BILL ANALYSIS                                                                                                                                                                                                    Ó






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          |SENATE RULES COMMITTEE            |                       SB 1177|
          |Office of Senate Floor Analyses   |                              |
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                                   THIRD READING 


          Bill No:  SB 1177
          Author:   Galgiani (D) 
          Amended:  6/1/16  
          Vote:     21 

           SENATE BUS., PROF. & ECON. DEV. COMMITTEE:  9-0, 4/18/16
           AYES:  Hill, Bates, Berryhill, Block, Galgiani, Hernandez,  
            Jackson, Mendoza, Wieckowski

           SENATE APPROPRIATIONS COMMITTEE:  7-0, 5/27/16
           AYES:  Lara, Bates, Beall, Hill, McGuire, Mendoza, Nielsen

           SUBJECT:   Physician and Surgeon Health and Wellness Program


          SOURCE:    California Medical Association

          DIGEST:   This bill authorizes the Medical Board of California  
          (MBC) to establish a Physician and Surgeon Health and Wellness  
          Program (PHWP) for the early identification and appropriate  
          interventions to support a licensee in his or her rehabilitation  
          from substance abuse, physical or mental illness, health,  
          burnout, or other similar conditions and authorizes MBC to  
          contract with an independent entity to administer the program.

          ANALYSIS:  


          Existing law:

          1)Establishes requirements for individuals or entities  
            contracting with the Department of Consumer Affairs (DCA)  
            or any board within the DCA to provide services relating  








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            to the treatment and rehabilitation of licentiates  
            impaired by alcohol or dangerous drugs.  Requires all  
            records and documents pertaining to services for the  
            treatment and rehabilitation of licentiates impaired by  
            alcohol or dangerous drugs provided by any contract  
            vendor to the DCA, or to any board to be kept  
            confidential, and not subject to discovery or subpoena.  
            (BPC § 156.1) 

          2)Establishes the Substance Abuse Coordination Committee  
            (SACC) in the DCA, and requires the SACC to formulate, by  
            January 1, 2010, uniform and specific standards in  
            specified areas that each healing arts board shall use in  
            dealing with substance-abusing licensees, whether or not  
            a board chooses to have a formal diversion program.  (BPC  
            § 315)

          3)Requires certain healing arts boards within the DCA to  
            establish a diversion program for board licensees in  
            order to seek ways and means to identify and rehabilitate  
            licensees whose competency may be impaired due to abuse  
            of dangerous drugs and alcohol, so that licensees may be  
            treated and returned to practice in a manner which will  
            not endanger the public health and safety.  Most also  
            specify legislative intent that a diversion program (or  
            intervention program) is a voluntary alternative approach  
            to traditional disciplinary actions.

          4)Requires MBC cases involving drug or alcohol abuse by a  
            physician and surgeon involving death or serious bodily  
            injury to a patient to be handled as a high priority.   
            (BPC § 2220.05)

          5)Provides MBC with the authority to issue a probationary  
            physician's and surgeon's certificate to an applicant subject  
            to terms and conditions, including, but not limited to  
            practice limited to a supervised, structured environment,  
            continuing medical or psychiatric treatment, ongoing  
            participation in a specified rehabilitation program, or  
            abstention from the use of alcohol or drugs.  (BPC § 2221)

          6)Provides that the use of, or self prescribing or self  
            administering, of any controlled substance or dangerous  
            drugs or alcoholic beverages in such a manner as to be  







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            dangerous or injurious to the licensee or any other  
            person or to the public, or to the extent that such use  
            impairs the ability of the licensee to practice medicine  
            safely, or more than one misdemeanor or any felony  
            involving the use, consumption or self-administration of  
            any of these substances, constitutes unprofessional  
            conduct.  (BPC § 2239) 
          
          This bill authorizes MBC to establish a PHWP and requires MBC,  
          if it establishes a PHWP, to contract for administration with an  
          independent administering entity selected by MBC through a  
          request for proposals process.  This bill also establishes  
          requirements for a PHWP and provides that MBC shall determine  
          the appropriate fee that a participant shall pay cover all costs  
          for participating in the program, including any costs to  
          administer the program.

          Background
          
          According to the author, currently, California physicians and  
          surgeons are the only licensed medical professionals without a  
          wellness and treatment program aimed at providing support and  
          rehabilitation for substance abuse, stress, and other health  
          issues.  

          The MBC's former Physician Diversion Program (PDP).  The MBC's  
          PDP was created in 1980 to rehabilitate doctors with mental  
          illness and substance abuse problems without endangering public  
          health and safety.  Under this concept, physicians who abuse  
          drugs and/or alcohol or who are mentally or physically ill may  
          be "diverted" from the disciplinary track into a program that  
          monitors their compliance with terms and conditions of a  
          contract that is aimed at ensuring their recovery.  The PDP  
          monitored participants' attendance at group meetings,  
          facilitated random drug testing, and required reports from  
          work-site monitors and treatment providers.  Many of the  
          physicians in the PDP retained full and unrestricted medical  
          licenses during their participation and enjoyed complete  
          confidentiality.  In recognition that patient safety could not  
          continue to be compromised, as numerous audits pointed out about  
          the PDP, the MBC voted unanimously on July 26, 2007 to end the  
          PDP.  The PDP was allowed to sunset on June 30, 2008.

          Other health board diversion programs.  While MBC housed its  







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          diversion program, other boards outsource these functions.  The  
          DCA currently manages a master contract with MAXIMUS, Inc.  
          (MAXIMUS), a publicly traded corporation for the healing arts  
          boards that have a diversion program.  Under this model, the  
          individual boards oversee the programs, but services are  
          provided by MAXIMUS.  These diversion programs generally follow  
          the same general principles of the MBC's former PDP.  Health  
          practitioners with substance abuse issues may be referred in  
          lieu of discipline or self-refer into the programs and receive  
          help with rehabilitation.  After an initial evaluation,  
          individuals accept a participation agreement and are regularly  
          monitored in various ways, including random drug testing, to  
          ensure compliance.  

          Uniform Substance Abuse Standards.  SB 1441 (Ridley-Thomas,  
          Chapter 548, Statutes of 2008) required the DCA to develop  
          uniform and specific standards that shall be used by each  
          healing arts board in dealing with substance-abusing licensees  
          in 16 specified areas, including requirements and standards for:  
           (1) clinical and diagnostic evaluation of the licensee; (2)  
          temporary removal of the licensee from practice; (3)  
          communication with licensee's employer about licensee status and  
          condition; (4) testing and frequency of testing while  
          participating in a diversion program or while on probation; (5)  
          group meeting attendance and qualifications for facilitators;  
          (6) determining what type of treatment is necessary; (7)  
          worksite monitoring; (8) procedures to be followed if a   
          licensee tests positive for a banned substance; (9) procedures  
          to be followed when a licensee is confirmed to have ingested a  
          banned substance; (10) consequences for major violations and  
          minor violations of the standards and requirements; (11) return  
          to practice on a full-time basis; (12) reinstatement of a health  
          practitioner's license; (13) use and reliance on a  
          private-sector vendor that provides diversion services; (14) the  
          extent to which participation in a diversion program shall be  
          kept confidential; (15) audits of a private-sector vendor's  
          performance and adherence to the uniform standards and  
          requirements; and (16) measurable criteria and standards to  
          determine how effective diversion programs are in protecting  
          patients and in assisting licensees in recovering from substance  
          abuse in the long term.  The "Uniform Substance Abuse Standards"  
          (Uniform Standards) were finally adopted in early 2010, with the  
          exception of the frequency of drug testing which was finalized  
          in March 2011.  The MBC formally implemented the Uniform  







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          Standards in July 2014.

          Post-diversion at MBC.  Without a diversion program, impaired  
          physicians with substance abuse issues must find their own  
          treatment facility for assistance.  MBC is not made aware that  
          the physician received treatment unless a complaint is received,  
          and the physician may present the treatment as evidence in a  
          disciplinary proceeding only if he or she wishes.  When MBC is  
          made aware of substance abuse, licensees are placed on formal  
          probation, with terms customized to fit the licensee's  
          individual need.  Typical terms include participation in support  
          group meetings, random testing for drug and alcohol use,  
          practice restrictions, and/or medical or psychiatric treatment,  
          including psychotherapy.  MBC still retains the power to  
          currently order biological fluid testing as a condition of  
          probation.  If the physician tests positive, MBC issues a cease  
          practice order, if allowed in the condition of probation, until  
          MBC investigates and takes subsequent action.  If the condition  
          does not authorize a cease practice order, MBC investigates  
          whether the physician is safe to practice medicine.  If not, MBC  
          staff will seek an Interim Suspension Order or ask the physician  
          to agree not to practice via a stipulated agreement.


          FISCAL EFFECT:   Appropriation:    No          Fiscal  
          Com.:YesLocal:   No


          According to the Senate Appropriations Committee, this bill will  
          result in likely ongoing costs up to $150,000 per year for staff  
          support of the new program by the MBC and likely ongoing  
          contract costs between $200,000 and $400,000 per year to operate  
          the PHWP. 




          SUPPORT:   (Verified6/1/16)


          California Medical Association (source)
          California Hospital Association
          California Primary Care Association
          Medical Board of California 







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          Union of American Physicians and Dentists


          OPPOSITION:   (Verified6/1/16)


          Center for Public Interest Law
          Consumer Attorneys of California
          Consumer Watchdog
          Consumers Union's Safe Patient Project


          ARGUMENTS IN SUPPORT:     Supporters believe that this bill will  
          bring California back in line with the majority of other states  
          and licensed professions who recognize that wellness and  
          treatment programs serve to enhance public health as well as  
          provide necessary resources for those in need of help.   
          Supporters also believe that this bill supports early  
          intervention, offers flexible treatment options and achieves the  
          goals of retaining valuable members of the medical community  
          while protecting the public.


          ARGUMENTS IN OPPOSITION:     Opponents do not believe there is a  
          need for this bill and cite the numerous documented failures of  
          the former PDP.  Opponents are concerned that the bill is  
          confusing and does not conform to the Uniform Standards.   
          Opponents also are concerned that the bill would allow  
          physicians accused of substance abuse to be diverted into a  
          confidential substance abuse program and that information will  
          be kept secret from their patients.  Opponents believe that as  
          soon as a physician is required to enter a substance  
          abuse-related program, the information should be publicly  
          reported on the MBC website.  Opponents are concerned that the  
          former PDP created a revolving door for drunk and high  
          physicians who went in and out of treatment.

           
          Prepared by:Sarah Mason / B., P. & E.D. / (916) 651-4104
          6/1/16 18:41:35


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