identity, and gender expression play in diagnosis, treatment, and clinical care. The bill would also make related technical, nonsubstantive changes.

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 852 of the Business and Professions Code
is amended to read:

852.  

(a) The Task Force on Culturally and Linguistically
Competent Physicians and Dentists is hereby created and shall
consist of the following members:

(1) The begin delete State end delete Director of Health begin insert Care end insert Services and the Director
of Consumer Affairs, who shall serve as cochairs of the task force.

(2) The Executive Director of the Medical Board of California.

(3) The Executive Director of the Dental Board of California.

(4) One member appointed by the Senate Committee on Rules.

(5) One member appointed by the Speaker of the Assembly.

(b) Additional task force members shall be appointed by the
Director of Consumer Affairs, in consultation with the begin delete State end delete
Director of Health begin insert Care end insert Services, as follows:

(1) Representatives of organizations that advocate on behalf of
California licensed physicians and dentists.

(2) California licensed physicians and dentists that provide
health services to members of language and ethnic minority groups
begin insert and lesbian, gay, bisexual, and transgender groups end insert .

(3) Representatives of organizations that advocate on behalf of,
or provide health services to, members of language and ethnic
minority groups begin insert and lesbian, gay, bisexual, and transgender
groups end insert .

(4) Representatives of entities that offer continuing education
for physicians and dentists.

(5) Representatives of California’s medical and dental schools.

(6) Individuals with experience in developing, implementing,
monitoring, and evaluating cultural and linguistic programs.

(c) The duties of the task force shall include the following:

(1) Developing recommendations for a continuing education
program that includes language proficiency standards of foreign
language to be acquired to meet linguistic competency.

(2) Identifying the key cultural elements necessary to meet
cultural competency by physicians, dentists, and their offices.

(3) Assessing the need for voluntary certification standards and
examinations for cultural and linguistic competency.

(d) The task force shall hold hearings and convene meetings to
obtain input from persons belonging to language and ethnic
minority groups begin insert and lesbian, gay, bisexual, and transgender groups end insert
to determine their needs and preferences for having culturally
competent medical providers. These hearings and meetings shall
be convened in communities that have large populations of
language and ethnic minority groups begin insert and lesbian, gay, bisexual,
and transgender groups end insert .

(e) The task force shall report its findings to the Legislature and
appropriate licensing boards begin delete within two years after creation of the
task force end delete begin insert on or before January 1, 2016 end insert .

(f) The Medical Board of California and the Dental Board of
California shall pay the state administrative costs of implementing
this section.

(g) Nothing in this section shall be construed to require
mandatory continuing education of physicians and dentists.

SEC. 2.  

Section 2198 of the Business and Professions Code is
amended to read:

2198.  

(a) This article shall be known and may be cited as the
Cultural and Linguistic Competency of Physicians Act of 2003.
The cultural and linguistic physician competency program is hereby
established and shall be operated by local medical societies of the
California Medical Association and shall be monitored by the
begin delete Division of Licensing end delete begin insert Medical Board of California end insert .

(b) This program shall be a voluntary program for all interested
physicians. As a primary objective, the program shall consist of
educational classes which shall be designed to teach physicians
the following:

(1) A foreign language at the level of proficiency that initially
improves their ability to communicate with non-English speaking
patients.

(2) A foreign language at the level of proficiency that eventually
enables direct communication with the non-English speaking
patients.

(3) Cultural beliefs and practices that may impact patient health
care practices and allow physicians to incorporate this knowledge
in the diagnosis and treatment of patients who are not from the
predominate culture in California.

(c) The program shall operate through local medical societies
and shall be developed to address the ethnic language minority
groups begin insert and lesbian, gay, bisexual, and transgender groups end insert of
interest to local medical societies.

(d) In dealing with Spanish language and cultural practices of
Mexican immigrant communities, the cultural and linguistic
training program shall be developed with direct input from
physician groups in Mexico who serve the same immigrant
population in Mexico. A similar approach may be used for any of
the languages and cultures that are taught by the program or
appropriate ethnic medical societies may be consulted for the
development of these programs.

(e) Training programs shall be based and developed on the
established knowledge of providers already serving target
populations and shall be formulated in collaboration with the
California Medical Association, the begin delete Division of Licensing end delete begin insert Medical
Board of California end insert , and other California-based ethnic begin insert and lesbian,
gay, bisexual, and transgender groups end insert medical societies.

(f) Programs shall include standards that identify the degree of
competency for participants who successfully complete
independent parts of the course of instruction.

(g) Programs shall seek accreditation by the Accreditation
Council for Continuing Medical Education.

(h) The begin delete Division of Licensing end delete begin insert Medical Board of California end insert shall
convene a workgroup including, but not limited to, representatives
of affected patient populations, medical societies engaged in
program delivery, and community clinics to perform the following
functions:

(1) Evaluation of the progress made in the achievement of the
intent of this article.

(2) Determination of the means by which achievement of the
intent of this article can be enhanced.

(3) Evaluation of the reasonableness and the consistency of the
standards developed by those entities delivering the program.

(4) Determination and recommendation of the credit to be given
to participants who successfully complete the identified programs.
Factors to be considered in this determination shall include, at a
minimum, compliance with requirements for continuing medical
education and eligibility for increased rates of reimbursement
under Medi-Cal, the Healthy Families Program, and health
maintenance organization contracts.

(i) Funding shall be provided by fees charged to physicians who
elect to take these educational classes and any other funds that
local medical societies may secure for this purpose.

(j) A survey for language minority patients shall be developed
and distributed by local medical societies, to measure the degree
of satisfaction with physicians who have taken the educational
classes on cultural and linguistic competency provided under this
section. Local medical societies shall also develop an evaluation
survey for physicians to assess the quality of educational or training
programs on cultural and linguistic competency. This information
shall be shared with the workgroup established by the begin delete Division of
Licensing end delete begin insert Medical Board of California end insert .

SEC. 3.  

Section 2198.1 of the Business and Professions Code
is amended to read:

2198.1.  

For purposes of this article, “cultural and linguistic
competency” means cultural and linguistic abilities that can be
incorporated into therapeutic and medical evaluation and treatment,
including, but not limited to, the following:

(a) Direct communication in the patient-client primary language.

(b) Understanding and applying the roles that culture, ethnicity,
begin delete and end delete race begin insert , sexual orientation, gender identity, and gender expression end insert
play in diagnosis, treatment, and clinical care.

(c) Awareness of how the health care providers and patients
attitudes, values, and beliefs influence and impact professional
and patient relations.