BILL ANALYSIS Ó 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 AB 2346 Page 2 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 AB 2346 Page 3 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