BILL ANALYSIS                                                                                                                                                                                                    Ó



          SENATE COMMITTEE ON
          BUSINESS, PROFESSIONS AND ECONOMIC DEVELOPMENT
                              Senator Jerry Hill, Chair
                                2015 - 2016  Regular 

          Bill No:            AB 2745         Hearing Date:    June 13,  
          2016
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          |Author:   |Holden                                                |
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          |Version:  |April 25, 2016                                        |
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          |Urgency:  |No                     |Fiscal:    |Yes              |
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          |Consultant|Sarah Mason                                           |
          |:         |                                                      |
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                Subject:  Healing arts:  licensing and certification


          SUMMARY:  Makes various changes to the Medical Practice Act.

          Existing law:
          
         1)Provides for the licensure and regulation of physicians  
            and surgeons by the Medical Board of California (MBC)  
            pursuant to the Medical Practice Act (Act). (Business and  
            Professions Code (BPC) § 2000 et. seq.)

         2)Authorizes an applicant for a physician's and surgeon's  
            license who is otherwise eligible for a license but  
            unable to practice some aspects of medicine safely due to  
            a disability to receive a limited license (LL) according  
            to certain requirements.  (BPC § 2088)  

         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.   (BPC § 2441)

         4)Authorizes MBC, in any investigation that involves the  







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

         6)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.)

         7)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) Authorizes all physician and surgeon licensees to apply for a  
             LL and ensures that physicians who have a disabled status  
             license and want to change to a LL to meet the same  
             requirements in existing law for a LL.

          2) Authorizes MBC to send a written request for medical records  
             to the facility where the care of a deceased patient  
             occurred, or where the records are located, in order to  
             review medical records under Item #4, above. 

          3) Authorizes MBC to place the license of a midwife on  
             probation, in addition to authority under current law to  








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             suspend or revoke a license for certain acts, including  
             unprofessional conduct and crimes of dishonesty.  Authorizes  
             MBC to revoke the midwife license of any person who has been  
             required to register as a sex offender.



          4) Clarifies MBC's authority to deny a post graduate training  
             authorization letter for the same reasons it can deny a  
             physician's and surgeon's license application under existing  
             law.

          5) Provides that the use of any controlled substance or the use  
             of dangerous drugs 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.  Provides that the record of the  
             conviction is conclusive evidence of this unprofessional  
             conduct and provides that a plea or verdict of guilty or a  
             conviction following a no contest plea is deemed to be a  
             conviction for purposes of discipline for a research  
             psychoanalyst or polysomnographic technologist registrant. 



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



          7) Authorizes 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 MBC for reinstatement or modification  
             of penalty, including modification or termination of  








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             probation.




          8) Permits MBC to revoke the research psychoanalyst or  
             polysomnographic technologist registration of any person who  
             has been required to register as a sex offender.



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



          10)Makes other technical, updating, and clarifying changes.



          
          FISCAL  
          EFFECT:   This bill is keyed "fiscal" by Legislative Counsel.   
          According to the Assembly Committee on Appropriations analysis  
          dated May 4, 2016, this bill will result in minor costs and  
          revenues to MBC and potential minor information technology costs  
          if changes are needed to the BrEZe licensing system.  

          
          COMMENTS:
          
          1. Purpose.   MBC  is the sponsor of this bill.  According to the  
             Author, the bill is intended to make clarifying changes to  
             the Act in order to assist MBC in its licensing and  
             enforcement functions.  According to the Author, MBC is  
             responsible for licensing and regulating allied health  
             licensees, which include Licensed Midwives, Polysomnographic  
             Technologists, Technicians and Trainees, and Research  
             Psychoanalysts.  The Author asserts that there are some  
             provisions that apply to physicians and surgeons in the Act  
             that MBC also applies to allied health licensees and as such,  
             this bill is necessary to clarify MBC's authority to: revoke  
             or deny a license for registered sex offenders; take  








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             disciplinary action for excessive use of drugs or alcohol;  
             allow allied health licensees to petition for license  
             reinstatement; and allow MBC to use probation as a  
             disciplinary option for allied health licensees, including  
             procuring payment for the costs of probation monitoring.

          2. Background.

             a)   Limited License (LL).  The Board offers a LL to  
               applicants or disabled status licensees if they are  
               otherwise eligible for licensure, but unable to practice  
               all aspects of medicine safely due to a disability.   
               Currently, only new licensees or disabled status licensees  
               can apply for this LL.  To allow all licensees the ability  
               to apply for a LL at any time, this bill provides the  
               changes to law necessary so that the LL is an option for  
               all licensees.  The bill also makes necessary changes to  
               allow physicians with a disabled status license to change  
               to a LL. 

             b)   Post Graduate Training Authorization.  Provision in the  
               Act specify reasons MBC is authorized to deny a physician's  
               and surgeon's application for licensure. Amendments to the  
               Act contained in this bill clarify that the Board can deny  
               a post graduate training authorization letter for the same  
               reasons it can deny a physician's and surgeon's license  
               application.

             c)   Obtaining Records for a Deceased Patient.  For  
               investigations involving the death of a patient, MBC is  
               authorized to inspect and copy the medical records of the  
               deceased patient without the approval of the next of kin of  
               the deceased patient or court order.  MBC only uses this  
               authority when determining whether the death stemmed from  
               violation of the Act by a physician or surgeon.  In these  
               instances, MBC must provide a written request to the  
               physician that owns the records, declaring that MBC has  
               been unsuccessful in locating or contacting the patient's  
               next of kin after reasonable efforts.  According to MBC, in  
               many cases, the patient's medical records do not reside  
               with the physician but rather at the facility where the  
               care of the deceased patient occurred.  MBC notes that the  
               language in this bill will ensure that investigations are  
               not hindered by allowing MBC to send a written request to  








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               the facility where the care actually occurred or where the  
               records are truly located.

             d)   Allied Health Professions.  MBC is responsible for  
               licensing and regulating allied health licensees, which  
               include Licensed Midwives, Polysomnographic Technologists,  
               Technicians and Trainees, and Research Psychoanalysts.  
               Amendments to the Act in this bill clarify MBC's  
               enforcement authority for these professions.  

          1. Arguments in Support.  The  American Federation of State,  
             County and Municipal Employees  (AFSCME) notes that the  
             organization promotes clarity within the medical field and  
             this measure will ensure MBC's authority to perform their  
             duties is clear.

              MBC  , the Sponsor of this bill, believes that it clarifies  
             MBC's authority for allied health licensees MBC licenses.   
             According to MBC, this bill will clean up existing law to  
             ensure that MBC's authority to perform its regulatory  
             oversight of licensees is clearly defined and aligned with  
             the Act.

          
          SUPPORT AND OPPOSITION:
          
           Support:  

          AFSCME
          Medical Board of California 

           Opposition:  

          None on file as of June 7, 2016.


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