BILL ANALYSIS Ó
-----------------------------------------------------------------
|SENATE RULES COMMITTEE | AB 496|
|Office of Senate Floor Analyses | |
|1020 N Street, Suite 524 | |
|(916) 651-1520 Fax: (916) | |
|327-4478 | |
-----------------------------------------------------------------
THIRD READING
Bill No: AB 496
Author: Gordon (D), et al.
Amended: 6/25/13 in Senate
Vote: 21
SENATE BUSINESS, PROF. & ECON. DEV. COMM. : 8-2, 7/1/13
AYES: Lieu, Block, Corbett, Galgiani, Hernandez, Hill, Padilla,
Yee
NOES: Emmerson, Wyland
SENATE APPROPRIATIONS COMMITTEE : Senate Rule 28.8
ASSEMBLY FLOOR : 54-20, 5/28/13 - See last page for vote
SUBJECT : Medicine: sexual orientation, gender identity, and
gender expression
SOURCE : Equality California
DIGEST : This bill reauthorizes the Task Force on Culturally
and Linguistically Competent Physicians and Dentists (Task
Force) to advocate for and provide health services to members of
language and ethnic minority groups and lesbian, gay, bisexual,
transgender (LGBT) and intersex groups; redefines "cultural and
linguistic competency;" requires that the Task Force report its
findings to the Legislature by January 1, 2016; and requires
that training programs for health professionals be formulated in
collaboration with medical societies.
ANALYSIS :
CONTINUED
AB 496
Page
2
Existing law:
1.Establishes the Office of Health Equity (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.
2.Establishes the Medical Board of California (MBC) to regulate
physicians and surgeons; and establishes continuing education
(CE) standards for physicians and surgeons.
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.
4.Establishes the Dental Board of California (DBC) to regulate
the practice of dentistry.
5.Establishes the Task Force 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.
1.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;
AB 496
Page
3
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.
1.Establishes the Cultural and Linguistic Physician Competency
Program (Program), which is a voluntary program operated by
local medical societies of the CMA, 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
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.
This bill:
1.Reestablishes the Task Force.
2.Specifies that the Deputy Director of the OHE or his/her
designee and the Director of the Department of Consumer
Affairs (DCA) or his/her designee shall serve as co-chairs of
the Task Force.
3.Authorizes additional members to the Task Force including (a)
the Executive Director of the MBC or his/her designee, (b) the
Executive Director of the DBC or his/her designee, (c) a
member appointed by the Senate Rules Committee and (d) a
member appointed by the Speaker of the Assembly.
4.Permits the Director of DCA or his/her designee in
consultation with the OHE to appoint additional members to the
Task Force.
AB 496
Page
4
5.Requires the Task Force to hold hearings and convene meetings
to obtain input from persons belonging to LGBT and intersex
groups in communities that have large populations of LGBT and
intersex groups.
6.Requires the Task Force to report its findings to the
Legislature and appropriate licensing boards by January 1,
2016.
7.Provides that the Program be monitored by the MBC.
8.Requires the Program to address the ethnic language minority
groups, as well as LGBT and intersex groups, of interest to
local medical societies.
9.Requires training programs to be formulated in collaboration
with LGBT and intersex medical societies, among others, and
specifies the accreditation standards as well as the
competency standards for participants.
10.Specifies the MBC 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 a series of participant
evaluations.
11.Requires local medical societies to develop a survey which
measures the degree of satisfaction with physicians who have
taken the educational classes on cultural and linguistic
competency and distribute the survey to (a) language minority
patients, and (b) LGBT and intersex patients.
12.Specifies that local medical societies shall also develop an
evaluation survey for physicians to assess the quality of
education or training programs on cultural and linguistic
competence.
13.Requires that the information required by these surveys be
shared with the workgroup established by the MBC.
14.Amends the definition of "cultural and linguistic competency"
to include:
A. Understanding and applying the roles that race, sexual
AB 496
Page
5
orientation, gender identity, and gender expression play in
diagnosis, treatment and clinical care;
B. Awareness of how attitudes, values and beliefs of
society influence and impact professional and patient
relations; and,
C. Developing behaviors that increase a patient's
satisfaction with, and trust in, his/her physicians and
health care institutions.
Background
Barriers to healthcare for LGBT and Intersex individuals . In
2011, both the Institute of Medicine (IOM) and the Health and
Human Services recognized the need for training in culturally
competent care for LGBT individuals. In its report, The Health
of Lesbian, Gay, Bisexual and Transgender People: Building a
Foundation for Better Understanding, the IOM, whose mission is
to be an independent and objective "adviser to the nation to
improve health" stated, "With respect to the healthcare provided
to LGBT people, a number of structural barriers result from
providers' lack of training in the health needs of LGBT
patients."
Stigma can have lifelong repercussions, continuing to affect
Americans as they age. According to a study, LGBT adults were
more likely to report being lonely, depressed and having a
disability. The study also found that eight in 10 LGBT adults
reported being verbally and/or physically assaulted, threatened
with violence or with being "outed." Furthermore, one in five
LGBT adults had not told their health care provider about their
sexual orientation, and some LGBT adults reported being turned
away by a health care provider after they disclosed their sexual
orientation.
The transgender community, in particular, faces unique
challenges. Negative attitudes toward transgender individuals
still prevail, with DSM-IV classifying "gender identity
disorder" as a mental illness. In studies, the transgender
community face rates of suicidal ideation and attempts ranging
from 16-37% and 27% have reported being a victim of violence.
Furthermore, a national survey found about 19% of transgender
men and women report being refused medical care and 28% delayed
AB 496
Page
6
medical care due to their gender non-conforming status. The
lack of health insurance or coverage, in addition to uninformed
medical providers, is still a continuing problem for transgender
people.
Task Force on Culturally and Linguistically Competent Physicians
and Dentists . In 2000, AB 2394 (Firebaugh, Chapter 802)
established the Task Force on Culturally and Linguistically
Competent Physicians and Dentists. In their approval of AB
2394, the Legislature and the Governor acknowledged the need for
California's health care delivery system to evolve in order to
meet the needs of California's diverse populations.
Specifically, AB 2394 required the Task Force to:
Develop recommendations for a continuing education program
that includes language proficiency standards of foreign
language to be acquired to meet linguistic competency;
Identify the key cultural elements necessary to meet cultural
competency by physicians, dentists and their office;
Assess the need for voluntary certification standards and
examinations for cultural and linguistic competency;
Hold hearings to obtain input from persons belonging to
language and ethnic minority groups to determine their needs
and preferences for having culturally competent medical
providers; and
Report its finding to the Legislature and appropriate
licensing boards within two years after creation of the Task
Force.
The Task Force was comprised of 37 members, including
representatives from state government and licensing boards,
community clinics, consumer advocacy groups, representative of
immigrant, Latino and Asian communities and other key
stakeholders. AB 2394 also created a Subcommittee of the Task
Force which was chaired by the Director of the Department of
Health Services, Diana Bonta. The subcommittee's purpose was
to, "examine the feasibility of establishing pilot program that
would allow Mexican and Caribbean licensed physicians and
dentists to practice in nonprofit community health centers in
California's medically underserved areas." The subcommittee
AB 496
Page
7
submitted a report to the Legislature in July 2001. The
subcommittee was comprised of the Director of the Department of
Health Services, the Executive Director of the MBC, the
Executive Officer of the DBC and the Director of the Office of
Statewide Health Planning and Development. There were advocates
for licensed physicians and dentists and representatives of
nonprofit clinic associations.
The Task Force contracted with the University of California at
San Francisco to examine what courses and experiences directed
toward increasing cultural and linguistic competence are
provided by California medical and dental schools and what the
content of these courses were. The study found that medical and
dental schools have a large number of hours spent on teaching
cultural competence, when measured to include both didactic and
clinical and group courses. The study found that current ethnic
diversity of faculty, students and community clinic experiences
seemed to contribute to the teaching of cultural competence in
these schools. The study indicated "As the curricula change
over time, vigilance is needed to ensure that there is continued
teaching in cultural competence and that current talent in this
area at the universities is used to enrich the medical and
dental school curriculum."
The Task Force issued its recommendations to the Legislature in
2003, but it did not take LGBT communities into consideration
under its original charge. The Task Force has been dormant
since the 2003 report to the Legislature.
Cultural competence . Cultural competence is defined as a set of
skills that allows providers to give culturally appropriate
high-quality care to individuals of cultures different from
their own and is an important aspect of care (IOM, 1999). In
addition, cultural competence plays a crucial role in
understanding, diagnosing and delivering appropriate care to
patients. The ability of physicians and other health care
providers to effectively communicate with and to create a
welcoming and safe environment for their patients has a
demonstrable impact on patient health outcomes.
FISCAL EFFECT : Appropriation: No Fiscal Com.: Yes
Local: No
SUPPORT : (Verified 8/9/13)
AB 496
Page
8
Equality California (source)
AFSCME
AIDS Legal Referral Panel
Asian & Pacific Islander American Health Forum
Asian & Pacific Islander Wellness Center
Asian Americans for Civil Rights & Equality
Asian Law Caucus
Asian Pacific Islander Equality- Northern Chapter
Black AIDS Institute
Board of Equalization Member, Betty T. Yee
California Academy of Family Physicians
California Communities United Institute
California Immigrant Policy Center
California Mental Health Directors Association
California Pan Ethnic Health Network
California Primary Care Association
City of West Hollywood
Gay and Lesbian Community Services Center of Orange County
Gay and Lesbian Medical Association: Health Professionals
Advancing LGBT
Equality
Gay Asian Pacific Alliance
Greenlining Institute
L.A. Gay and Lesbian Center
Latino Equality Alliance
Lyon-Martin Health Services
Medical Board of California
Mental Health America of Northern California
National Asian Pacific American Women's Forum - San Diego
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 Eligible Metropolitan Area HIV Health Services
Planning Council
Trevor Project
OPPOSITION : (Verified 8/9/13)
California Right to Life Committee, Inc.
ARGUMENTS IN SUPPORT : According to the bill's sponsor,
AB 496
Page
9
Equality California, "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 would require the licensed
task force members and advocate task force members to provide
health services to, or advocate on behalf of, members of
language and ethnic minority groups and, in addition, LGBT
groups. The bill would require the task force to report its
findings to the Legislature and appropriate licensing boards by
January 1, 2016."
Proponents write, "AB 496 would ensure that the Cultural and
Linguistic Competency Program also addresses LGBT groups. The
bill would require the training programs to be formulated in
collaboration with California-based LGBT medical societies. 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."
ARGUMENTS IN OPPOSITION : The California Right to Life
Committee (CLCR) argues, "The CLRC believes that AB 496 is an
unnecessary measure and insinuates that the medical and dental
professionals are not adequately trained to be sensitive to any
special needs of this selected group of patients. This
dishonors these professionals and is not needed."
ASSEMBLY FLOOR : 54-20, 5/28/13
AYES: Alejo, Ammiano, Atkins, Bloom, Blumenfield, Bocanegra,
Bonilla, Bonta, Bradford, Brown, Buchanan, Ian Calderon,
Campos, Chau, Chesbro, Cooley, Daly, Dickinson, Eggman, Fong,
Fox, Frazier, Garcia, Gatto, Gomez, Gonzalez, Gordon, Gray,
Hall, Roger Hernández, Jones-Sawyer, Levine, Lowenthal,
Maienschein, Medina, Mitchell, Mullin, Muratsuchi, Nazarian,
Pan, Perea, V. Manuel Pérez, Quirk, Quirk-Silva, Rendon,
Salas, Skinner, Stone, Ting, Weber, Wieckowski, Williams,
Yamada, John A. Pérez
NOES: Allen, Bigelow, Conway, Dahle, Donnelly, Beth Gaines,
Gorell, Grove, Hagman, Harkey, Jones, Linder, Logue, Mansoor,
Melendez, Morrell, Olsen, Patterson, Wagner, Waldron
AB 496
Page
10
NO VOTE RECORDED: Achadjian, Chávez, Holden, Nestande, Wilk,
Vacancy
MW:ej 8/12/13 Senate Floor Analyses
SUPPORT/OPPOSITION: SEE ABOVE
**** END ****