BILL ANALYSIS �
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THIRD READING
Bill No: SB 670
Author: Steinberg (D)
Amended: 4/8/13
Vote: 21
SENATE BUSINESS, PROF. & ECON. DEV. COMM. : 8-0, 4/15/13
AYES: Price, Block, Corbett, Galgiani, Hernandez, Hill,
Padilla, Yee
NO VOTE RECORDED: Emmerson, Wyland
SENATE APPROPRIATIONS COMMITTEE : 7-0, 4/29/13
AYES: De Le�n, Walters, Gaines, Hill, Lara, Padilla, Steinberg
SUBJECT : Physicians and surgeons: drug prescribing
privileges: investigation
SOURCE : Author
DIGEST : This bill authorizes the Medical Board of California
(MBC) to inspect medical records of a patient who died of a
prescription drug overdose without the consent of the patient's
next of kin or a court order, as specified; makes it
unprofessional conduct for a licensee who is under investigation
by the MBC to fail to attend and participate in an interview
within 30 days from notification, as specified; authorizes an
administrative law judge to issue an interim suspension order
(ISO) limiting the authority of a physician to prescribe,
furnish, administer, or dispense controlled substances; and
requires the MBC to impose limitations on the authority of a
physician and surgeon to prescribe, furnish, administer, or
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dispense controlled substances during a pending investigation if
there is a reasonable suspicion that the physician and surgeon
has engaged in overprescribing drugs, or other drug prescribing
behavior that has resulted in the death of a patient.
ANALYSIS :
Existing law:
1. Licenses and regulates physicians and surgeons under the
Medical Practice Act (MPA) by the MBC and states that the
protection of the public is the highest priority of the MBC
in exercising its functions.
2. Authorizes investigators and representatives of the MBC,
among others, to inquire into any alleged violation of the
MPA or any other federal or state law, regulation, or rule
relevant to the practice of medicine or podiatric medicine,
and to inspect documents relevant to those investigations,
including the inspection and copying of any document relevant
to an investigation where patient consent is given.
3. Provides for the professional review of specified healing
arts licentiates by a peer review body, as defined.
4. Defines a licentiate, for purposes of item #3 above, as a
physician and surgeon, doctor of podiatric medicine, clinical
psychologist, marriage and family therapist, clinical social
worker, or dentist.
5. Requires an 805 report, as specified, to be filed by the
chief of staff, chief executive officer, medical director, or
administrator of any peer review body and the chief executive
officer or administrator of a health facility or clinic, as
defined, with the MBC, among other agencies having regulatory
jurisdiction over a licensee within 15 days after the
effective date of any specified action taken against a
licensee for a medical disciplinary cause or reason.
6. Requires a coroner to make a report to the MBC, among other
specified entities, when he/she receives information that
indicates that a death may be the result of a physician and
surgeon's, podiatrist's, or physician assistant's gross
negligence or incompetence.
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7. Requires the MBC to take action against any licensee who is
charged with unprofessional conduct. Unprofessional conduct
is defined to include, among other things, the repeated
failure by a licensee who is the subject of an MBC
investigation, in the absence of good cause, to attend and
participate in an interview scheduled by the mutual agreement
of the licensee and the MBC.
8. Under the Administrative Procedure Act (APA), establishes
within the Office of Administrative Hearings a Medical
Quality Hearing Panel to conduct adjudicative hearings and
proceedings relative to licensees of the MBC under the terms
and conditions set forth in the APA, except as provided in
the MPA.
9. Authorizes an administrative law judge of the Medical Quality
Hearing Panel to issue an ISO suspending a license, or
imposing drug testing, continuing education, supervision of
procedures, or other licensee restrictions.
10.Requires that the burden and standards of proof to obtain an
ISO shall be those applicable to a preliminary injunction
under Code of Civil Procedure Section 527.
This bill:
1. Authorizes the MBC, when it receives an 805 report, or a
coroner's report, as described above, that involves the death
of a patient from a prescription drug overdose, to inspect
and copy the medical records of the deceased patient without
the consent of the patient's next of kin or a court order in
order to determine the extent to which the death was the
result of a prescriber's inappropriate conduct.
2. Revises the definition of unprofessional conduct under the
MPA to include the failure by a licensee who is the subject
of an MBC investigation, in the absence of good cause, to
attend and participate in an interview scheduled within 30
days of notification from the MBC.
3. Authorizes an administrative law judge to issue an ISO
limiting the authority of a physician to prescribe, furnish,
administer, or dispense controlled substances.
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4. Requires the MBC, notwithstanding the authority of an
administrative law judge, to impose limitations on the
authority of a physician and surgeon to prescribe, furnish,
administer, or dispense controlled substances during a
pending investigation if there is a reasonable suspicion that
the physician and surgeon has engaged in either (a)
overprescribing drugs, or (b) other behavior related to
his/her drug prescribing privileges that has resulted in the
death of a patient.
Background
Prescription drug deaths . A recent Centers for Disease Control
(CDC) analysis found that drug overdose deaths increased for the
11th consecutive year in 2010 and prescription drugs,
particularly opiod analgesics, are the top drugs leading the
list of those responsible for fatalities. According to CDC,
38,329 people died from a drug overdose in 2010, up from 37,004
deaths in 2009, and 16,849 deaths in 1999. CDC found that
nearly 60% of the overdose deaths in 2010, involved
pharmaceutical drugs, with opiods associated with approximately
75% of these deaths. Nearly three out of four prescription drug
overdoses are caused by opioid pain relievers. CDC recommends
the use of Prescription Drug Monitoring Programs (PDMPs) with a
focus on both patients at highest risk in terms of prescription
painkiller dosage, numbers of prescriptions and numbers of
prescribers as well as prescribers who deviate from accepted
medical practice and those with a high proportion of doctor
shoppers among their patients. CDC also recommends that PDMPs
link to electronic health records systems so that the
information is better integrated into health care providers'
day-to-day practices. CDC believes that state benefits programs
like Medicaid and workers' compensation should consider
monitoring prescription claims information and PDMP data for
signs and inappropriate use of controlled substances. CDC also
acknowledges the value of PDMPs in taking regulatory action
against health care providers who do operate outside the limits
of appropriate medical practice when it comes to prescription
drug prescribing.
Drug deaths and MBC enforcement issues . In late 2012, the Los
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Angeles Times published a series of four articles titled "Dying
For Relief," which were the outcome of an intensive review of
the epidemic of prescription drug-related deaths in four
Southern California counties (Los Angeles, Orange, Ventura and
San Diego). In the investigation, reporters examined coroners'
records and interviewed doctors, regulators, law enforcement
officials and relatives of those who died from overdoses. In
these cases toxicology tests found a prescription drug in the
deceased's system, usually a painkiller, anti-anxiety drug or
other narcotic; coroners' investigators reported finding a
container of the same medication bearing the doctor's name, or
records of a prescription; and the coroner determined that the
drug caused or contributed to the death. The investigators also
created and analyzed a searchable database of 3,700 drug related
deaths during a five-year span (2005-2011) in Southern
California to identify those tied to doctors' prescriptions.
An examination of coroner records by the Times found that:
In 47% of those cases (1,762 deaths) drugs for which the
deceased had a prescription were the sole cause or a
contributing cause of death.
A small number of doctors were associated with a
disproportionate number of those fatal overdoses. 71
physicians in the four counties wrote prescriptions for drugs
that caused or contributed to 298 deaths. That is 17% of the
total deaths linked to doctors' prescriptions.
Each of the 71 physicians prescribed drugs to three or more
patients who died; four of the physicians had 10 or more
patients who fatally overdosed; and one physician had 16
patients who died.
The Times found that the 71 physicians with three or more fatal
overdoses among their patients are primarily pain specialists,
general practitioners and psychiatrists. Four of the physicians
have been convicted of drug offenses in connection with their
prescriptions, and a fifth is awaiting trial on second-degree
murder charges in the overdose deaths of three patients. The
remaining physicians had clean records with the MBC, according
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to the Times.
Sunset review oversight hearing . Earlier this year, the Senate
Business, Professions and Economic Development Committee and the
Assembly Business, Professions and Consumer Protection Committee
held a Joint Oversight Hearing of the MBC. At that hearing,
testimony was heard from the MBC, consumers, parents, consumer
groups, professional associations and the public at large.
Primarily focused on the enforcement program of the MBC. The
question was raised about the MBC's effectiveness in protecting
consumers from dangerous practitioners in the medical field.
Comments
According to the author's office, Senator Steinberg was prompted
to pursue the legislation following the recent Los Angeles Times
investigation that uncovered significant issues with physicians,
overprescribing and patient deaths. To speed up investigations
in cases where patients have died as a result of prescription
drug overdose, this bill seeks to:
Authorize the MBC, if it receives an 802.5 report or 805
report that involves the death of a patient from a
prescription drug overdose, to inspect and copy the medical
records of the deceased patient without the consent of the
patient's next of kin or a court order in order to determine
the extent to which the death was the result of a
prescriber's inappropriate conduct.
Revise the definition of unprofessional conduct to include
the failure by a licensee who is the subject of an MBC
investigation, in the absence of good cause, to attend and
participate in an interview scheduled within 30 days of
notification from the MBC.
In order to ensure potentially dangerous doctors are not able to
continue prescribing, while an investigation is pending, this
bill seeks to require the MBC to impose limitations on the
authority of a physician and surgeon to prescribe, furnish,
administer, or dispense controlled substances during a pending
investigation if there is a reasonable suspicion that the
physician has engaged in overprescribing drugs or other behavior
related to his/her drug prescribing privileges that has resulted
in the death of a patient.
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Related Legislation
SB 62 (Price) requires coroners' reports to be transmitted to
various health practitioner boards in the event that cause of
death is determined to be prescription drug overdose.
FISCAL EFFECT : Appropriation: No Fiscal Com.: Yes
Local: No
According to the Senate Appropriations Committee:
One-time costs between $75,000 and $150,000 for the MBC to
adopt regulations (Contingent Fund of the MBC).
Minor cost savings to the MBC due to streamlined processes
when conducting investigations (Contingent Fund of the MBC).
The Committee states that this bill expands some of the MBC's
authority to investigate and sanction licensees. According to
MBC, the changes in this bill are likely to streamline the
investigatory process. For example, by simplifying the process
for gaining access to medical records or by requiring licensees
under investigation to meet with the MBC staff earlier in an
investigation. Thus, the overall impact of this bill is likely
to be reduced investigation costs.
SUPPORT : (Verified 5/1/13)
Center for Public Interest Law
ARGUMENTS IN SUPPORT : The Center for Public Interest Law
writes that this bill will provide needed tools to the MBC to
protect patients from potentially dangerous physicians who
improperly prescribe drugs, and that each of the bill's reforms
will save lives.
MW:k 5/1/13 Senate Floor Analyses
SUPPORT/OPPOSITION: SEE ABOVE
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