BILL ANALYSIS                                                                                                                                                                                                    Ó



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          Date of Hearing:  April 19, 2016


                   ASSEMBLY COMMITTEE ON BUSINESS AND PROFESSIONS


                                  Rudy Salas, Chair


          AB 2745  
          Holden - As Amended April 12, 2016


          SUBJECT:  Healing arts: licensing and certification.


          SUMMARY:  Makes a number of changes to the Medical Practice Act  
          including: specifies that a physician's and surgeon's licensee,  
          as specified, is authorized to receive the limited license;  
          authorizes the Medical Board of California (MBC) to require an  
          independent clinical evaluation before providing a limited or  
          disability license;  authorizes the MBC, during an investigation  
          of the death of a patient, to provide a written request to a  
          facility where medical records are located or the care to a  
          deceased patient was provided; authorizes the MBC to place a  
          midwife license on probation and establish a fee for monitoring  
          a licensee on probation; authorizes a person whose midwife  
          license has been voluntarily surrendered while under  
          investigation or while charges are pending or whose license has  
          been suspended, revoked, or placed on probation to petition the  
          MBC for reinstatement or modification of penalty; requires the  
          revocation of a midwife license for a person required to  
          register as a sex offender; authorizes a polysomnographic  
          technician registration to be placed on probation and would  
          establish a fee for monitoring a registrant on probation;  
          authorizes a person whose polysomnographic registration has been  
          voluntarily surrendered while under investigation or while  
          charges are pending or whose registration has been suspended,  
          revoked, or placed on probation to petition the MBC for  








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          reinstatement or modification of penalty;  and requires the  
          revocation of a research psychoanalyst or polysomnographic  
          technologist registration for a person required to register as a  
          sex offender.


          EXISTING LAW:


          1)Provides for the licensure and regulation of physicians and  
            surgeons by the MBC.  (Business and Professions Code (BPC) §  
            2004 et seq; 2307; 2232.)



          2)Provides for the licensing and regulation of midwives by the  
            MBC.  (BPC § 2512 et seq.)



          3)Authorizes a licensee who demonstrates that he or she is  
            unable to practice medicine due to a disability to request a  
            waiver of the license renewal fee, and specifies that a  
            licensee granted that waiver is prohibited from practicing  
            medicine until he or she establishes that the disability no  
            longer exists or signs an agreement, under penalty of perjury,  
            agreeing to limit his or her practice in the manner prescribed  
            by the reviewing physician.   (Title 17 California Code of  
            Regulations (CCR) §§ 1315.50; 1315.55; 1315.53)



          4)Authorizes the MBC, in any investigation that involves the  
            death of a patient, to inspect and copy the medical records of  
            the deceased patient without the authorization of the  
            beneficiary or personal representative of the deceased patient  
            or a court order solely to determine the extent to which the  
            death was the result of the physician and surgeon's violation  
            of the Medical Practice Act, if the MBC provides a written  








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            request to the physician and surgeon that includes a  
            declaration that the MBC has been unsuccessful in locating or  
            contacting the deceased patient's beneficiary or personal  
            representative after reasonable efforts.  (BPC § 2225(c)(1))



          5)Prohibits a person from using the title "certified  
            polysomnographic technologist" or engaging in the practice of  
            polysomnography unless he or she is registered as a certified  
            polysomnographic technologist, is supervised and directed by a  
            licensed physician and surgeon, and meets certain other  
            requirements.  (BPC § 3575 et seq.)



          6)Requires polysomnographic technologists to apply to and  
            register with the MBC and to pay specified fees to be fixed by  
            the MBC at no more than $100 each, and to renew their  
            registration biennially for a fee of no more than $150.  (BPC  
            § 3577)
          THIS BILL:


          1)Specifies that an applicant for a physician's and surgeon's  
            license or a physician's and surgeon's licensee  who is  
            otherwise eligible for that license but is unable to practice  
            some aspects of medicine safely due to a disability may  
            receive a limited license if he or she does both of the  
            following:





             a)   Pays the appropriate initial or renewal license fee.











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             b)   Signs an agreement on a form prescribed by the MBC in  
               which the applicant or licensee agrees to limit his or her  
               practice in the manner prescribed by the reviewing  
               physician and agreed to by the MBC.



          2)Indicates that the MBC may require the applicant or licensee  
            to obtain an independent clinical evaluation of his or her  
            ability to practice medicine safely as a condition of  
            receiving a limited or a disability license.



          3)Requires an agreement for a disability license, as specified,  
            to additionally be signed by the MBC.



          4)Specifies that any person who knowingly provides false  
            information in a disability license agreement shall be subject  
            to any sanctions available to the MBC.



          5)Authorizes the MBC to deny a physician's and surgeon's  
            postgraduate training authorization letter for unprofessional  
            conduct and other violations, as specified.



          6)Specifies that in any investigation that involves the death of  
            a patient, the MBC may inspect and copy the medical records of  
            the deceased patient without the authorization of the  
            beneficiary or personal representative of the deceased patient  
            or a court order solely for the purpose of determining the  
            extent to which the death was the result of the physician and  
            surgeon's conduct in violation of the Medical Practice Act, if  
            the MBC provides a written request to either  the physician  








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            and surgeon or the facility where the medical records are  
            located or the care to the deceased patient was provided,   
            that includes a declaration that the MBC has been unsuccessful  
            in locating or contacting the deceased patient's beneficiary  
            or personal representative after reasonable efforts. 



          7)Authorizes the MBC to suspend, revoke, or place on probation  
            the license of a midwife for specified acts, including  
            unprofessional conduct and crimes of dishonesty.



          8)Specifies that the fee for the midwife examination shall be  
            the cost of administering the examination to the applicant, as  
            determined by the organization that has entered into a  
            contract with the Division of Licensing and that fee may be  
            collected and retained by that organization.  The fee for  
            monitoring a licensee on probation shall be the cost of  
            monitoring, as fixed by the MBC.



          9)Allows a person whose midwife license has been voluntarily  
            surrendered while under investigation or while charges are  
            pending or whose license has been revoked or suspended or  
            placed on probation, to petition the MBC for reinstatement or  
            modification of penalty, including modification or termination  
            of probation.



          10)Specifies that the person may file the petition after a  
            period of not less than the following minimum periods have  
            elapsed from the effective date of the surrender of the  
            license or the decision ordering that disciplinary action:










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             a)   At least three years for reinstatement of a license  
               surrendered or revoked for unprofessional conduct, except  
               that the MBC may, for good cause shown, specify in a  
               revocation order that a petition for reinstatement may be  
               filed after two years.



             b)   At least two years for early termination of probation of  
               three years or more.



             c)   At least one year for modification of a condition, or  
               reinstatement of a license surrendered or revoked for  
               mental or physical illness, or termination of probation of  
               less than three years.



          11)Indicates that the petition shall state any facts as may be  
            required by the MBC. The petition shall be accompanied by at  
            least two verified recommendations from midwives licensed in  
            any state who have personal knowledge of the activities of the  
            petitioner since the disciplinary penalty was imposed.



          12)Further notes that the petition may be heard by a panel of  
            the MBC or the MBC may assign the petition to an  
            administrative law judge.  After a hearing on the petition,  
            the administrative law judge shall provide a proposed decision  
            to the MBC, which shall be acted upon, as specified.



          13)Allows the panel of the MBC or the administrative law judge  
            hearing the petition to consider all activities of the  








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            petitioner since the disciplinary action was taken, the  
            offense for which the petitioner was disciplined, the  
            petitioner's activities during the time the license was in  
            good standing, and the petitioner's rehabilitative efforts,  
            general reputation for truth, and professional ability.  The  
            hearing may be continued from time to time as the  
            administrative law judge finds necessary.



          14)Specifies that the administrative law judge reinstating a  
            license or modifying a penalty may recommend the imposition of  
            any terms and conditions deemed necessary.



          15)Indicates that no petition shall be considered while the  
            petitioner is under sentence for any criminal offense,  
            including any period during which the petitioner is on  
            court-imposed probation or parole.  No petition shall be  
            considered while there is an accusation or petition to revoke  
            probation pending against the person.  The MBC may deny  
            without a hearing or argument any petition filed pursuant to  
            this section within a period of two years from the effective  
            date of the prior decision following a hearing under this  
            section.



          16) Permits the MBC to revoke the midwife license of any person  
            who has been required to register as a sex offender.



          17)Specifies that provisions of the bill shall not apply to a  
            person or licensed midwife who is required to register as a  
            sex offender pursuant to Section 290 of the Penal Code solely  
            because of a misdemeanor conviction under Section 314 of the  
            Penal Code.








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          18)Further specifies that provisions of the bill shall not apply  
            to a person or licensed midwife who has been relieved under  
            Section 290.5 of the Penal Code of his or her duty to register  
            as a sex offender, or whose duty to register has otherwise  
            been formally terminated under California law.



          19)Provides that the use of any controlled substance or the use  
            of any of the dangerous drugs specified in Section 4022, or of  
            alcoholic beverages, to the extent, or in such a manner as to  
            be dangerous or injurious to a research psychoanalyst or  
            polysomnographic technologist registrant, or to any other  
            person or to the public, or to the extent that this use  
            impairs the ability of the registrant to practice safely or  
            more than one misdemeanor or any felony conviction involving  
            the use, consumption, or self-administration of any of the  
            substances referred to in this section, or any combination  
            thereof, constitutes unprofessional conduct.  The record of  
            the conviction is conclusive evidence of this unprofessional  
            conduct.



          20)A plea or verdict of guilty or a conviction following a plea  
            of nolo contendere is deemed to be a conviction for purposes  
            of discipline for a research psychoanalyst or polysomnographic  
            technologist registrant.  The MBC may order discipline of the  
            registrant in accordance with Section 2227 or may order the  
            denial of the registration when the time for appeal has  
            elapsed or the judgment of conviction has been affirmed on  
            appeal or when an order granting probation is made suspending  
            imposition of sentence, irrespective of a subsequent order  
            under the provisions of Section 1203.4 of the Penal Code  
            allowing this person to withdraw his or her plea of guilty and  
            to enter a plea of not guilty, or setting aside the verdict of  








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            guilty, or dismissing the accusation, complaint, information,  
            or indictment.



          21)Authorizes the MBC to suspend or revoke the registration of a  
            polysomnographic technologist, polysomnographic technician, or  
            polysomnographic trainee for unprofessional conduct as  
            specified.



          22)Permits a person whose polysomnographic technologist  
            registration has been voluntarily surrendered while under  
            investigation or while charges are pending or whose  
            registration has been revoked or suspended or placed on  
            probation, to petition the MBC for reinstatement or  
            modification of penalty, including modification or termination  
            of probation.



          23)Specifies that the person may file the petition after a  
            period of not less than the following minimum periods have  
            elapsed from the effective date of the surrender of the  
            registration or the decision ordering that disciplinary  
            action:



             a)   At least three years for reinstatement of a registration  
               surrendered or revoked for unprofessional conduct, except  
               that the MBC may, for good cause shown, specify in a  
               revocation order that a petition for reinstatement may be  
               filed after two years.



             b)   At least two years for early termination of probation of  








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               three years or more.



             c)   At least one year for modification of a condition, or  
               reinstatement of a registration surrendered or revoked for  
               mental or physical illness, or termination of probation of  
               less than three years.



          24)Indicates that the petition shall state any facts as may be  
            required by the MBC.  The petition shall be accompanied by at  
            least two verified recommendations from polysomnographic  
            technologists registered in any state who have personal  
            knowledge of the activities of the petitioner since the  
            disciplinary penalty was imposed.



          25)Permits the petition to be heard by a panel of the MBC.  The  
            MBC may assign the petition to an administrative law judge,  
            and after a hearing on the petition, the administrative law  
            judge shall provide a proposed decision to the MBC.



          26)Indicates that the panel of the MBC or the administrative law  
            judge hearing the petition may consider all activities of the  
            petitioner since the disciplinary action was taken, the  
            offense for which the petitioner was disciplined, the  
            petitioner's activities during the time the registration was  
            in good standing, and the petitioner's rehabilitative efforts,  
            general reputation for truth, and professional ability.  The  
            hearing may be continued from time to time as the  
            administrative law judge finds necessary.











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          27)Specifies that the administrative law judge reinstating a  
            registration or modifying a penalty may recommend the  
            imposition of any terms and conditions deemed necessary.



          28)Indicates that no petition shall be considered while the  
            petitioner is under sentence for any criminal offense,  
            including any period during which the petitioner is on  
            court-imposed probation or parole.  No petition shall be  
            considered while there is an accusation or petition to revoke  
            probation pending against the person.  The MBC may deny  
            without a hearing or argument any petition filed pursuant to  
            this section within a period of two years from the effective  
            date of the prior decision following a hearing under this  
            section.



          29)Permits the MBC to revoke the research psychoanalyst or  
            polysomnographic technologist registration of any person who  
            has been required to register as a sex offender pursuant to  
            Section 290 of the Penal Code.



          30)Indicates that provisions of this bill shall not apply to a  
            person or research psychoanalyst or polysomnographic  
            technologist registrant who is required to register as a sex  
            offender pursuant to Section 290 of the Penal Code solely  
            because of a misdemeanor conviction under Section 314 of the  
            Penal Code.



          31)Indicates that the provisions of the bill shall not apply to  
            a person or research psychoanalyst or polysomnographic  
            technologist registrant who has been relieved under Section  
            290.5 of the Penal Code of his or her duty to register as a  








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            sex offender, or whose duty to register has otherwise been  
            formally terminated under California law.



          32)Specifies that the fee for monitoring a licensee on probation  
            shall be the cost of monitoring, as fixed by the MBC.



          33)Makes other technical, updating, and clarifying changes. 
          FISCAL EFFECT:  Unknown.  This bill has been keyed fiscal by the  
          Legislative Counsel.


          COMMENTS:


          Purpose.  This bill is sponsored by the  MBC  .  According to the  
          author, "[The MBC's] authority consists of licensing and  
          regulating allied health licensees such as Licensed Midwives,  
          Research Psychoanalysts and Polysomnographic Technologists and  
          Trainees.  There are also many provisions that apply to  
          physicians and surgeons that the MBC also applies to health  
          licensees.  Assembly Bill 2745 is a clean-up bill to ensure that  
          the MBC's authority to perform their duties is clearly defined  
          and aligned with current law."


          Background.  Licensing and Regulation of Allied Health  
          Professionals.  The MBC is responsible for licensing and  
          regulating allied health licensees, including licensed midwives  
          and polysomnographic technologists, technicians and trainees.   
          There are certain provisions in the Medical Practice Act that  
          apply to physicians and surgeons that the MBC also relies upon  
          when regulating the aforementioned allied health licensees.  As  
          such, the author believes it is necessary to clarify the MBC's  
          authority to do the following:









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                 Revoke or deny a license for registered sex offenders; 



                 Allow allied health licensees to petition for license  
               reinstatement; and,



                 Allow the MBC to use probation as a disciplinary option  
               for allied health licenses, and to procure payment for the  
               costs of probation monitoring.
          Limited License.  The MBC offers a limited practice license to  
          new applicants or disabled status licensees who have a  
          disability and are unable to practice all aspects of medicine  
          safely.  Only new licensees or disabled status licensees can  
          apply for a limited practice license.  Physicians and surgeons  
          who have disabled license status, and who wish to switch their  
          license to a limited practice license, do not currently have a  
          pathway to do so. 


          Written Records Request.  Current law authorizes the MBC to  
          investigate patient deaths and to copy medical records of the  
          deceased patient without obtaining the approval of the next of  
          kin of the deceased patient or a court order.  This authority  
          was granted in order for the MBC to determine if the death was a  
          result of a physician and surgeon violating the Medical Practice  
          Act.  


          Standard protocol is for the MBC to submit a written request to  
          the physician, declaring that the MBC has been unsuccessful in  
          contacting the patient's next of kin.  However, the MBC  
          indicates that for certain cases, the records reside with the  
          facility where care was provided versus the physician who  
          provided care.  This hinders the MBC's ability to obtain records  
          and proceed with its investigation.








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          ARGUMENTS IN SUPPORT: 


          The  Medical Board of California  (sponsor) writes in support,  
          "This bill would clean up existing law to ensure that the MBC's  
          authority to perform its regulatory oversight of licensees is  
          clearly defined and aligned with current law.  For these  
          reasons, the MBC is please to sponsor this important bill."


          ARGUMENTS IN OPPOSITION:


          None on file.


          AMENDMENTS:


          The bill includes the terminology: "disability license."   
          However, the current terminology utilized on forms of the MBC is  
          "disabled status license." In order to be consistent, the bill  
          should be amended as follows:


          On page 8, line 31 strike:  disability license  and insert:  
           disabled status license  .


          The language in the bill refers to polysomnographic technicians  
          as "licensees," but the proper terminology is "registrant" as  
          these allied healthcare professionals are registered, not  
          licensed, with the MBC.


          On page 18, line 8 strike:  licensee  and insert:  registrant









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           REGISTERED SUPPORT:  


          Medical Board of California (sponsor)


          REGISTERED OPPOSITION:  


          None on file.




          Analysis Prepared by:Le Ondra Clark Harvey Ph.D. / B. & P. /  
          (916) 319-3301