BILL ANALYSIS Ó
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|SENATE RULES COMMITTEE | SB 304|
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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
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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.
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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
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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
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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.
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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
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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.
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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.
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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.
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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
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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
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