BILL ANALYSIS                                                                                                                                                                                                    Ó



          SENATE COMMITTEE ON APPROPRIATIONS
                             Senator Ricardo Lara, Chair
                            2015 - 2016  Regular  Session

          SB 1033 (Hill) - Medical Board:  disclosure of probationary  
          status
          
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          |Version: May 10, 2016           |Policy Vote: B., P. & E.D. 7 -  |
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          |Urgency: No                     |Mandate: No                     |
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          |Hearing Date: May 16, 2016      |Consultant: Brendan McCarthy    |
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          This bill meets the criteria for referral to the Suspense File.

          Bill  
          Summary:  SB 1033 would require physicians, osteopathic  
          physicians, podiatrists, acupuncturists, chiropractors, and  
          naturopathic doctors to notify patients of their probationary  
          status before a patient visit occurs.


          Fiscal  
          Impact:  
           Ongoing costs of about $1 million per year for additional  
            disciplinary hearings for physicians licensed by the Medical  
            Board (Contingent Fund of the Medical Board of California).  
            See below.

           Ongoing costs in the tens of thousands per year, on average,  
            for additional disciplinary hearings by the Osteopathic  
            Medical Board (Osteopathic Medical Board of California  
            Contingent Fund).

           Ongoing costs in the low tens thousands per year, on average,  







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            for additional disciplinary hearings by the Board of Podiatric  
            Medicine (Board Podiatric Medicine Fund).

           Ongoing costs in the tens of thousands per year, on average,  
            for additional disciplinary hearings by the Board of  
            Chiropractic Examiners (State Board of Chiropractic Examiners  
            Fund).

           Minor average annual costs for additional disciplinary  
            hearings by the Naturopathic Medical Committee (Naturopathic  
            Doctors Fund).


          Background:  Under current law, certain boards committees within the  
          Department of Consumer Affairs license and regulate the practice  
          of medicine, osteopathic medicine, podiatric medicine,  
          acupuncture, chiropractic, and naturopathic medicine. Under  
          current law and regulation, licensees are subject to  
          disciplinary action by their licensing board or committee for  
          actions in violation of law or regulation. Depending on the  
          severity of the violation and the licensee's past disciplinary  
          history, a licensing board or committee can suspend or revoke a  
          license, place the licensee on probation, or issue a citation.  
          Generally, the licensing boards and committees make information  
          about disciplinary actions available on their websites, although  
          consumers may have difficulty finding such information.


          Proposed Law:  
            SB 1033 would require physicians, osteopathic physicians,  
          podiatrists, acupuncturists, chiropractors, and naturopathic  
          doctors to notify patients of their probationary status before a  
          patient visit occurs.
          Specific provisions of the bill would:
                 Authorize the Medical Board to seek recovery for the  
               costs of a disciplinary proceeding against a physician, in  
               cases where the licensee is placed on probation;
                 Require physicians and surgeons, osteopathic physicians,  
               podiatrists, acupuncturists, chiropractors, and  
               naturopathic doctors to disclose his or her probationary  
               status (including the causes for probation listed in the  
               accusation) to a patient, guardian, or health care  
               surrogate prior to the patient's first visit, under  
               specified circumstances, after January 1, 2018;








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                 Require the licensee to obtain from each patient a  
               signed receipt of the disclosure;
                 Exempt licensees from the disclosure requirement under  
               certain circumstances (e.g. when a patient is unconscious  
               or for visits occurring in an emergency room);
                 Require the appropriate licensing board to develop a  
               standardized format for listing required information in the  
               disclosure to patients by January 1, 2018;
                 Require the appropriate licensing board to make  
               specified information regarding licensee probation status  
               available to the public by January 1, 2018.


          Staff  
          Comments:  Under current practice, many disciplinary actions  
          against physicians licensed by the Medical Board are resolved  
          through a stipulated settlement. In those cases the accused  
          physician stipulates to one or more lesser disciplinary charges  
          and accepts probation. Under this bill, the requirement to  
          notify patients of a physician's probationary status and the  
          reasons for probation listed in the accusation is likely to  
          result in some accused physicians forgoing a stipulated  
          settlement and seeking an administrative hearing on the case.  
          The average cost difference between a full administrative  
          proceeding versus a stipulated settlement is about $35,000 per  
          case. There are about 130 cases per year that result in  
          probation. Of those, about 30 cases result in a stipulated  
          settlement for a probationary period of less than three years.  
          Generally, those cases result from first-time offenses or  
          accusations of lesser significance. Under the bill, it is likely  
          that most of those cases would result in a full administrative  
          hearing. Cases resulting in a probation period of more than  
          three years are less likely to proceed to a full administrative  
          hearing under the bill, because a licensee in those cases has a  
          greater chance of losing his or her license in the  
          administrative hearing process and so would likely be less  
          willing to forgo a stipulated settlement resulting in probation.
          The cost estimates above for the boards other than the Medical  
          Board are based on cost information provided by the Medical  
          Board. The costs above assume that the number of additional  
          administrative hearings per year is proportional to the size of  
          the board's licensed population and that the costs are similar  
          to those experienced by the Medical Board.









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          Under current law, most licensing boards and bureaus except for  
          the Medical Board can seek to recover the cost of a disciplinary  
          proceeding. This bill would extend this authority to the Medical  
          Board. Therefore, the Medical Board and other licensing boards  
          would be able to recover some to the additional costs identified  
          above, for those cases that are found in favor of the licensing  
          board.




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