BILL ANALYSIS Ó ----------------------------------------------------------------- |SENATE RULES COMMITTEE | SB 1177| |Office of Senate Floor Analyses | | |(916) 651-1520 Fax: (916) | | |327-4478 | | ----------------------------------------------------------------- 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 SB 1177 Page 2 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 SB 1177 Page 3 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 SB 1177 Page 4 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 SB 1177 Page 5 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 SB 1177 Page 6 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 **** END **** SB 1177 Page 7