BILL ANALYSIS Ó
AB 496
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Date of Hearing: August 20, 2014
ASSEMBLY COMMITTEE ON BUSINESS, PROFESSIONS AND CONSUMER
PROTECTION
Susan A. Bonilla, Chair
AB 496 (Gordon) - As Amended: June 25, 2014
SUBJECT : Medicine: continuing medical education: sexual
orientation, gender identity, and gender expression.
SUMMARY : Includes information pertinent to the appropriate care
and treatment of lesbian, gay, bisexual, transgender (LGBT) and
intersex communities in recommended continuing medical education
(CME) requirements for cultural competency, and authorizes
associations that accredit CME courses to update continuing
education standards as needed. Specifically, this bill :
1)Authorizes associations that accredit continuing medical
education courses to update as needed the standards for
continuing medical education courses that contain curriculum
that includes cultural and linguistic competency in the
practice of medicine.
2)Expands the definition of cultural competency to include
understanding and applying information pertinent to the
appropriate treatment of, and provision of care to, the
lesbian, gay, bisexual, transgender and intersex communities
to the process of clinical care, as appropriate.
3)Makes other technical or clarifying changes.
EXISTING LAW :
1)Establishes the Medical Board of California (MBC) to regulate
physicians and surgeons. Establishes CME standards for
physicians and surgeons. (Business and Professions Code (BPC)
2000 et seq.)
2)Requires that on and after July 1, 2006, all medical CME
courses shall contain curricula that include cultural and
linguistic competency in the practice of medicine. (BPC
2190.1)
3)Defines "cultural and linguistic competency" to mean cultural
and linguistic abilities that can be incorporated into
AB 496
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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)
FISCAL EFFECT : According to the Senate Appropriations
Committee, pursuant to Senate Rule 28.8, negligible state costs.
COMMENTS :
1)Purpose of this bill . This bill is intended to promote better
education of physicians on issues affecting the delivery of
care to individuals in the LGBT and intersex communities by
including these issues under the definition of "cultural
competency" for purposes of updating CME requirements. 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."
3)Unique Health Challenges for the LGBT and Intersex Community .
Multiple 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.
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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, which 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)CME and cultural competency . Existing law requires MBC to
adopt and administer standards for CME, and requires that all
CME courses contain curriculum that includes cultural and
linguistic competency in the practice of medicine. MBC
recognizes certain associations to accredit CME courses, and
requires these associations to develop standards to ensure
that accredited CME courses comply with MBC's standards.
Current law defines "cultural competency" as a set of
integrated attitudes, knowledge, and skills that enable a
health care professional or organization to care effectively
for patients from diverse cultures, groups, and communities.
This bill specifies that cultural competency is recommended to
include information pertinent to the appropriate treatment of,
and provision of care to, the LGBT and intersex communities.
This bill also authorizes the accrediting associations to
update their standards to accommodate this new directive.
5)Senate amendments . The previous version of this bill
attempted to achieve the same goal of better educating
physicians about LGBT-specific health issues, but by a
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different means. The prior version heard in the Assembly
reestablished and expanded the Task Force on Culturally and
Linguistically Competent Physicians and Dentists to consider
the needs of LGBT groups and required the Cultural and
Linguistic Physician Competency Program to address LGBT groups
of interest to local medical societies. This bill now
integrates the goal of better understanding the healthcare
needs of LGBT and intersex communities into existing CME
requirements. This bill no longer includes dentists, however,
but has included the intersex community.
6)Arguments in support . The American Federation of State,
County and Municipal Employees (AFSCME), AFL-CIO, states,
"This bill will promote a higher quality of patient care in
California for members of the LGBT community. By directly
addressing the care needs of LGBT individuals, this bill will
mitigate disease transmission, reduce care costs, and increase
the overall mental and physical well-being of patients."
REGISTERED SUPPORT / OPPOSITION :
Support
Equality California (sponsor)
AFSCME
Medical Board of California
Opposition
None on file.
Analysis Prepared by : Sarah Huchel / B.,P. & C.P. / (916)
319-3301
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