BILL ANALYSIS Ó ----------------------------------------------------------------- |SENATE RULES COMMITTEE | SB 304| |Office of Senate Floor Analyses | | |1020 N Street, Suite 524 | | |(916) 651-1520 Fax: (916) | | |327-4478 | | ----------------------------------------------------------------- UNFINISHED BUSINESS Bill No: SB 304 Author: Lieu (D), et al. Amended: 9/6/13 Vote: 21 SENATE BUSINESS, PROF. & ECON. DEV. COMM. : 9-0, 4/29/13 AYES: Price, Emmerson, Corbett, Galgiani, Hernandez, Hill, Padilla, Wyland, Yee NO VOTE RECORDED: Block SENATE APPROPRIATIONS COMMITTEE : 5-0, 5/23/13 AYES: De León, Walters, Hill, Lara, Padilla NO VOTE RECORDED: Gaines, Steinberg SENATE FLOOR : 35-2, 5/28/13 AYES: Beall, Berryhill, Block, Cannella, Corbett, Correa, De León, DeSaulnier, Emmerson, Evans, Fuller, Gaines, Galgiani, Hancock, Hill, Hueso, Huff, Jackson, Knight, Lara, Leno, Lieu, Liu, Monning, Nielsen, Padilla, Pavley, Price, Roth, Steinberg, Torres, Walters, Wolk, Wright, Yee NOES: Anderson, Wyland NO VOTE RECORDED: Calderon, Hernandez, Vacancy ASSEMBLY FLOOR : Not available SUBJECT : Healing arts: boards SOURCE : Author DIGEST : This bill revises the Medical Practice Act (MPA) to CONTINUED SB 304 Page 2 transfer inspectors and medical consultants from the Medical Board of California (MBC) to the Division of Investigation (DOI) within the Department of Consumer Affairs (DCA), extends the sunset date of MBC by four years, and amends the Veterinary Practice Act to extend its sunset date by two years. Assembly Amendments (1) change the author of the bill; (2) include the Osteopathic Medical Board and the Physician Assistant Board among the boards whose jurisdictional violations are investigated by the Health Quality Investigation Unit (Unit); (3) include the Physical Therapy Board among the boards whose applicants and licensees are investigated by the Department of Justice (DOJ), as specified; (4) add language to avoid chaptering-out issues with SB 670 (Steinberg); and (5) make other technical and clarifying changes. ANALYSIS : Existing law: 1.Authorizes the licensing and regulation of physicians and surgeons and other professions regulated under the MPA by MBC, and sunsets those provisions on January 1, 2014. 2.Provides for the licensing and regulation of the practice of veterinary medicine by the Veterinary Medical Board (VMB), and sunsets these provisions on January 1, 2014. 3.Specifies for both MBC and the VMB that protection of the public shall be the highest priority for the board in exercising its licensing, regulatory, and disciplinary functions; and whenever the protection of the public is inconsistent with other interests sought to be promoted, the protection of the public shall be paramount. This bill: 1.Transfers the Unit from MBC to DOI within DCA, and clarifies that the primary responsibility of the Unit is to investigate violations of law or regulation by licensees and applicants within the jurisdiction of MBC, the Board of Podiatric Medicine, the Board of Psychology, the Osteopathic Medical Board, and the Physician Assistant Board, or any entity under the jurisdiction of MBC. CONTINUED SB 304 Page 3 2.Clarifies that medical consultant positions and staff support for the medical consultant positions shall be transferred to the Unit. 3.Adds the Physical Therapy Board to those boards whose licensees and applicants are investigated by the DOJ, as specified. 4.Prohibits MBC from being charged an hourly rate, or for investigation costs, for the performance of investigations by the Unit. 5.Clarifies that all civil service employees whose functions are transferred to DOI as a result of this bill and who are currently employed by MBC shall retain their positions, status, and rights, as specified. 6.Requires the transfer of the Unit to DOI to occur by July 1, 2014. 7.Requires that the transfer of employees shall include all peace officer positions and all staff support positions for those peace officer positions. 8.Extends MBC's sunset date until January 1, 2018, and makes MBC subject to review by the appropriate policy committees of the Legislature. 9.Requires that MBC's executive director be approved by the Director of DCA. 10.Requires each physician and surgeon applicant and licensee who has an electronic mail address to report it to MBC by July 1, 2014. The electronic mail address shall be considered confidential and not subject to public disclosure. 11.Removes language requiring MBC to send regular mail to those physician and surgeons who do not confirm his/her electronic mail address. 12.Permits eligibility for a physician and surgeon's certificate for a graduate from an unrecognized foreign medical school if that individual holds an unlimited and unrestricted license as CONTINUED SB 304 Page 4 a physician and surgeon in a Canadian province for a minimum of 10 years. 13.Reduces the number of years, from five to two, for a physician and surgeon's certificate applicant to have held an unrestricted license and continuously practiced in another state, federal territory, or Canadian province. 14.Permits eligibility for a physician and surgeon's certificate for an applicant who acquired any part of his/her professional instruction from a foreign medical school that was disapproved by MBC at the time he/she attended the school after 12 years of unrestricted practice as a physician and surgeon, as specified, instead of 20 years. 15.Clarifies that a physician and surgeon applicant shall have obtained a passing score on all parts of Step 3 of the United States Medical Licensing Examination (USMLE) within not more than four attempts in order to be eligible for a physician's and surgeon's certificate. 16.Clarifies that an applicant who obtains a passing score on all parts of Step 3 of the USMLE in more than four attempts and who meets specified requirements shall be eligible to be considered for issuance of a physician's and surgeon's certificate. 17.Changes references from the Department of Corporations to the Department of Business Oversight. 18.Changes references from the California Emergency Management Agency to the Office of Emergency Services. 19.Requires an accredited outpatient setting to report an adverse event to MBC no later than five days after the adverse event has been detected, or, if that event is an ongoing urgent or emergent threat to the welfare, health, or safety of patients, personnel, or visitors, not later than 24 hours after the adverse event has been detected. States that disclosure of individually identifiable patient information shall be consistent with applicable law. 20.Permits MBC to fine an accredited outpatient setting an amount not to exceed $100 for each day that the adverse event is not reported, as specified. If the accredited outpatient CONTINUED SB 304 Page 5 setting disputes a determination by MBC regarding alleged failure to report an adverse event, the accredited outpatient setting may, within 10 days of notification of MBC's determination, request a hearing, as specified. Requires that penalties be paid when appeals have been exhausted. 21.Declares that civil settlements are treated as complaints by the board, as specified. 22.States that a health care facility with electronic health records' failure to provide an authorizing patient's certified medical records to MBC within 15 days of receiving the request, authorization, and notice will subject the health care facility to a civil penalty, payable to MBC, of up to $1,000 per day for each day that the documents have not been produced, and after the 15th day, up to $10,000, unless the health care facility is unable to provide the documents within this time period for good cause. 23.Strikes provisions of law related to expert testimony before MBC. 24.Permits corporations to employ physicians and surgeons or doctors of podiatric medicine enrolled in approved residency postgraduate training programs or fellowship programs. 25.Permits a bona fide student to engage in the practice of midwifery if the student is under the supervision of a certified nurse-midwife, as specified. 26.Defines a "bona fide student" to mean an individual who is enrolled and participating in a midwifery education program or who is enrolled in a program of supervised clinical training as part of the instruction of a three-year postsecondary midwifery education program approved by MBC. 27.States that the failure of a physician and surgeon to comply with an order to be examined by one or more physicians and surgeons or psychologists designated by DCA for evaluation of competency to practice may constitute grounds to issue an interim suspension order (ISO). 28.Extends the time period, from 15 to 30 days, between the issuance of an ISO and the filing of an accusation. CONTINUED SB 304 Page 6 29.Deletes the sunset date on the Health Quality Enforcement Section in the DOJ and vertical enforcement. 30.Requires MBC, in consultation with DOJ and DCA, to report and make recommendations to the Governor and the Legislature on the vertical enforcement and prosecution model, by March 1, 2015. 31.Extends until January 1, 2016, the provisions establishing the VMB and subjects the VMB to a review by the appropriate policy committees of the Legislature and clarifies that the review of the VMB shall be limited to those issues identified by the appropriate policy committees and does not involve the preparation or submission of a sunset review document or questionnaire. 32.Clarifies that the VMB's inspection authority does not extend to premises that are not required to be registered with the VMB and specifies that this provision does not affect the VMB's ability to investigate alleged unlicensed activity. 33.Requires the VMB to make every effort to inspect at least 20% of veterinary premises on an annual basis. 34.Requires the Multidisciplinary Committee (MDC) to only serve in an advisory capacity to the VMB and specifies that the objectives, duties and actions of the MDC shall not be a substitute for or conflict with any of the powers, duties and responsibilities of the VMB. 35.Increases the membership of the MDC from seven to nine by adding a veterinarian member of the VMB, who is to be appointed by the VMB President, and the Registered Veterinary Technician (RVT) member of the VMB and specifies that VMB members on the MDC serve concurrently with their term of office. 36.States the intent of the Legislature that the MDC give appropriate consideration to issues pertaining to the practice of RVTs. 37.Requires prior to authorizing a veterinary assistant (VA) to obtain or administer a controlled substance by the order of a supervising veterinarian, the licensee manager in a veterinary CONTINUED SB 304 Page 7 practice to conduct a background check on that VA and specifies that a VA who has a drug or alcohol-related felony conviction, as indicated in the background check, shall be prohibited from obtaining or administering controlled substances. 38.Authorizes an RVT or a VA to administer a drug, including but not limited to, a drug that is a controlled substance under the direct or indirect supervision of a licensed veterinarian when done pursuant to the order, control, and full professional responsibility of a licensed veterinarian and further specifies that no person other than a licensed veterinarian may induce anesthesia unless authorized by regulation of the VMB. 39.Authorizes a VA to obtain or administer a controlled substance pursuant to the order, control, and full professional responsibility of a licensed veterinarian if he/she (a) is designated by a licensed veterinarian to obtain or administer controlled substances; and (b) holds a veterinary assistant controlled substance permit (VACSP), as specified. 40.Permits the VMB to restrict access to a drug that the VMB in consultation with the Board of Pharmacy identifies as a dangerous drug that has an established pattern of being diverted, as specified. 41.Provides a definition for "controlled substance," "direct supervision," "drug," and "indirect supervision," as specified. 42.Specifies that the provision pertaining to an RVT or VA administering a drug, as specified, becomes operative on January 1, 2015, or the effective date of the statute in which the Legislature makes a determination that the VMB has sufficient staffing to implement. 43.Requires applications for a VACSP to be on a form furnished by the VMB. 44.Specifies that the application fee for a VACSP is set by the VMB in an amount it determines is reasonably necessary, not to exceed $100. CONTINUED SB 304 Page 8 45.Authorizes the VMB to deny, suspend or revoke the controlled substance permit of a VA after notice and hearing for any cause, as specified, and specifies that proceedings shall be conducted in accordance with the provisions of administrative adjudication as specified. 46.Specifies that the VMB may revoke or suspend a VACSP for any of the following reasons: A. The employment of fraud, misrepresentation or deception in obtaining a VACSP; B. Chronic inebriety or habitual use of controlled substances; and C. Violating or attempts to violate, directly or indirectly, or assisting in or abetting the violation of, or conspiring to violate, any specified provision or adopted regulations. 1.Specifies that the VMB shall not issue a VACSP to any applicant with state or federal felony controlled substance convictions. 2.Authorizes the VMB to revoke a VACSP upon notification that the VA has been convicted of a state or federal felony controlled substance violation. 3.Requires the applicant for a VACSP, as part of the application process, to submit to the DOJ fingerprint images and related information as required by DOJ for the purposes of obtaining information as to the existence and content of a record of state or federal convictions and state or federal arrests and also information as to the existence and content of a record of state or federal arrests for which the DOJ establishes that the person is free on bail or on his/her recognizance pending trial or appeal. 4.Requires the DOJ to forward to the Federal Bureau of Investigation (FBI) requests for federal summary criminal history information that it receives, as specified, and requires the DOJ to review any information returned from the FBI and compile and disseminate a response to the VMB summarizing that information. CONTINUED SB 304 Page 9 5.Requires the DOJ to provide a state or federal level response to the VMB as specified. 6.Requires the DOJ to charge a reasonable fee sufficient to cover the cost of processing the requests. 7.Requires the VMB to request from the DOJ subsequent notification service, as specified, for VACSP applicants. 8.Requires each person who has been issued a VACSP by the VMB, to biennially apply for renewal of his/her permit on or before the last day of the applicant's birthday month and requires the application to be made on a form provided by the VMB. 9.Requires the application for a VACSP to contain a statement that the applicant has not been convicted of a felony, has not been the subject of professional disciplinary action taken by any public agency in California or any other state or territory, and has not violated any of the provisions pertaining to the VACSP, and specifies that if the applicant is unable to make that statement, the application shall contain a statement of the conviction, professional discipline, or violation. 10.Permits the VMB, as part of the renewal process, to make the necessary inquiries of the applicant and conduct an investigation in order to determine if cause for disciplinary action exists. 11.Authorizes the VMB to establish the fee for filing a renewal application for a VACSP in an amount the VMB determines is reasonable necessary not to exceed $50. 12.Clarifies that VMB may inspect premises for which registration has lapsed or is delinquent. 13.Requires every person who has been issued a VACSP, who changes his/her mailing or employer address to notify the VMB of his/her new mailing or employer address within 30 days of that change and specifies that the VMB may not renew the permit of any person who fails to comply with address change notification requirements unless the person pays a specified penalty fee. CONTINUED SB 304 Page 10 14.Requires an applicant for a renewal permit to specify in his/her application whether he/she has changed his/her mailing or employer address and the VMB may accept that statement as evidence of the fact. 15.Specifies that the provisions pertaining to the VACSP and the renewal application for the VACSP becomes operative on January 1, 2015, or the effective date of the statute in which the Legislature makes a determination that the VMB has sufficient staffing to implement. 16.Makes clarifying and technical changes. 17.Adds language to avoid chaptering out issues with SB 670 (Steinberg). Comments According to the author's office, "When the bill left the Senate it would have transferred the peace officer investigators from the MBC to the Health Quality Enforcement Section in the Attorney General's office. The bill now transfers the peace officer investigators and the medical consultants (which are integral to the investigation process) to a newly created Unit in the DCA's DOI. This is a cost-neutral move which will place the investigators under professional peace officer management and direction. This will improve the investigatory process and quality of investigations. It will also move investigations of physician misconduct out from under a regulatory board controlled by physicians." FISCAL EFFECT : Appropriation: Yes Fiscal Com.: Yes Local: Yes Unknown, with latest amendments. SUPPORT : (Verified 9/10/13) California Veterinary Medical Association California Veterinary Medical Board ARGUMENTS IN SUPPORT : The Veterinary Medical Association writes, "The bill among other things, continues the Veterinary CONTINUED SB 304 Page 11 Medical Board in statute, and makes several changes to the veterinary Medicine Practice Act as part of the legislature's 'sunset review' process?.The provisions pertaining to veterinary medicine in this 'sunset vehicle' are the work product of a very active and productive stakeholder process and represent a fair compromise." MW:ej 9/11/13 Senate Floor Analyses SUPPORT/OPPOSITION: SEE ABOVE **** END **** CONTINUED