BILL ANALYSIS Ó AB 496 Page 1 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 Page 2 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. AB 496 Page 3 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 AB 496 Page 4 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 FN: