BILL ANALYSIS                                                                                                                                                                                                    



                                                                  AB 2346
                                                                  Page  1

          Date of Hearing:   May 14, 2014

                        ASSEMBLY COMMITTEE ON APPROPRIATIONS
                                  Mike Gatto, Chair

                    AB 2346 (Gonzalez) - As Amended:  May 5, 2014 

          Policy Committee:                              Business and  
          Professions  Vote:                            10-0

          Urgency:     No                   State Mandated Local Program:  
          No     Reimbursable:              No

           SUMMARY  

          This bill authorizes the Medical Board of California (MBC) to  
          establish a voluntary and confidential program to aid physicians  
          struggling with substance abuse, mental health concerns, or  
          other issues, and specifies the program is to be modeled after  
          the State Bar's Lawyer Assistance Program.

          It also authorizes the MBC to charge a reasonable administrative  
          fee to support the program, and requires participants in the  
          program to pay all expenses relating to treatment and recovery. 

           FISCAL EFFECT  

          1)Estimated one-time costs of $250,000 to the MBC (Contingent  
            Fund of the MBC) associated with developing the program. 

          2)Ongoing costs associated with the program of $2 million  
            annually (Contingent Fund of the MBC), likely offset by some  
            level of increased fee revenue.  The bill authorizes the MBC  
            to charge a reasonable administrative fee to support the  
            program, but does not require the program to be fully  
            fee-supported.

          3)Given the bill requires participants in the program to pay all  
            expenses relating to treatment and recovery, treatment costs  
            are assumed to be off-budget and privately, directly paid for  
            by program participants. 

           COMMENTS  

           1)Purpose  . The author argues the 2007 dissolution of a  








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            problem-plagued physician diversion program previously  
            operated by the MBC left a gap in the state's ability to  
            address serious physician health conditions.  She indicates  
            since the program ended, physicians dealing with alcohol or  
            substance abuse issues, mental illness, or other health  
            conditions that may interfere with their ability to practice  
            medicine safely have not had a centralized resource to assist  
            them in seeking private treatment and monitoring services. The  
            author contends this is a serious public health risk for the  
            state, as troubled practitioners present a threat to patients.  
             This bill is sponsored by the California Medical Association.

           2)Background  . The MBC voted to allow California's previous  
            physician health program to sunset in 2008 after reports by  
            the California State Auditor cited numerous problems,  
            including inconsistent monitoring of doctors and poor  
            oversight.  This program was run by the MBC itself, and  
            functioned as an option for diversion from enforcement.  Since  
            the program was terminated and a transition plan was  
            established for participants, there has not been a diversion  
            from the discipline process for physician with substance abuse  
            or mental health problems.

            Many other states offer centralized physician health programs  
            that offer assistance to physicians struggling with health  
            conditions that impair their ability to care for patients.  
            Other California boards offer similar programs, some of which  
            actually divert professionals from discipline.

           3)Opposition  . The Center for Public Interest Law opposes this  
            bill, arguing the state need not be involved in a personal  
            journey to recovery.  

            In addition, consumer groups, consumer attorneys, the  
            University of San Diego, and senior advocacy groups oppose  
            this bill, indicating suspicion that information about failed  
            drug tests would be kept secret from MBC enforcement personnel  
            under the bill. Staff notes this bill states participation in  
            the program shall not "relieve the physician or surgeon of any  
            lawful duties and obligations under this chapter or otherwise  
            under any disciplinary action."

           4)Previous Legislation .  Since the dissolution of the prior  
            program, there have been several legislative attempts to  
            reestablish a program.  SB 1483 (Steinberg) of 2012 required  








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            the Department of Consumer Affairs to contract with a vendor  
            to administer a physician health program. That bill was held  
            on the Assembly Floor.   

            AB 214 (Fuentes) in 2008 established a voluntary program  
            within the Department of Public Health, and was vetoed due to  
            concerns that physician oversight would be fragmented without  
            MBC involvement. 

            AB 526 (Fuentes) in 2009 established a voluntary program  
            within the State and Consumer Services Agency, and was held on  
            the Suspense File in Senate Appropriations Committee.

            SB 1441 (Ridley-Thomas), Chapter 548, Statutes of 2008 created  
            the Substance Abuse Coordination Committee (SACC) and required  
            the committee to formulate uniform and specific standards in  
            specified areas that each healing arts board shall use in  
            dealing with substance-abusing licensees, whether or not a  
            board chooses to have a formal diversion program.

           Analysis Prepared by  :    Lisa Murawski / APPR. / (916) 319-2081