BILL ANALYSIS                                                                                                                                                                                                    



                                                                    SB 1039


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          Date of Hearing:  June 28, 2016


                   ASSEMBLY COMMITTEE ON BUSINESS AND PROFESSIONS


                                  Rudy Salas, Chair


                      SB 1039(Hill) - As Amended June 22, 2016


          SENATE VOTE:  25-12


          SUBJECT:  Professions and vocations


          SUMMARY:  Makes several changes to the statutes governing  
          various boards and bureaus under the Department of Consumer  
          Affairs (DCA); includes specified fee increases for several  
          boards including the Dental Hygiene Committee of California  
          (DHCC), the California Board of Optometry (CBO), the Board of  
          Registered Nursing (BRN), the Board of Pharmacy (BOP), and the  
          Contractors State License Board (CSLB); and eliminates the  
          Telephone Medical Advice Services Bureau (TMAS). 


          EXISTING LAW: 


           1) Establishes, under the Dental Board of California (DBC), the  
             Dental Corps Loan Repayment Program (DCLRP) and requires the  
             DBC in consultation with the Office of Statewide Health  
             Planning and Development, the dental community, other public  
             health facilities and those serving underserved communities  
             to develop and implement the DCLRP.  (Business and  
             Professions Code (BPC)  1970-1976)









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          2)Requires the DHCC to establish by resolution the amount of the  
            fees that relate to the licensing of a registered dental  
            hygienist, a registered dental hygienist in alternative  
            practice, and a registered dental hygienist in extended  
            functions. Prohibits the biennial renewal fee from exceeding  
            $160.  (BPC  1944)


           3) Establishes the Board of Podiatric Medicine (BPM) within the  
             jurisdiction of the Medical Board of California (MBC).  (BPC  
              2460)


           4) Specifies that the MBC shall issue, upon the recommendation  
             of the BPM, a certificate to practice podiatric medicine to  
             each applicant who meets the requirements of the Medical  
             Practice Act.  (BPC  2479)


          5)Establishes various fees applicable to certificates to  
            practice podiatric medicine, including, an application fee, a  
            duplicate wall certificate fee, a duplicate renewal receipt, a  
            letter of good standing fee or a letter for a loan deferment  
            fee, a fee for the issuance of a resident's license, a filing  
            fee to appeal the failure of an oral examination, a fee for  
            continuing education approval, and a fee for ankle  
            certification for persons licensed prior to January 1, 1984.   
            (BPC  2499.5)


          6)Establishes the CBO to regulate nonresident contact lens  
            sellers, registered dispensing opticians (RDO), spectacle lens  
            dispensers, and contact lens dispensers.  Establishes the  
            CBO's regulatory fees, including an initial registration fee,  
            a renewal fee, and a delinquency fee.  (BPC  2546.9, 2565,  
            2566, 2566.1)










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           7) Provides that certificates to practice podiatric medicine  
             and registrations of spectacle lens dispensers and contact  
             lens dispensers, among others, expire on a certain date  
             during the second year of a 2-year term if not renewed.  (BPC  
              2423)


           8) Requires the BRN to adopt regulations establishing standards  
             for continuing education for licensees, as specified, and  
             requires that the standards take cognizance of specialized  
             areas of practice.  (BPC  2811.5)


           9) Prescribes various fees to be paid by licensees and  
             applicants for licensure for the BRN and requires these fees  
             to be credited to the BRN Fund, which is a continuously  
             appropriated fund as it pertains to fees collected by the  
             BRN.  (BPC  2786.5, 2815, 2815.5, 2830.7, 2838.2)


           10)      Prescribes various fees to be paid by licensees and  
             applicants for licensure, and requires all fees collected on  
             behalf of the BOP to be credited to the BOP Contingent Fund,  
             which is continuously appropriated as it pertains to fees  
             collected by the BOP.  (BPC  4400)


           11)      Provides that the licensure requirements for a  
             veterinarian practicing in California do not apply if a  
             veterinarian from another state provides consultation from  
             another state or is called to attend to a case in this state  
             and does not open an office or appoint a place to do business  
             or if a veterinarian from another state is called into this  
             state by a law enforcement or animal control agency to attend  
             to cases that are part of an investigation of an alleged  
             violation of federal or state animal fighting or animal  
             cruelty laws.  (BPC  4830)










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           12)      Requires the certain businesses that provide telephone  
             medical advice services to a patient at a California address  
             to be registered with the TMAS and further requires telephone  
             medical advice services to comply with the requirements  
             established by the DCA, among other provisions, as specified.  
              (BPC  4999 et seq.)


           13)      Prescribes various fees to be paid by licensees and  
             applicants for licensure with the CSLB, and requires fees and  
             civil penalties received under the Contractors' State License  
             Law to be deposited in the Contractors' License Fund, which  
             is a continuously appropriated fund as it pertains to fees  
             collected by the CSLB.  (BPC  7137 and 7153.3)


           14)      Provides for the licensure and regulation of  
             structural pest control operators and registered companies,  
             as defined, by the Structural Pest Control Board (SPCB)  
             within the DCA.  (BPC  8500-8697.4)


           15)      Prohibits a registered company or licensee under the  
             Structural Pest Control Board (SPCB) from commencing work on  
             a contract relating to the presence of wood destroying pests  
             or organisms until an inspection has been made by a licensed  
             Branch 3 field representative or operator; requires that the  
             address of each property inspected or upon which work was  
             completed to be reported to the SPCB, as specified; requires  
             that a written inspection report be prepared and delivered to  
             the person requesting the inspection or his or her agent; and  
             requires that the original inspection report to be submitted  
             to the SPCB upon demand.  (BPC  8516)


           16)      Requires the report to the SPCB to contain specified  
             information, including a foundation diagram or sketch of the  
             structure or portions of the structure inspected and requires  
             the report, and any contract entered into, to expressly state  








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             if a guarantee for the work is made, and if so, the terms and  
             time period of the guarantee.  (BPC  8519)


           17)      Defines "control service" as the regular inspection of  
             a property after a report has been made in compliance with  
             the requirements of an inspection as specified above, and any  
             corrections as have been agreed upon and have been completed.  
              (BPC  8516 (g))


          THIS BILL: 


           1) Increases the statutory cap for the biennial renewal fee for  
             various types of registered dental hygienists from $160 to  
             $500.
           2) Removes the BPM from the jurisdiction of the MBC,  
             establishes it within the DCA, and makes conforming changes. 


           3) Increases various processing fees for the BPM, including  
             fees for issuance of duplicate certificate, issuance of a  
             resident's license, and others. 


           4) Deletes the provisions relating to the BPM's ankle  
             certification fee. 


           5) Establishes a specified minimum and maximum application fee  
             amount for nonresident contact lens sellers, registered  
             dispensing opticians, and spectacle lens dispensers and  
             increases minimum and maximum amounts for already established  
             fees.  Authorizes the CBO to periodically revise and fix the  
             fees, as specified.


           6) Specifies that the CE standards established by the BRN for  








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             nurses shall take cognizance of specialized areas of  
             practice, as currently required, but in addition the content  
             shall be relevant to the practice of nursing and shall be  
             related to the scientific knowledge or technical skills  
             required for the practice of nursing or be related to direct  
             or indirect patient or client care.  
           7) Requires the BRN to audit CE providers at least once every  
             five years to ensure adherence to regulatory requirements,  
             and requires the BRN to withhold or rescind approval from any  
             provider that is in violation of the regulatory requirements.


           8) Prescribes various fee changes to be paid by licensees and  
             applicants for licensure and requires these fees to be  
             credited to the BRN Fund, which is a continuously  
             appropriated fund as it pertains to fees collected by the BRN  
             and also raises specified fees, and provides for additional  
             fees to be paid by licensees and applicants for licensure as  
             well as by schools seeking approval by the BRN.


           9) Modifies, on or after July 1, 2017, specified fees to be  
             paid by the licensees and applicants for licensure with the  
             BOP.


           10)Specifies that a veterinarian from another state or country  
             does not have to be licensed in California if they are  
             holding a current, valid license in good standing in another  
             state or country and provide assistance to a California  
             licensed veterinarian.  The California licensed veterinarian  
             shall maintain a valid veterinarian-client-patient  
             relationship and that the veterinarian providing the  
             assistance shall not establish a veterinarian-client-patient  
             relationship with the client, as specified.  Clarifies that a  
             veterinarian in good standing from another state does not  
             have to be licensed in California if they are called into  
             this state by law enforcement agency or animal control  
             agency, as specified.








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           11)Eliminates the TMAS and repeals the requirement that certain  
             businesses that provide telephone medical advice services to  
             a patient at a California address to be registered with the  
             TMAS. 


           12)Raises specified fees to be paid by the licensees and  
             applicants to the CSLB and requires the CSLB to establish  
             criteria for the approval of expedited processing  
             applications, as specified.


           13)Requires the operator licensed and regulated by the SPCB  
             prior to conducting an inspection as specified above to be  
             employed by a registered company.  Requires that the written  
             inspection report be prepared and delivered to the person  
             requesting it, the property owner, or the property owner's  
             designated agent.  Requires all inspection reports to be  
             submitted to the SPCB and maintained with field notes,  
             activity forms, and notices of completion until one year  
             after the guarantee expires if the guarantee extends beyond 3  
             years.  Requires the inspection report to clearly list the  
             infested or infected wood members or parts of the structure  
             identified in the required diagram or sketch.  Clarifies the  
             definition of "control service agreement" as an agreement,  
             including extended warranties, to have a licensee conduct  
             over a period of time regular inspections and other  
             activities related to the control or eradication of wood  
             destroying pests and organisms.  Makes other clarifying and  
             technical changes regarding the SPCB.


          FISCAL EFFECT:  According to the Senate Appropriations Committee  
          Analysis dated May 27, 2016:


          1)One-time costs of $260,000 and ongoing costs of $250,000 per  








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            year for the Board of Registered Nursing to audit providers of  
            continuing education.
          2)Increased licensing fee revenues of about $23 million per year  
            to the Board of Registered Nursing.


          3)Increased licensing fee revenues of about $7 million per year  
            to the Board of Pharmacy.


          4)Increased licensing fee revenues of about $13 million per year  
            to the Contractor's State Licensing Board.


          5)Increased licensing fee revenues of about $950,000 per year to  
            the Court Reporters Board.


          6)Reduced expenditures (and license fee revenues) of about  
            $200,000 per year from the elimination of the Telephone  
            Medical Advice Services Bureau.


          7)Unknown additional fee revenues due to increases in various  
            licensing fees assessed by the Contractors State Licensing  
            Board.


          COMMENTS:  


          Purpose.  This bill is sponsored by the author.  According to  
          the author, "?this bill is intended to be an omnibus bill which  
          includes several changes to a number of boards under the [DCA]  
          and would also include necessary fee increases for certain  
          boards to ensure they continue to operate without a major  
          structural deficit and maintain adequate reserves.  With the  
          advent of the BreEZe project, which is an attempt to replace  
          multiple antiquated standalone information technology (IT)  








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          systems for most of the boards under the DCA, some boards have  
          anticipated what may be significant costs and have also provided  
          projections of future fund conditions which show less than  
          possibly 3 months in reserve because of overall increased  
          budgetary costs for these individual boards.  (Typically, boards  
          consider seeking fee increases when they project their funds in  
          will be at, or dip below, a three-month reserve.)  



          This bill also makes other clarifying substantive changes for  
          the [SPCB] in regards to inspection conducted by structural pest  
          control operators and their companies and eliminates the [TMAS]  
          Bureau which is no longer necessary to provide oversight of  
          remote advice provided by healthcare practitioners."
          Background.  This bill contains several fee increases requested  
          by boards which have projected fund condition issues,  
          incorporates several of the recommendations from the DCA-wide  
          sunset paper published for this year's sunset review oversight  
          hearing in March, and other technical changes.


          BPM and MBC Jurisdiction.  This bill makes technical changes  
          striking references to the MBC in the podiatry practice act,  
          which are intended to reflect the independent status of each  
          board.  While the BPM was once housed within the MBC, it has  
          been an independent entity since the late 1980's and relies on  
          the MBC only for contractually specified duties, which the MBC  
          provides for other boards as well.  


          For instance, existing law specifies that the MBC issues the  
          podiatric medicine license.  As a result, podiatric licenses are  
          printed with the text "The Medical Board of California Certifies  
          that [insert name of licensee] possesses [the required  
          qualifications] and is hereby granted a license?."  However, in  
          practice, the BPM is responsible for determining the eligibility  
          of its licensees and making final disciplinary decisions. 









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          Fee Changes for the BPM.  The BPM's current fee schedule  
          (excluding initial and renewal fees) has not been increased in  
          over 25 years.  According to the BPM, the costs for performing  
          the services under the schedule have increased significantly  
          over the 25 years.  According to the BPM's two recent fee audits  
          (one performed by DCA and one by a contract consultant), in  
          order to cover the costs of the services, the BPM will need to  
          increase fees.  


          The BPM notes that, "Assuming full expenditures, BPM's projected  
          Fund Condition Analysis indicates that in the FY 16-17 BPM will  
          have one month of expenditures remaining and during FY 17-18  
          will be in the negative by six months."  As a result, the BPM  
          will increase the following fees: (1) Application Fee; (2)  
          Duplicate License; (3) Duplicate License Renewal Fee; (4) Letter  
          of Good Standing; (5) Resident's License; (6) Exam Appeal Fee;  
          and (7) CME Course Approval.  


          In addition, because the ankle license application and exam fees  
          are obsolete, this bill will delete the reference to those fees.  



          Fee Changes for the CBO.  AB 684 (Alejo), Chapter 405, Statutes  
          of 2015, among other things, transferred the regulation of RDOs  
          from the MBC to the CBO, along with the authority to inspect  
          leases and premise locations for compliance with BPC  655  
          (dealing with various kick-back arrangements).  However, neither  
          the MBC nor the CBO collected data on how many locations are  
          co-located, so there is no concrete data on how many registrants  
          are subject to inspection.  In the following years, the CBO will  
          collect the data and use it to further develop the inspection  
          program.


          Currently, the additional revenue brought in by a fee floor will  








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          not support the inspection program.  After more data is  
          collected, the CBO will reassess the cost of this new function  
          (as recommended by the fee audit) and potentially increase fees  
          through the regulation process.


          Still, the fee audit shows that current RDO fee structure is not  
          sufficient to sustain the new RDO program.  The fee audit shows  
          that the proposed fee floor is just enough to sustain the  
          program without factoring in the requirements specified in AB  
          684.  Further, the CBO notes that there are a lot of "unknowns"  
          pertaining to the total impact on the program in regards to the  
          license population and enforcement workload.   The fee auditor  
          recommended setting a fee floor, due to the immediate need, and  
          a fee ceiling high enough to allow the CBO to reassess total  
          impact after a few years of data collection.


          The auditor recommended fees based on cost per item.  However,  
          in an effort to even out the fees and make them more reasonable,  
          the DCA budgets used the auditor's projected program's  
          revenue/budget needs to determine the proposed fee structure.


          BRN CE Audits.  All BRN licensees are required by statute to  
          complete 30 hours of CE during each two year renewal cycle to  
          ensure continued competence.  Licensees are required to submit  
          proof of their compliance by signing a statement under penalty  
          of perjury and agreeing to produce documentation upon request.   
          The BRN relies on adherence to CE standards as the primary  
          method of assuring the continued competence of its licensees,  
          but it has not institutionalized regular audits of licensees'  
          CEs or CE providers (CEPs) since 2002.  This issue was raised in  
          the 2011 Sunset Review Report.  


          During the comprehensive sunset review oversight of the BRN  
          in 2015 conducted by the Senate Committee on Business,  
          Professions and Economic Development and Assembly Committee  








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          on Business and Professions (Committees), staff recommended  
          the following:  "The BRN should review its criteria for  
          CEPs and require content to be science-based and directly  
          related to professionally appropriate practice.  The BRN  
          should continue to pursue additional staffing for CE  
          auditors, but should simultaneously rebalance its existing  
          workload and prioritize ongoing CE and CEP audits."


          This measure reflects the recommendation made in 2015 during  
          sunset review and provides more staffing to audit CE provided  
          pursuant to the fee increase.  



           Fee Changes for BRN.  The BRN Fund is maintained by the BRN and  
          includes the revenues and expenditure related to licensing  
          nurses.  According to the BRN, the cause of its projected  
          deficit is an ongoing problem.
          Also, increasing costs to the BRN as a result of unanticipated  
          BreEZe cost increases (which increased from $2,444,396 million  
          in FY 2014/15 to $5,182,708 million in FY 2015/16 and $4,997,301  
          in FY 2016/17).  As of March 31, 2016, the BRN has expended  
          approximately $10,596,070 on BreEZe.  


          The BRN further indicates that as a result of the high volume of  
          work regularly referred to the Office of the Attorney General,  
          they have requested additional deputies beginning in FY 2016/17  
          and 10 senior legal analysts to comply with the data reporting  
          requirements contained in SB 467 (Hill), Chapter 656, Statutes  
          of 2015.  The BRN also underwent a fee audit of all fees to  
          determine whether the BRN was charging appropriate fees in order  
          to conduct its business at an adequate service level to provide  
          public protection.  It was found that the BRN has not been  
          charging enough fees for many areas and has not been collecting  
          enough fees to support the increased enforcement efforts.  










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          Fee Changes for the BOP.  The BOP's current statutory authority  
          establishes both a minimum and maximum level for all fees.  The  
          BOP uses its regulatory authority to establish each fee within  
          this range.  As a result of a regulatory change that took effect  
          July 1, 2014, with few exceptions, all of the BOP's fees are at  
          their statutory maximums.  The BOP indicates that it is seeking  
          to realign its current fee structure to address a structural  
          imbalance in its current budget resulting from an increase in  
          annual authorized expenditures that is not offset by a  
          corresponding increase in revenue.  As a precursor to  
          establishing the new fee schedules, the DCA's Budget Office  
          completed a fee analysis of the BOP's fund condition and fee  
          structure in late 2015.  


          Requirements for Veterinarians from Other States.  This bill  
          makes changes to the exemption from California licensure for  
          out-of-state veterinarians who may consult or provide assistance  
                                                                     to a California licensed veterinarian to make it clear under  
          what circumstances veterinary practice in this state would be  
          permissible. 


          TMAS.  Under current law, any business that provides telephone  
          medical advice services to a patient in California and who  
          employs or contracts with five or more health care professionals  
          to register with the TMAS.  The registrant must renew every two  
          years and file quarterly reports which, among other  
          requirements, list all California and out-of-state employees who  
          provide medical advice services to California patients.  The  
          TMAS ensures that all registrants file quarterly reports and  
          checks to make sure that all the licensees provided on the list  
          by the registrant are properly licensed.  However, there is no  
          effort to independently confirm the accuracy of the lists  
          provided - for example, whether the registrant has provided a  
          comprehensive list of their licensed providers or whether any  
          non-California licensed providers offered advice to  
          Californians.  









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          TMAS receives, on average, 21 consumer complaints per year.  In  
          the past five years, 105 complaints were received, and all but  
          two were closed without referral for investigation.  According  
          to the most recent DCA reports, there have been zero citations,  
          fines assessed, referrals for criminal or civil action, formal  
          disciplinary actions filed, or consumer restitution ordered by  
          the TMAS in the last five years.  DCA licensing boards already  
          have concurrent authority with the practice of healthcare by  
          licensed and unlicensed individuals and can effectively police  
          this area without TMAS. 


          Fee Changes for the CSLB.  The proposed fee increases for the  
          CSLB seek to provide the CSLB with sufficient funding to support  
          its existing budget and provide for reasonable inflationary cost  
          increases.  While costs have increased in every area in the last  
          few years, the most significant areas are in Personal Services,  
          DCA Pro Rata and Enforcement.  The CSLB anticipates that it will  
          have, by FY 2018/19, a deficit of approximately $6 million.   
          CSLB needs a fee increase in order to continue to provide its  
          existing level of service to both licensees and consumers.  


          In FY 2012/13, the CSLB spent approximately $54 million, and in  
          the current budget year we expect to spend approximately $61  
          million, an increase of approximately 16% and close to $8.5  
          million.  Of that $8.5 million in increased spending, $4.4  
          million went to Personal Services, which includes salary,  
          benefits, and retirements.  During that time period, CLSB added  
          4 positions, which were approved through the annual budget  
          process.  The amount CSLB pays to DCA in pro rata charges  
          increased by $2 million.  A significant portion of that $2  
          million increase is due to DCA's new BreEZe IT system.  While  
          CSLB was previously scheduled to be included in the BreEZe  
          system, it is now not currently scheduled to be included.  


          The CSLB also had increased enforcement costs of about $2  








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          million, which is primarily costs for the use of services by the  
          Attorney's General's Office and the Office of Administrative  
          Hearings.  If the CSLB is not able implement a fee increase, it  
          reports that it will have to reduce costs in enforcement,  
          beginning with cuts to proactive enforcement (stings and  
          sweeps).


          Inspection Requirements for Licensees of the SPCB.  Currently,  
          the Structural Pest Control Act outlines the procedures to be  
          followed during the performance of wood destroying organism pest  
          inspections and in the preparation of the accompanying  
          inspection reports and also provides guidelines for the  
          preparation of a notice of work completed and not completed  
          after a company completes work under a contract.  In 2010, the  
          SPCB created an Act Review Committee and tasked it with  
          reviewing the Act for the purpose of making recommendations to  
          modernize and improve the language for the benefit of consumers  
          and the pest control industry.  The proposed changes in this  
          measure related to SPCP are the result of that review and are  
          intended to clarify its provisions.


          Prior Related Legislation.  AB 684 (Alejo), Chapter 405,  
          Statutes of 2015, authorized the establishment of  
          landlord-tenant relationships between a RDO, optometrist and an  
          optical company as specified; transfers the regulation of RDOs  
          from the MBC to the CBO; replaces an optometrist with a RDO on  
          the CBO; establishes a RDO advisory committee; and establishes a  
          three-year period for the transition of direct employment of  
          optometrists to leasing arrangements.


          ARGUMENTS IN SUPPORT: 


          The  California State Council of Laborers  writes in support, "It  
          is important that the fee cap be adjusted to ensure CSLB  
          enforcement officials have the resources they need to conduct  








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          undercover sting and sweep operations that have successfully  
          targeted egregious offenders who continue to pose a threat to  
          consumers, employees, businesses, and legitimate licensed  
          contractors."


          The  Dental Board of California (DBC)  has a support if amended  
          position.  It will support the bill "if it is amended to add  
          back in the language relating to the [DBC's] ability to approve  
          foreign dental schools.


          The language relating to foreign dental schools, as amended on  
          April 12, 2016, would have authorized the [DBC], in lieu of  
          conducting its own survey and evaluation of a foreign dental  
          school, to accept the findings of any commission or  
          accreditation agency approved by the [DBC], if the findings meet  
          specified standards, and adopt those findings as the [DBC's]  
          own.  Additionally, it would have deleted the requirement to  
          establish a technical advisory group and would have authorized  
          periodic surveys and evaluations instead of requiring periodic  
          surveys and evaluations to be made to ensure compliance with the  
          Dental Practice Act."


          The  Medical Board of California  writes in support, "The BPM is  
          its own board and is completely separate from the [MBC].  For  
          the past two decades, the BPM has been issuing its own podiatric  
          licenses, separate and apart from the [MBC].  It came to the  
          [MBC's] attention that the statute does not reflect this  
          practice in all sections of the [BPC] and there are some  
          conflicting provisions.


          Currently, the [MBC] does not issue licenses for the BPM, nor  
          does it have any impact on the enforcement decisions of the BPM.  
           The [MBC] does provide shared services for the BPM, which means  
          BPM pays [MBC] staff to do some work for the BPM.  This work  
          includes processing complaints and disciplinary actions for the  








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          BPM.  If an investigation is warranted, these complaints are  
          sent to the [DCA] for investigation.  The [MBC] will continue to  
          provide shared serves to BPM and the [MBC] is currently working  
          with DCA staff on a memorandum of understanding to formalize the  
          shared services agreement between the [MBC] and BPM.  Nothing in  
          the statute authorizes the [MBC] to perform these services.   
          This is solely done through the shared services agreement.


          The changes included in [this bill] will make it clear that the  
          BPM is its own board that performs its own licensing functions,  
          as this is existing practice.  The [MBC] believes this is  
          important, as it does not have any control over the BPM, and the  
          law should accurately reflect each board's actual  
          responsibilities.  This bill will not have any effect on BPM  
          licensees or their scope, as it is not changing the role of the  
          [MBC] or the BPM or either board's practices or functions."


          ARGUMENTS IN OPPOSITION:


          The  Board of Podiatric Medicine  has an opposed unless amended  
          and support if amended position.  The BPM writes, "The [BPM]  
          understands how [this bill] could look non-substantive on its  
          face, however, [this bill] changes the authority of the [MBC] to  
          issue licenses to the [BPM] alters the structures currently in  
          place as to enforcement, and has negative financial  
          implications.  The public needs an opportunity to fully review  
          and understand the effects of [this bill]."  The BPM writes that  
          this bill will affect the following:


          8)The status and privileges of Doctors of Podiatric Medicine  
            (DPM) who currently hold licenses that are issued by the MBC.
          9)The BPM's enforcement activities that are vertically aligned  
            with those of the MBC.










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          10)The statutory and regulatory frameworks that currently  
            reference "podiatry" or "podiatric."  The BPM believes this  
            will create confusion. 


          11)The BPM's current workload, finances, and fund condition.   
            The BPM believes this may cause the BPM to eventually become  
            insolvent. 


          The  California Podiatric Medical Association (CPMA) has an  
          opposed unless amended position and writes, "Since 2004, Doctors  
          of Podiatric Medicine (DPMs) practice independently, prescribe  
          medications, perform surgery, and admit and care for patients in  
          hospitals and emergency rooms.  Currently, DPMs are included in  
          Business and Professions Code "Chapter 5, Medicine" as part of  
          the allopathic medical practitioners.  Creating a separate  
          chapter outside of "Medicine" will be considered an "allied"  
          profession.  Podiatrists are currently on staff at surgical  
          centers, hospitals and clinics and it is unclear what impact  
          these major changes will have on the profession, such as  
          hospital privileges or reimbursement issues from insurance  
          companies.


          DPMs perform surgeries alongside their physician colleagues on a  
          daily basis.  Removing the [BPM] from the Medical Practice Act  
          could create two standards from two separate boards for the same  
          procedures.  Patients receiving treatment for a diabetic foot  
          could have a [DPM] with oversight from one board while their  
          primary care physician has oversight from a separate board.  
          Nothing in the bill prevents the boards from having inconsistent  
          standards of care for patients.  Further, many statutes make  
          reference to providers 'licensed by the medical board.'  It will  
          take time to cross reference all of these statutes to know the  
          full impact this bill will have on the practice of podiatry or  
          on board enforcement and consumer safety."










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          The  California Medical Association  has an opposed unless amended  
          position and writes, "podiatric medicine is appropriately  
          incorporated into the Medical Practice Act.  The creation of a  
          new code section for podiatry that is unaffiliated with the  
          Medical Practice Act is a significant change that must avoid  
          unintended consequences.  The kind of significant transition  
          envisioned in [this bill] warrants its own bill and the focused  
          attention that a single subject bill affords.  We ask that the  
          provisions of [this bill] dealing with podiatry be removed from  
          this bill."


          The  American Nurses Association\California (ANA\C)  writes in  
          opposition, "The ANAC supports without question evidence-based  
          nursing education, nursing practice and evidence-based  
          continuing nursing education. Furthermore, we do not question  
          the need for regular audits every 5 years.  We do however  
          question the BRN's current capacity of its already  
          stretched-to-the-max staff to effectively work on all the  
          courses curriculums and approvals, to efficiently process all  
          CEPs applications and to provide timely audits of all offered  
          courses?. 


          To sum it up, in order for the BRN to continue its duty in  
          safeguarding and protecting the public, it requires an increase  
          in budget to have more staff working on approving curriculums  
          for [CE] courses and on auditing of said education courses since  
          currently, the BRN is required to only audit the providers and  
          NOT their courses, [this bill] will fundamentally alter and  
          increase BRN's work load and its responsibility and increased  
          work load cannot be accomplished without increased budget."


          POLICY ISSUES:


          Removal of the BPM from MBC Jurisdiction.  At this time, the  
          MBC, BPM, and stakeholders are unable to reach a consensus on  








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          the effect of the removal of the language establishing the BPM  
          under the MBC's jurisdiction from the Medical Practice Act and  
          recasting it as its own chapter in the BPC.  The disagreement  
          ranges from the administrative responsibilities of each board to  
          the implications of the perceived disconnect among licensees and  
          the public.  Given the disagreement, the author should consider  
          allowing time for additional discussion of this issue.  


          AMENDMENTS:


          Strike the provisions relating to the removal of the BPM from  
          within the MBC to keep existing law and make conforming changes  
          to ensure the BPM's fee increases are maintained, consistent  
          with the rest of the bill. 


          REGISTERED SUPPORT:


          California State Council of Laborers


          Dental Board of California (support if amended)
          Medical Board of California
          REGISTERED OPPOSITION:


          American Nurses Association\California


          Board of Podiatric Medicine
          California Podiatric Medical Association
          California Medical Association
          Analysis Prepared by:Vincent Chee /Le Ondra Clark Harvey, Ph.D.,  
          B. & P. / (916) 319-3301










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