BILL ANALYSIS Ó
AB 496
Page 1
Date of Hearing: April 16, 2013
ASSEMBLY COMMITTEE ON BUSINESS, PROFESSIONS AND CONSUMER
PROTECTION
Richard S. Gordon, Chair
AB 496 (Gordon) - As Amended: April 10, 2013
SUBJECT : Medicine: sexual orientation, gender identity, and
gender expression.
SUMMARY : Reestablishes and expands the Task Force on
Culturally and Linguistically Competent Physicians and Dentists
(Task Force) to consider the needs of lesbian, gay, bisexual and
transgender (LGBT) groups and report findings to the Legislature
and appropriate licensing boards by January 1, 2016, and further
requires the Cultural and Linguistic Physician Competency
Program (Program) to address the lesbian, gay, bisexual, and
transgender groups of interest to local medical societies.
Specifically, this bill :
1)Reestablishes the Task Force with the following changes to
membership:
a) Replaces the State Director of Health Services with the
Deputy Director of the Office of Health Equity (OHE);
b) Authorizes the Deputy Director of OHE, Director of
Consumer Affairs, Executive Director of the Medical Board
of California, and the Executive Director of the Dental
Board to designate a representative to the Task Force;
c) Requires the participation of California licensed
physicians and dentists who provide health services to LGBT
groups; and,
d) Requires the participation of representatives of
organizations that advocate on behalf of, or provide health
services to, LGBT groups.
2)Requires the Task Force to hold hearings and convene meetings
to obtain input from persons belonging to LGBT groups in
communities that have large populations of LGBT groups.
3)Requires the Task Force to report its findings to the
Legislature and appropriate licensing boards by January 1,
AB 496
Page 2
2016.
4)Requires the Program to address the LGBT groups of interest to
local medical societies.
5)Requires the Program to include educational classes about LGBT
groups.
6)Requires Program trainings to be formulated in collaboration
with LGBT medical societies, among others.
7)Amends the definition of "cultural and linguistic competency"
to include:
a) Understanding and applying the roles that race, sexual
orientation, gender identity, and gender expression play in
diagnosis, treatment, and clinical care; and,
b) Awareness of how attitudes, values, and beliefs of
society influence and impact professional and patient
relations.
8)Makes other technical changes to conform to current law.
EXISTING LAW :
1)Establishes the OHE within the Department of Public Health to
achieve the highest level of physical and mental health for
all people, with a focus on socioeconomically disadvantaged
populations, including vulnerable and isolated communities.
The OHE seeks to eliminate physical and mental health
disparities and inequities and incorporates the functions and
missions of the Office of Multicultural Services. (Health and
Safety Code Section 152)
2)Establishes the Medical Board of California (MBC) to regulate
physicians and surgeons. Establishes continuing education
(CE) standards for physicians and surgeons. (Business and
Professions Code (BPC) 2000 et seq.)
3)Requires that on and after July 1, 2006, all medical CE
courses shall contain curricula that include cultural and
linguistic competency in the practice of medicine. (BPC
2190.1)
AB 496
Page 3
4)Establishes the Dental Board of California (DBC) to regulate
the practice of dentistry. (BPC 1600 et seq.)
5)Establishes the Task Force on Culturally and Linguistically
Competent Physicians and Dentists which was required report
its findings to the Legislature on the following topics in
2003:
a) Recommendations for a continuing education program that
includes foreign language proficiency standards to be
acquired to meet linguistic competency;
b) Key cultural elements necessary to meet cultural
competency by physicians, dentists, and their offices; and,
c) The need for voluntary certification standards and
examinations for cultural and linguistic competency. (BPC
822)
6)Defines "cultural and linguistic competency" to mean 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, and race play in diagnosis, treatment, and
clinical care; and,
c) Awareness of how the attitudes, values, and beliefs of
health care providers, patients, and society influence and
impact professional and patient relations. (BPC 2198.1)
7)Establishes the Cultural and Linguistic Physician Competency
Program, which is a voluntary program operated by local
medical societies of the California Medical Association, with
the primary objective of teaching physicians the following:
a) A foreign language at the level of proficiency that
initially improves their ability to communicate with
non-English speaking patients;
b) A foreign language at the level of proficiency that
AB 496
Page 4
eventually enables direct communication with the
non-English speaking patients; and,
c) 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.
(BPC 2198)
FISCAL EFFECT : Unknown
COMMENTS :
1)Purpose of this bill . This bill is intended to better educate
physicians and dentists on issues in the LGBT community that
may impact healthcare and healthcare delivery. This bill
builds upon a previous task force that met between 2001 and
2003 and published a report with several comprehensive
suggestions for increasing the cultural and linguistic
competency of physicians and dentists. This bill is sponsored
by Equality California.
2)Author's statement . According to the author's office, "The
Legislature has found culturally and linguistically competent
care to be essential in providing patients with the highest
level of care. Medical groups, community organizations and
even the federal government are reaching a consensus that more
time and resources need to be dedicated to ensure that all
Americans have access to quality health care. Extending
cultural competency provisions to members of the LGBT
community is not only a medical necessity, but makes common
sense. By addressing the needs of the LGBT community, we can
reduce disease transmission and progression, reduce health
care costs and increase overall mental and physical well-being
for all Californians.
"AB 496 will address the issue of LGBT cultural competency by
reauthorizing the Task Force on Culturally and Linguistically
Competent Physicians and Dentists to include input from
relevant lesbian, gay, bisexual and transgender interest
groups and medical societies. The Task Force will be comprised
of health professionals, advocates, and providers and
consumers of care."
3)Unique Health Challenges for the LGBT Community . Multiple
AB 496
Page 5
medical and dental studies have noted unique social and health
challenges of the LGBT community, and that additional training
for healthcare providers can enhance the quality of care
delivered to this population.
According to a 2011 article published in the Journal of the
American Medical Association, "[LGBT] individuals have
specific health and health care needs relating to chronic
disease risk, adult and adolescent mental health, unhealthy
relationships (e.g. intimate partner violence), gender
identity, sexually transmitted infections, and [HIV]
infection, among others. Compared with heterosexual and
nontransgender socioeconomically matched peers, LGBT
individuals are more likely to face barriers accessing
appropriate medical care, with may create or increase existing
disparities. A 2011 Institute of Medicine report on the
health of LGBT individuals noted that 'although LGBT
individuals share with the rest of society the full range of
health risks, they also face a profound and poorly understood
set of additional health risks due largely to social stigma."
A 2009 article in the Journal of Dental Education noted the
need to make progress within the professional dental
population to understand the particular needs of LGBT patients
and create a more welcoming environment for both LGBT patients
and practitioners.
4)Office of Health Equity . OHE was established in 2012 by AB
1467 (Budget Committee), Chapter 23, Statutes of 2012, to
provide leadership in reducing physical and mental health
disparities in vulnerable communities. OHE is tasked with
many ambitious goals, including:
a) Achieving the highest level of health and mental health
for all people, with special attention focused on those who
have experienced socioeconomic disadvantage and historical
injustice, including, but not limited to, vulnerable
communities and culturally, linguistically, and
geographically isolated communities; and,
b) Improving the health status of all populations and
places, with a priority on eliminating health and mental
health disparities and inequities.
AB 496
Page 6
To do this, OHE is statutorily required to establish an
advisory committee by October 1, 2013 and conduct periodic
demographic analyses on health and mental health disparities
and inequities (updated periodically, but not less than every
two years). OHE explicitly recognizes the health disparities
that afflict LGBT populations in California.
5)2001 Task Force on Culturally and Linguistically Competent
Physicians and Dentists . The original Task Force, created in
2001, published 22 recommendations in its 2003 report to the
Legislature. It is unclear to what extent, if any, those
recommendations were acted upon.
6)Related 2012 Legislation Vetoed . SB 747 (Kehoe) of 2012 would
have required physicians and surgeons, registered nurses,
licensed vocational nurses, psychologists, psychiatric
technicians, marriage and family therapists, and clinical
social workers, to take at least one CE course that provides
instruction on cultural competency, sensitivity, and best
practices for providing adequate care to LGBT people on and
after January 1, 2013, as specified.
That bill was vetoed by the Governor, who wrote, "This bill
would order doctors, nurses and other licensed health care
professionals to take a brief 'continuing education' course on
how to treat and care for lesbian, gay, bisexual, and
transgender persons. I believe that respective licensing
boards are better suited than the Legislature or the Governor
to decide these matters."
AB 496 attempts to address these concerns by directing the
question of how to better serve the LGBT community to the
licensing boards themselves, which could independently
determine how to implement any changes.
7)Arguments in support . Equality California writes, "Lack of
provider understanding is a major barrier to adequate
healthcare for LGBT people. LGBT patients often experience
inequities in treatment because their doctors or dentists have
not received training in cultural competency on LGBT issues,
and therefore do not understand the specific needs of or the
health disparities impacting the community. There is no
statutory requirement that doctors and dentists receive such
training, so most do not.
AB 496
Page 7
"AB 496 makes clear that LGBT issues should be included in
existing cultural competency training for doctors and
dentists, and ensures that the LGBT community will be
represented on the existing cultural competency task force."
8)Previous legislation . SB 747 (Kehoe) of 2012 would have
required physicians and surgeons, registered nurses, licensed
vocational nurses, psychologists, psychiatric technicians,
marriage and family therapists, and clinical social workers,
to take at least one CE course that provides instruction on
cultural competency, sensitivity, and best practices for
providing adequate care to LGBT people. That bill was vetoed
by the Governor.
AB 673 (Pérez), Chapter 639, Statutes of 2011, added
consideration of LGBT communities to the duties of the Office
of Multicultural Health (which is now part of OHE.)
AB 801 (Diaz), Chapter 510, Statutes of 2003, established the
Cultural and Linguistic Physician Competency Program to be
operated by local medical societies of the California Medical
Association and monitored by MBC.
AB 2394 (Firebaugh), Chapter 802, Statutes of 2000, created
the Task Force on Culturally and Linguistically Competent
Physicians and Dentists and requires the Task Force to, among
other things, develop recommendations for a CE program.
REGISTERED SUPPORT / OPPOSITION :
Support
Equality California (sponsor)
AIDS Legal Referral Panel
API Equality - Northern California
Asian & Pacific Islander American Health Forum
Asian American Center for Advancing Justice
Asian Americans for Civil Rights and Equality
Asian Law Caucus
Black AIDS Institute
California Communities United Institute
California Immigrant Policy Center
California Pan-Ethnic Health Network
Gay Asian Pacific Alliance
AB 496
Page 8
GLMA: Health Professionals Advancing LGBT Equity
Greenlining Institute
L.A. Gay and Lesbian Center
Latino Equality Alliance
National Asian Pacific American Women's Forum
National Association of Social Workers, California Chapter
National Center for Lesbian Rights
Our Family Coalition
Planned Parenthood Affiliates of California
San Diego LGBT Community Center
San Francisco HIV Health Services Planning Council
Trevor Project
61 private individuals
Opposition
None on file.
Analysis Prepared by : Sarah Huchel / B.,P. & C.P. / (916)
319-3301