BILL ANALYSIS Ó
-----------------------------------------------------------------
|SENATE RULES COMMITTEE | SB 1033|
|Office of Senate Floor Analyses | |
|(916) 651-1520 Fax: (916) | |
|327-4478 | |
-----------------------------------------------------------------
THIRD READING
Bill No: SB 1033
Author: Hill (D)
Amended: 5/31/16
Vote: 21
SENATE BUS., PROF. & ECON. DEV. COMMITTEE: 7-0, 4/11/16
AYES: Hill, Block, Galgiani, Hernandez, Jackson, Mendoza,
Wieckowski
NO VOTE RECORDED: Bates, Berryhill
SENATE APPROPRIATIONS COMMITTEE: 5-0, 5/27/16
AYES: Lara, Beall, Hill, McGuire, Mendoza
NO VOTE RECORDED: Bates, Nielsen
SENATE FLOOR: 15-13, 6/1/16 (FAIL)
AYES: Allen, Beall, Block, De León, Hernandez, Hertzberg,
Hill, Hueso, Lara, Leno, Leyva, McGuire, Mendoza, Mitchell,
Pavley
NOES: Anderson, Bates, Fuller, Gaines, Galgiani, Glazer,
Jackson, Nguyen, Nielsen, Pan, Roth, Stone, Vidak
NO VOTE RECORDED: Berryhill, Cannella, Hall, Hancock, Huff,
Liu, Monning, Moorlach, Morrell, Runner, Wieckowski, Wolk
SUBJECT: Medical professionals: probation
SOURCE: Author
DIGEST: This bill requires physicians and surgeons, osteopathic
physicians and surgeons, podiatrists, acupuncturists,
chiropractors and naturopathic doctors to notify patients of
their probationary status before visits take place.
SB 1033
Page 2
ANALYSIS:
Existing law:
1)Requires health care licensing boards to create and maintain a
central file of the names of all persons who hold a license,
certificate, or similar authority. Requires the central file
to be created and maintained to provide an individual
historical record for each licensee and must include specified
information including the following: any conviction of a
crime, any judgment or settlement in excess of $3,000, any
public complaints as specified, and any disciplinary
information, as specified. States that the content of the
central file that is not public record under any other
provision of law is confidential. Allows a licensee to submit
any exculpatory or explanatory statements or other information
to be included in the central file. (Business and Professions
Code (BPC) § 800)
2)Requires the Medical Board of California (MBC) to
disclose on the Internet specified information in its
possession, custody, or control regarding licensed
physicians and surgeons, including: any felony
convictions reported to the MBC after January 3, 1991;
or, any misdemeanor conviction that results in a
disciplinary action or an accusation that is not
subsequently withdrawn or dismissed. (BPC § 2027)
3)Requires MBC to prioritize its investigative and
prosecutorial resources to ensure that physicians and
surgeons representing the greatest threat of harm are
identified and disciplined expeditiously. (BPC §2220.05)
4)Sets forth what the MBC may do in disciplining a physician
(e.g., revoke or suspend a license, place a physician on
probation, etc); further states that a licensee can "Have any
other action taken in relation to discipline as part of an
order as the board or administrative law judge may deem
proper." (BPC § 2227)
This bill:
SB 1033
Page 3
1) Requires MBC, Osteopathic Medical Board of California (OMBC),
Board of Podiatric Medicine (BPM), Acupuncture Board (CAB),
Board of Chiropractic Examiners (BCE) and the Naturopathic
Medicine Committee (NMC) by January 1, 2018, to include a
standardized, single paragraph, plain-language summary that
contains the listing of causes that led to a licensee's
probation, the length of the probation and the end date, and
all practice restrictions placed on the licensee in a
disclosure regarding the status of a licensee's license made
to an inquiring member of the public as well as on any
documents informing the public of probation orders and
probation licenses, including but not limited to newsletters.
Requires the summary to be posted on the BreEZe profile Web
site of each licensee subject to probation.
2) Requires licensees of the MBC, OMBC, BPM, CAB, BCE and NMC to
disclose their probationary status and the address of his or
BreEZe profile or licensing boards' Web site and phone number
to patients or their guardians or health care surrogates
prior to the patient's first visit while the licensee is on
probation.
3)Provides an exemption to this requirement if the patient is
unconscious or otherwise unable to comprehend the disclosure
and sign the receipt of disclosure and if a guardian or health
care surrogate is unavailable to comprehend the disclosure and
sign the receipt of disclosure and if the visit occurs in an
emergency room and the licensee who will be treating the
patient during the visit is not known to the patient until
immediately prior to the start of the visit. Specifies that
the licensee shall disclose his or her status as soon as
either the patient or a guardian or health care surrogate is
available to comprehend and sign the disclosure.
4)Requires boards to develop a standardized format for the
summary in #1 above.
5)Authorizes MBC to request investigation and prosecution costs
for a disciplinary proceeding against a licentiate in which
the licentiate's license is placed on probation.
6)Specifies that the provisions of this bill apply to
probationary orders made after January 1, 2017.
SB 1033
Page 4
Background
The Author is the Sponsor of this bill and notes that SB 1033
will only require additional disclosure for patients served by
500 - 600 licensed physicians in the state. According to the
Author, patients deserve to be proactively informed if their
doctor has been placed on probation by the boards in this bill
for serious offenses such as sexual misconduct, substance abuse,
gross negligence, or a felony conviction related to patient care
and treatment. The Author notes that physicians, osteopathic
physicians and podiatrists are already required to inform
hospitals and malpractice insurers of their probation status,
but their patients have to seek out the information for
themselves on the state's licensee database. The Author adds
that while California licensing boards post information on their
Web sites related to licensee discipline, patients may not know
about this resource or have the ability to check the databases.
Probation. According to information provided by the Author and
in a petition filed before the MBC by Consumers' Union Safe
Patient Project calling on MBC to amend its Manual of Model
Disciplinary Orders and Disciplinary Guidelines and require
physicians on probation to inform their patients of this,
physicians are routinely placed on probation by MBC for multiple
years. Generally, while on probation these physicians are
allowed to continue practicing medicine, often with limitations
and requirements, but most commonly they are not required to
provide any information to their patients regarding their MBC
discipline. As of September 29, 2015, according to information
provided by MBC, nearly 500 California physicians - among
102,000 California physicians in active practice - were on
probation. Physicians are placed on probation following the
Attorney General making an accusation for a variety of reasons,
for example, gross negligence/incompetence (the most common
reason for probation), substance abuse, inappropriate
prescribing, sexual misconduct, conviction of a felony or other
miscellaneous violations.
A November 2008 report issued by The California Research Bureau
(CRB), Physician Misconduct and Public Disclosure Practices at
the Medical Board of California, reported that physicians who
have received serious sanctions in the past are far more likely
to receive additional sanctions in the future. According to the
CRB report, "These findings strongly imply that disciplinary
SB 1033
Page 5
histories provide patients with important information about the
likely qualities of different physicians." MBC data from a 2013
Enforcement Committee meeting also showed that in FY 2011-2012
and FY 2012-2013, 17 percent of 444 actively-practicing
California physicians on probation (77 doctors total) either
required subsequent discipline or surrendered their licenses
while on probation.
Disclosures. When the MBC places physicians on probation,
generally they continue to practice medicine and see patients
under restricted conditions. The MBC posts information
regarding probation on its Web site and distributes the
information to its email list which includes media and
interested persons who have signed up to receive it. In
October, 2012 MBC staff made a proposal to the MBC to require
physicians to inform their patients when the physician is on
probation and required to have a monitor. In its recommendation
staff said, "This would insure the public has the ability to
make informed decisions regarding their healthcare provider."
The Board did not approve the staff proposal.
FISCAL EFFECT: Appropriation: No Fiscal
Com.:YesLocal: No
According to the Senate Committee on Appropriations analysis
dated May 27, 2016, this bill will result in ongoing costs of
about $1 million per year for additional disciplinary hearings
for physicians licensed by MBC, ongoing costs in the tens of
thousands per year, on average, for additional disciplinary
hearings by the OMBC, ongoing costs in the low tens thousands
per year, on average, for additional disciplinary hearings by
the BPM, ongoing costs in the tens of thousands per year, on
average, for additional disciplinary hearings by the BCE and
minor average annual costs for additional disciplinary hearings
by the NMC.
SUPPORT: (Verified5/31/16)
SB 1033
Page 6
California Board of Chiropractic Examiners
California Chiropractic Association
California Public Interest Research Group
Californians for Patients Rights
Center for Public Interest Law
Consumer Attorneys of California
Consumer Federation of California
Consumers Union
Consumer Watchdog
OPPOSITION: (Verified5/31/16)
California Academy of Family Physicians
California Chapter of the American College of Cardiology
California Dental Association
California Medical Association
California Psychiatric Association
California Society of Plastic Surgeons
ARGUMENTS IN SUPPORT: Supporters cite examples of patients
who were harmed by or died under the care of physicians on
probation as need for this bill. Supporters believe that this
is important legislation that will improve physician
accountability, transparency and public participation.
Supporters believe that patients deserve to know critical
information such as if their doctor is practicing while on
probation and that when a physician is on probation for serious
offenses, patients are typically unaware of conditions licensees
must follow or the fact that their doctor is on probation at
all. The Consumers Union's Safe Patient Project believes this
legislation is necessary because MBC declined to require
notification to patients, a fact the organization believes is
particularly necessary as physicians on probation are allowed to
continue practicing medicine. Supporters note that information
from published research and the MBC's own data that show
physicians who receive serious sanctions like probation are more
likely to receive additional sanctions. Supporters also believe
that the requirements in this bill for direct reporting to
patients are essential in light of the varied availability of
the internet in California and potential inability for health
care consumers to easily obtain this information.
SB 1033
Page 7
ARGUMENTS IN OPPOSITION: Opponents state that this bill will
have grave impact on a physician's practice by cutting into time
in which patient care can be provided and that the impact of
this bill is similar to suspension. Opponents note that this
bill will discourage stipulated settlement and encourage more
physicians to pursue a hearing on their case, slowing down the
disciplinary process for all cases.
The California Dental Association believes this legislation sets
a problematic precedent for all healing arts licensees and their
patients and that while well intentioned, the provisions in this
bill interfere with a licensing board's authority and
responsibility to protect consumers.
The California Medical Association states that the broad manner
in which the notification requirement may be imposed as a
condition of probation is unfair and is concerned that this bill
is inconsistently applied to licensees who may be interacting
with the same patients a physician would see.
Prepared by:Sarah Mason / B., P. & E.D. / (916) 651-4104
6/1/16 18:33:05
**** END ****