BILL ANALYSIS Ó
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|SENATE RULES COMMITTEE | AB 1886|
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THIRD READING
Bill No: AB 1886
Author: Eggman (D)
Amended: 6/26/14 in Senate
Vote: 21
SENATE BUSINESS, PROF. & ECON. DEV. COMM. : 8-0, 6/23/14
AYES: Lieu, Wyland, Berryhill, Corbett, Galgiani, Hernandez,
Hill, Torres
NO VOTE RECORDED: Block
SENATE APPROPRIATIONS COMMITTEE : Senate Rule 28.8
ASSEMBLY FLOOR : 50-25, 5/29/14 - See last page for vote
SUBJECT : Medical Board of California
SOURCE : Medical Board of California
DIGEST : This bill recasts and revises the law regarding
Internet posting of physician and surgeon license information by
the Medical Board of California (MBC); requires MBC to post,
indefinitely, information related to all physician and surgeon
discipline, including revocation, suspension, probation,
surrender of a license or other equivalent action taken by MBC
or a board of another state or jurisdiction; reduces the amount
of time from 10 years to three years for posting citation
information; and reduces the amount of time from 10 years to
five years for posting settlement information.
ANALYSIS :
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Existing law:
1. Licenses and regulates physicians and surgeons under the
Medical Practice Act by MBC within the Department of Consumer
Affairs (DCA).
2. Specifies that protection of the public shall be the highest
priority for MBC in exercising its licensing, regulatory, and
disciplinary functions; and requires that whenever the
protection of the public is inconsistent with other interests
sought to be promoted, the protection of the public shall be
paramount.
3. Requires any complaint to MBC against a physician and surgeon
determined to involve quality of care to meet the following
criteria before referral to a field office for further
investigation:
A. The complaint must be reviewed by one or more medical
experts with the pertinent education, training, and
expertise to evaluate the specific standard of care
issues in the complaint to determine if further field
investigation is required; and
B. The complaint must include a review of (1) relevant
patient records; (2) the statement or explanation of the
care and treatment provided by the physician and
surgeon; (3) any additional expert testimony or
literature provided by the physician and surgeon; and
(4) any additional facts or information requested by the
medical expert reviewers that may assist them in
determining whether the care rendered constitutes a
departure from the standard of care.
4. Requires an accusation to be filed against a licensee within
three years after MBC discovers the act or omission alleged
as the ground for disciplinary action, or within seven years
after the act or omission alleged as the ground for
disciplinary action occurs, whichever occurs first, as
specified.
5. Authorizes MBC to discipline a licensee by placing him/her on
probation, which may include, but is not limited to (a)
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requiring the licensee to obtain additional professional
training and to pass an examination upon the completion of
the training; (b) requiring the licensee to submit to a
complete diagnostic examination by one or more physicians and
surgeons appointed by MBC; and (c) restricting or limiting
the extent, scope, or type of practice of the licensee,
including requiring notice to patients that the licensee is
unable to perform the indicated treatment, where appropriate.
6. Authorizes MBC to issue to public letter of reprimand
concurrently with issuing a license to a physician and
surgeon license applicant who has committed a minor
violation. Requires that the public letter of reprimand to
be purged three years from the date it was issued.
7. Authorizes MBC, instead of filing a formal accusation, to
instead issue a public letter of reprimand by stipulation or
settlement with a physician and surgeon after it has
conducted an investigation or inspection, subject to the
following: (a) the public letter of reprimand may include a
requirement for specified training or education; (b) use of a
public letter of reprimand shall be limited to minor
violations; and (c) a public letter of reprimand may be
disclosed to an inquiring member of the public.
8. Declares as public information all civil judgments in any
amount, whether or not vacated by a settlement after entry of
the judgment, that were not reversed on appeal and
arbitration awards in any amount of a claim or action for
damages for death or personal injury caused by the physician
and surgeon's negligence, error, or omission in practice, or
by his/her rendering of unauthorized professional services.
9. Requires MBC to adopt regulations designating each specialty
and subspecialty practice area as either high risk or low
risk.
10.Requires the following information to be posted on MBC's
Internet Web site for a period of 10 years from the date MBC
obtains possession, custody, or control of the information,
and after the end of that period, be removed: (a) whether a
license is subject to a temporary restraining order (TRO) or
interim suspension order (ISO); (b) revocations, suspensions,
probations, or limitations on practice ordered by MBC,
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including those made as part of a probationary order or
stipulated agreement; (c) public letters of reprimand; (d)
discipline from a board of another state or jurisdiction; (e)
current accusations filed by the Attorney General (AG),
including those on appeal; (f) any malpractice judgment or
arbitration award reported to MBC after January 1, 1993; and
(g) any misdemeanor conviction that results in a disciplinary
action or an accusation that is not subsequently withdrawn or
dismissed.
11.Requires the following information to be posted on MBC's
Internet Web site indefinitely: (a) whether a licensee is in
good standing; (b) any felony convictions reported to MBC
after January 3, 1991; and (c) any hospital disciplinary
actions that resulted in the termination or revocation of a
licensee's hospital staff privileges for a medical
disciplinary cause or reason, and any additional explanatory
or exculpatory information submitted by the licensee, as
specified.
12.Provides that if a licensee's hospital staff privileges are
restored, and the licensee notifies MBC of the restoration,
the information pertaining to the termination or revocation
of those privileges, as specified, shall remain posted for a
period of 10 years from the restoration date of the
privileges.
This bill:
1. Recasts and revises existing law regarding Internet posting
of physician and surgeon licensee information, to instead
require MBC to post on its Internet Web site, specified
information on all current and former licensees of MBC, as
detailed below.
2. Requires MBC to post the following information on the current
status of the license:
A. Whether or not the licensee is presently in good
standing;
B. Current American Board of Medical Specialties
certification or board-equivalent as certified by MBC;
and
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C. Any of the following enforcement actions or
proceedings to which the licensee is actively subjected:
(1) TROs; (2) ISOs; (3) revocations, suspensions,
probations, or limitations on practice ordered by MBC or
the board of another state or jurisdiction, including
those made part of a probationary order or stipulated
agreement; (4) current accusations filed by the AG,
including accusations on appeal. Defines a "current
accusation" as an accusation that has not been
dismissed, withdrawn, or settled, and has not been
finally decided upon by an administrative law judge and
MBC unless there is a pending appeal of the decision;
and (5) citations issued that have not been resolved or
appealed within 30 days.
3. Requires MBC to post historical information in MBC's
possession, custody, or control regarding all current and
former licensees, including:
A. Approved postgraduate training;
B. Any final revocations and suspensions, or other
equivalent actions, taken against the licensee by MBC or
the board of another state or jurisdiction or the
surrender of a license in relation to a disciplinary
action or investigation, including the accusation which
resulted in the license surrender or discipline;
C. Probation or other equivalent action ordered by MBC,
or the board of another state or jurisdiction, completed
or terminated, including the accusation which resulted
in the discipline;
D. Any felony convictions. Upon receipt of a certified
copy of an expungement order granted, as specified, from
a licensee, MBC shall post notification of the
expungement order and date within six months of receipt
of the order;
E. Misdemeanor convictions resulting in a disciplinary
action or accusation that is not subsequently withdrawn
or dismissed. Upon receipt of a certified copy of an
expungement order granted, as specified, from a
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licensee, MBC shall post notification of the expungement
order and date within six months of receipt of the
order;
F. Civil judgments issued in any amount, whether or not
vacated by a settlement after entry of the judgment,
that were not reversed on appeal, and arbitration awards
issued in any amount, for a claim or action for damages
for death or personal injury caused by the physician and
surgeon's negligence, error, or omission in practice, or
by his/her rendering of unauthorized professional
services; and
G. A summary of any final hospital disciplinary actions
that resulted in the termination or revocation of a
licensee's hospital staff privileges for a medical
disciplinary cause or reason. Requires the posting to
provide any additional explanatory or exculpatory
information submitted by the licensee, as specified.
Requires MBC to post a factsheet that explains and
provides information on the reporting requirements under
Business and Professions Code (BPC) Section 805.
(1) Provides that if a licensee's hospital staff
privileges are restored and the licensee notifies
MBC, the information pertaining to the termination
or revocation of those privileges shall remain
posted for a period of 10 years from the
restoration date of the privileges, and at the end
of that period shall be removed.
(2) Provides that if a court finds, in a final
judgment, that peer review resulting in hospital
disciplinary action was conducted in bad faith and
the licensee notifies MBC of the finding, the
information concerning that hospital disciplinary
action shall be immediately removed.
4. Requires posting for 10 years, public letters of reprimand by
MBC or the board of another state or jurisdiction, including
the accusation, if any, which resulted in discipline.
5. Requires posting for three years, citations that have been
resolved by payment of the administrative fine or compliance
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with the order of abatement.
6. Requires posting for five years, all settlements in the
possession, custody, or control of MBC to be disclosed for a
licensee in a "low-risk category" of practice if there are
three or more settlements for that licensee within the last
five years, and for a licensee in the "high-risk category" of
practice if there are four or more settlements for that
licensee within the last five years. Specifies that
classification of a licensee in either a "high-risk category"
or a "low-risk" category depends upon the specialty or
subspecialty practiced by the licensee and the designation
assigned to that specialty or subspecialty by MBC in
regulations.
A. "Settlement" means a settlement in an amount of
$30,000 or more of any claim or action for damages for
death or personal injury caused by the physician and
surgeon's negligence, error, or omission in practice, or
by his/her rendering of unauthorized professional
services;
B. "Settlement" does not include a settlement by a
licensee, regardless of the amount paid, when (1) the
settlement is made as a part of the settlement of a
class claim, (2) the amount paid in settlement of the
class claim is the same amount paid by the other
licensees in the same class or similarly situated
licensees in the same class, and (3) the settlement was
paid in the context of a case for which the complaint
that alleged class liability on behalf of the licensee
also alleged a products liability class action cause of
action; and
C. MBC shall not disclose the actual dollar amount of a
settlement, but shall disclose settlement information in
the same manner and with the same disclosures required
under BPC Section 803.1 (b) (2) (B).
7. Requires MBC to post appropriate disclaimers and explanatory
statements to accompany the information posted as required
above, including an explanation of what types of information
are not disclosed. The disclaimers and statements shall be
developed by MBC and shall be adopted by regulation.
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8. Requires MBC to post links to other Internet Web sites that
provide information on board certifications that meet the
advertising requirements in existing law. Authorizes MBC to
post links to any other Internet Web sites that provide
information on the affiliations of licensed physicians and
surgeons. Authorizes MBC to provide links to other Internet
Web sites that provide information on health care service
plans, health insurers, hospitals, or other facilities.
Background
Removal of public disciplinary records from MBC's Internet Web
site . In 2003, the law was amended to require MBC to remove
certain public information from its Internet Web site after 10
years, and MBC began removing these documents in 2013. On
January 1, 2013, MBC had to remove approximately 6,900 records
from its Internet Web site due to this 10-year limit, and
continues to remove 30-40 records per month, which equates to
350-400 records per year. MBC will return the applicable
records to its Internet Web site should this bill be enacted.
Differences in disclosure between public records and MBC's
Internet Web site . The approach taken by this bill is echoed in
recommendations from MBC's 2013 Sunset Review report, in which
it was recommended that the 10-year posting requirement be
removed "in order to ensure transparency to the public." The
California Research Bureau (CRB) also recommended this change in
their 2008 report, "Physician Misconduct and Public Disclosure
Practices at the Medical Board of California."
Although MBC posts disclaimers about the availability and extent
of information on its Internet Web site, consumers may
reasonably believe that MBC's Internet Web site presents all the
publicly available information on a physician and surgeon's
license. As a result, consumers may be misled into believing -
incorrectly - that some physicians have no record of discipline.
This bill helps rectify that discrepancy by putting more - but
not all - public disciplinary information online.
In its 2008 report, CRB concluded that past disciplinary history
of a physician is predictive of future disciplinary troubles,
stating "the largest single predictive factor in the odds that a
physician faces an accusation appears to be whether the
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physician has a history of past disciplinary proceedings." CRB
also noted that "malpractice payout information has predictive
power." Ultimately CRB recommended MBC improve and expand the
information it discloses about physicians on the Internet,
stating: "Our statistical analysis of MBC accusations suggests
that 10-year availability of disciplinary documents is a minimum
period for which such documents likely are informative to
members of the public, rather than a maximum. Hence, the
current ten-year (or shorter) Internet disclosure limitations
are counter-productive for the goal of public protection."
Although this bill does not fully expand MBC disclosures on the
Internet as broadly as what might be indicated by CRB, it
appears to move further in the direction of better public
protection by giving greater disclosures to the public.
FISCAL EFFECT : Appropriation: No Fiscal Com.: Yes
Local: No
SUPPORT : (Verified 8/1/14)
Medical Board of California (source)
Center for Public Interest Law
Consumers Union's Safe Patient Project
ARGUMENTS IN SUPPORT : In sponsoring this bill, the MBC
states, "Currently, public disciplinary information for licensed
physicians can only be posted on the Board's website for 10
years. AB 1886 would allow the Board to post the most serious
disciplinary information, which is already public information,
on the Board's website for as long as it remains public."
The Center for Public Interest Law (CPIL) believes this bill
enhances the MBC's public disclosure policy - a centerpiece of
its public protection mandate. CPIL contends "the MBC Web site
should disclose- truthfully and accurately- complete public
information about the disciplinary, hospital privileges, medical
malpractice, and criminal track record of all physicians
licensed in California. Adequate and accurate public disclosure
of adverse events in a physician's professional life is
especially important in light of the fact that it still takes
MBC an average of 2.36 years to complete an investigation and
take public disciplinary action against a license. "AB 1886
would remove that arbitrary 10-year limitation on Internet
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posting as to the Board's own disciplinary actions, disciplinary
actions taken against California-licensed physicians by other
state medical boards, and medical malpractice judgments (usually
entered by a jury after a public trial) and arbitration awards
reported to MBC after January 1, 1993 - thus allowing patients
immediate access to public, accurate, and complete information
about a physician's disciplinary history."
ASSEMBLY FLOOR : 50-25, 5/29/14
AYES: Alejo, Ammiano, Bloom, Bocanegra, Bonilla, Bonta,
Bradford, Buchanan, Ian Calderon, Campos, Chau, Chesbro,
Cooley, Dababneh, Daly, Dickinson, Eggman, Fong, Fox, Frazier,
Garcia, Gatto, Gomez, Gonzalez, Hall, Roger Hernández, Holden,
Jones-Sawyer, Levine, Lowenthal, Medina, Mullin, Muratsuchi,
Nazarian, Pan, Perea, John A. Pérez, Quirk, Quirk-Silva,
Rendon, Ridley-Thomas, Salas, Skinner, Stone, Ting, Weber,
Wieckowski, Williams, Yamada, Atkins
NOES: Achadjian, Allen, Bigelow, Chávez, Conway, Dahle,
Donnelly, Beth Gaines, Gorell, Grove, Hagman, Harkey, Jones,
Linder, Logue, Maienschein, Mansoor, Melendez, Nestande,
Olsen, Patterson, V. Manuel Pérez, Wagner, Waldron, Wilk
NO VOTE RECORDED: Brown, Gordon, Gray, Rodriguez, Vacancy
MW:de 8/6/14 Senate Floor Analyses
SUPPORT/OPPOSITION: SEE ABOVE
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