BILL ANALYSIS Ó
SB 1177
Page 1
Date of Hearing: June 21, 2016
ASSEMBLY COMMITTEE ON BUSINESS AND PROFESSIONS
Rudy Salas, Chair
SB 1177(Galgiani) - As Amended June 1, 2016
SENATE VOTE: 39-0
SUBJECT: Physician and Surgeon Health and Wellness Program
SUMMARY: Authorizes the Medical Board of California (MBC) to
contract with a private third party to allow physicians and
surgeons to participate in a Physician Health and Wellness
Program (PHWP) to provide treatment for substance abuse
disorders.
EXISTING LAW:
1)Establishes the Department of Consumer Affairs (DCA) which
oversees boards and bureaus that license and regulate
businesses and professions, including but not limited to
physicians, nurses, dentists, engineers, architects,
contractors, cosmetologists, automotive repair facilities and
private postsecondary education institutions. (Business and
Professions Code (BPC) § 101)
2)Requires individuals or entities contracting with the DCA, or
any board within the DCA, to provide services relating to the
treatment and rehabilitation of licentiates impaired by
alcohol or dangerous drugs to retain all records and documents
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pertaining to those services until such time as these records
and documents have been reviewed for audit by the DCA for a
maximum of three years, as specified. (BPC § 156.1)
3)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.
4)Establishes the Substance Abuse Coordination Committee (SACC)
within the DCA, comprised of executive officers of the DCA's
healing arts boards and a designee of the State Department of
Health Care Services. (BPC § 315 (a))
5)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 (c))
6)Requires a healing arts board, except the Board of Registered
Nursing (BRN), to order a licensee of the board to cease
practice if the licensee tests positive for any substance that
is prohibited under the terms of the licensee's probation or
diversion program. (BPC § 315.2)
7)Permits a healing arts board to adopt regulations authorizing
the board to order a licensee on probation or in a diversion
program to cease practice due to a major violation, or if the
licensee has been ordered to undergo a clinical diagnostic
evaluation pursuant to uniform and specific standards, as
specified, but that this requirement shall not apply to the
BRN for purposes of their intervention program. (BPC §§ 315.4
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(a) and (d))
8)Prohibits an order to cease practice from being governed by
the Administrative Procedures Act (APA), and states that the
order shall not constitute a disciplinary action. (BPC §§
315.4 (b) and (c))
9)Requires the following boards 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's health and safety. Most
boards also specify Legislative intent that a diversion
program (or intervention program) is a voluntary alternative
approach to traditional disciplinary actions:
a) The Dental Board of California for dentists and dental
hygienists. (BPC §§ 1695-1699; 1966-1966.6)
b) The Osteopathic Medical Board of California for
osteopathic physicians and surgeons. (BPC §§ 2360-2370)
c) The Physical Therapy Board of California for physical
therapists. (BPC §§ 2662-2669)
d) The Board of Registered Nursing for registered nurses.
(BPC §§ 2770-2770.14)
e) The Physician Assistant Board for physician assistants.
(BPC §§ 3534- 3534.10)
f) The Board of Pharmacy to operate a recovery program for
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pharmacists or intern pharmacists. (BPC §§ 4360-4373)
g) The Veterinary Medical Board for veterinarians and
registered veterinary technicians. (BPC §§ 4860-4873)
10)Establishes the Attorney Diversion and Assistance Act within
the State Bar of California to address the substance abuse and
mental health problems of attorneys who voluntarily
participate in the program. (BPC §§ 6230-6238)
11)Provides for the professional review of specified healing
arts licentiates by a peer review body, as defined, including
a medical or professional staff of any licensed health care
facility or clinic, health care service plan, specified health
professional societies, or a committee organized by any entity
that functions as a body to review the quality of professional
care provided by specified health care practitioners. (BPC §
805)
12)Requires a report to be filed by a peer review body to an
agency having regulatory jurisdiction over healing arts
licentiates if a licentiate's application for staff privileges
is denied or rejected, has had his or her membership, staff
privileges, or employment terminated or revoked for medical
disciplinary reasons; or if restrictions are imposed, or
voluntarily accepted, on staff privileges, membership or
employment for a cumulative total of 30 days or more for any
12-month period, for a medical disciplinary cause or reason.
(BPC § 805)
13)Requires a peer review body to file a report with the
relevant agency within 15 days after a peer review body makes
a final decision or recommendation regarding the disciplinary
action to be taken against a licentiate if it is determined,
based on the investigation of the licentiate, that the
licentiate was involved in the use of, or prescribing for or
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administering to himself or herself, any controlled substance;
or the use of any dangerous drug or alcoholic beverages, to
the extent, or in such a manner as to be dangerous or
injurious to the licentiate, any other person, or to the
public, or to the extent that such use impairs the ability of
the licentiate to practice safely. (BPC § 805.01)
14)Provides for the licensure and regulation of physicians and
surgeons by the MBC pursuant to the Medical Practice Act
(Act). (BPC § 2000 et. seq.)
15)Requires the MBC to investigate complaints from the public,
other licensees, health care facilities, or from others as
specified. Requires the MBC to investigate the circumstances
underlying a report received pursuant to BPC § 805 or § 805.01
above within 30 days to determine if an interim suspension
order or temporary restraining order should be issued. (BPC §
2220)
16)Requires the 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. Requires 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)
17)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 the
applicant to limited practice under 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)
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18)Provides that the MBC shall take action against a physician
who is charged with unprofessional conduct, as specified.
(BPC § 2234)
19)Provides that a violation of any federal or state statute or
regulation regulating dangerous drugs or controlled substances
constitutes unprofessional conduct. (BPC § 2238)
20)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
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:
21)Permits the MBC to establish a PHWP for the early
identification of, and appropriate interventions to support a
physician and surgeon in his or her rehabilitation from,
substance abuse to ensure that the physician and surgeon
remains able to practice medicine in a manner that will not
endanger the public health and safety and that will maintain
the integrity of the medical profession.
22)Defines "program" as the PHWP.
23)Requires the PHWP to:
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a) Provide for the education of all licensed physicians and
surgeons with respect to the recognition and prevention of
physical, emotional, and psychological problems;
b) Offer assistance to a physician and surgeon in
identifying substance abuse problems;
c) Evaluate the extent of substance abuse problems and
refer the physician and surgeon to the appropriate
treatment by executing a written agreement with a physician
and surgeon participant;
d) Provide for the confidential participation by a
physician and surgeon with substance abuse issues who does
not have a restriction on his or her practice related to
those substance abuse issues; and,
e) Comply with the Uniform Standards Regarding
Substance-Abusing Healing Arts Licensees as adopted by the
SACC of the DCA.
24)Specifies that if the MBC establishes a PHWP, the MBC shall
contract for the program's administration with a private
third-party independent administering entity pursuant to a
request for proposals.
25)Requires the administering entity to:
a) Have expertise and experience in the areas of substance
or alcohol abuse in healing arts professionals;
b) Identify and use a statewide treatment resource network
that includes treatment and screening programs and support
groups and shall establish a process for evaluating the
effectiveness of such programs;
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c) Provide counseling and support for the physician and
surgeon and for the family of any physician and surgeon
referred for treatment;
d) Make their services available to all licensed California
physicians and surgeons, including those who self-refer to
the PHWP; and,
e) Have a system for immediately reporting a physician and
surgeon who withdraws or is terminated from the PHWP to the
MBC. This system shall ensure absolute confidentiality in
the communication to the MBC. The administering entity
shall not provide this information to any other individual
or entity unless authorized by the participating physician
and surgeon.
26)Additionally requires the administering entity to do the
following:
a) Provide regular communication to the MBC, including
annual reports to the MBC with PHWP statistics, including,
but not limited to, the number of participants currently in
the PHWP, the number of participants referred by the MBC as
a condition of probation, the number of participants who
have successfully completed their agreement period, and the
number of participants terminated from the PHWP. In making
reports, the administering entity shall not disclose any
personally identifiable information relating to any
participant.
b) Submit to periodic audits and inspections of all
operations, records, and management related to the PHWP to
ensure compliance with the requirements of this article and
its implementing rules and regulations. Specifies that any
audit conducted pursuant to this section shall maintain the
confidentiality of all records reviewed and information
obtained in the course of conducting the audit and shall
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not disclose any information identifying a PHWP
participant.
c) Allow the MBC to terminate the contract in the event
that the MBC determines the administering entity is not in
compliance with the requirements of the PHWP or contract
entered into with the MBC.
27)Indicates that a physician and surgeon shall, as a condition
of participation in the PHWP, enter into an individual
agreement with the PHWP and agree to pay expenses related to
treatment, monitoring, laboratory tests, and other activities
specified in the participant's written agreement. The
agreement shall include all of the following:
a) A jointly agreed upon plan and mandatory conditions and
procedures to monitor compliance with the PHWP;
b) Compliance with terms and conditions of treatment and
monitoring;
c) Criteria for PHWP completion;
d) Criteria for termination of a physician and surgeon
participant from the PHWP;
e) Acknowledgment that withdrawal or termination of a
physician and surgeon participant from the PHWP shall be
reported to the MBC; and,
f) Acknowledgment that expenses related to treatment,
monitoring, laboratory tests, and other activities
specified by the PHWP shall be paid by the physician and
surgeon participant.
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28)Specifies that any agreement entered into pursuant to this
section shall not be considered a disciplinary action or order
by the MBC and shall not be disclosed to the MBC if both of
the following apply:
a) The physician and surgeon did not enroll in the PHWP as
a condition of probation or as a result of an action by the
MBC; and,
b) The physician and surgeon is in compliance with the
conditions and procedures in the agreement.
29)States that any oral or written information reported to the
MBC shall remain confidential and does not constitute a waiver
of any existing evidentiary privileges under any other
provision or rule of law. However, confidentiality regarding
the physician and surgeon's participation in the PHWP and
related records do not apply if the MBC has referred a
participant as a condition of probation.
30)Specifies that nothing in this section prohibits, requires,
or otherwise affects the discovery or admissibility of
evidence in an action by the MBC against a physician and
surgeon based on acts or omissions within the course and scope
of his or her practice.
31)Indicates that any information received, developed, or
maintained regarding a physician and surgeon in the PHWP is
not to be used for any other purposes.
32)States that participation in the PHWP is not a defense to any
disciplinary action that may be taken by the MBC. This section
does not preclude the MBC from commencing disciplinary action
against a physician and surgeon who is terminated
unsuccessfully from the PHWP. However, that disciplinary
action may not include as evidence any confidential
information unless authorized by this section.
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33)Establishes the Physician and Surgeon Health and Wellness
Program Account within the Contingent Fund of the MBC.
34)Specifies that any fees collected by the MBC, as specified,
must be deposited in the Physician and Surgeon Health and
Wellness Program Account and shall be available, upon
appropriation by the Legislature, for the support of the
program.
35)States that the MBC shall adopt regulations to determine the
appropriate fee that a physician and surgeon participating in
the PHWP is required to provide to the MBC. The fee amount
adopted by the MBC must be set at a level sufficient to cover
all costs for participating in the PHWP including any
administrative costs incurred by the board to administer the
PHWP.
36)Permits the MBC, subject to appropriation by the Legislature,
to use moneys from the Contingent Fund of the MBC to support
the initial costs for the MBC to establish the PHWP under this
article, except these moneys is not to be used to cover any
costs for individual physician and surgeon participation in
the PHWP.
FISCAL EFFECT: Unknown. This bill has been keyed fiscal by the
Legislative Counsel.
COMMENTS:
Purpose. This bill is sponsored by the California Medical
Association . According to the author, "As in other states,
[this bill] will establish a much-needed statewide Physician
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Health and Wellness Program in California, which is essential
for increasing patient safety through early identification of
physicians with substance abuse disorders. It will ensure
resources are available to increase awareness, coordination, and
monitoring of treatment for physicians, and will ensure the
[MBC] can take decisive action to protect patients."
Background. Substance Misuse, Abuse, and Addiction among Health
Care Licensees. The distinctions between misuse, abuse, and
addiction are important. Substance misuse is defined as
inappropriate use of any substance, such as alcohol, a street
drug, or misuse of a prescription or over the counter drug.
Substance abuse has been described as unreasonable ingestion of
a mind-altering substance that causes harm or injury to the
health care professional. Addiction is a compulsive or chronic
need for, or an active addiction to, alcohol or drugs.
Healthcare professionals are at particular risk for substance
misuse, abuse, and addiction; however, limited data is available
on the rates of incidence because abusing or addicted health
care professionals rarely report abuse or addiction for fear of
disciplinary action against their license to practice. It is
also difficult to gather accurate statistics because employers
often fail to recognize the signs and symptoms of these
disorders. Available literature estimates that between 10 to 15
percent of health care professionals are afflicted with alcohol
or drug addiction.
Health care professionals are at particular risk for
alcohol/drug misuse, abuse, or addiction for many reasons.
Drugs are one of the primary tools used by health care
professionals to treat and help their patients. They prescribe,
administer, and dispense medications every day. In addition,
their exposure and accessibility to mind-altering medications,
pharmacological knowledge of the drugs that fosters a false
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sense of control, and a tendency to self-treat or self-medicate
are contributing factors. (Nebraska Department of Health and
Human Services, Alcohol and Drug Abuse and Addiction: A
Healthcare Professional's Guide, 2011).
In a study conducted by Cicala (2003), 8 to 12 percent of
physicians were estimated to be at risk of developing a
substance use problem. Specifically, emergency medicine and
anesthesiology tend to be the highest-risk specialties for
substance use problems among physicians. Similarly, Trinkoff
and Storr (1998) conducted an investigation where substance use
was studied among nurses. Thirty-two percent of 4,438
respondents indicated some substance abuse. Emergency room
nurses were 3.5 times as likely to abuse substances as general
practice or pediatric nurses. Oncology or administrative nurses
were twice as likely to binge-drink. Psychiatric nurses were 2.5
times as likely as general practice nurses to smoke.
Diversion and Physician Health Programs. Diversion programs are
established by enforcement entities to allow professional
licensees the opportunity to address their substance misuse,
abuse or addiction, in lieu of automatic discipline. Physician
health programs (PHPs) offer the same services to enrollees as
diversion programs, but not all PHPs provide the ability for
certain enrollees to "divert" automatic discipline from
enforcement entities by instead enrolling, participating, and
completing treatment. In 1974, the American Medical Association
and the Federation of State Medical Boards advised state medical
boards on the importance of developing PHPs. By 1980, almost
all states had authorized or implemented PHPs. To date, PHPs
operate in 47 states and the District of Columbia.
Several studies have reported recovery rates between 70 to 90
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percent for physicians with substance use problems monitored by
PHPs (DuPont, R.L. et al., 2009; McLellan, A.T., 2008). Other
studies cite abstinence rates of almost 90 percent five years
after physicians completed PHPs (Institute for Behavior and
Health, Creating a New Standard for Addiction Treatment
Outcomes, 2014).
Diversion Programs in California. Across the state, there are
multiple programs including seven programs housed within the DCA
and one program, the Lawyer Assistance Program, operated by the
State Bar of California.
The BPC requires seven different boards to establish diversion
programs which will allow the boards to identify and
rehabilitate licensees whose competency may be impaired due to
substance misuse, abuse, or addiction. The programs are
intended to provide treatment to licenses so that they can
return to practice in a manner that will not endanger the
public's health and safety. Most of these boards specify in
their practice acts that participation in the diversion programs
is a voluntary alternative approach to traditional disciplinary
actions. The following boards are authorized to administer a
diversion program via statute:
1) The Dental Board of California
2) The Osteopathic Medical Board of California
3) The Physical Therapy Board of California
4) The Board of Registered Nursing
5) The Physician Assistant Board
6) The Board of Pharmacy
7) The Veterinary Medical Board
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The MBC's Diversion Program. The MBC previously operated a
diversion program from 1980 until 2008. The program re-routed
physicians with substance use problems out of the enforcement
program and into a monitoring program intended to assist them in
their recovery. Participants were required to adhere to an
agreement for a five-year monitoring program, including random
bodily fluids testing, mandatory group meeting attendance,
worksite monitoring, and often substance abuse treatment and/or
psychotherapy. Those who complied with these terms and
maintained sobriety for three years were discharged from the
program without facing disciplinary action. Those who violated
the agreement were referred to the enforcement program for
discipline. Many of the physicians in the program retained full
and unrestricted medical licenses during their participation in
the diversion program and their participation was confidential.
Audit of the MBC's Diversion Program. The MBC's diversion
program was audited five times with its first audit commencing
in 2003 as a result of a legislatively mandated enforcement
monitor who was placed at the MBC to monitor its oversight of
the diversion program (SB 1950 (Figueroa), Chapter 1085, Statues
of 2002). The fifth audit was completed in 2007 by the Bureau
of State Audits.
In a report of the first audit, it was recommended that MBC
consider contracting the program out to another entity due to
the MBC's problems with administering the program. All
subsequent audits resulted in reports that highlighted the MBC's
difficulty with establishing and maintaining sufficient quality
controls in administering the program, and pointed out problems
including insufficient staff, inadequate monitoring and
reporting mechanisms, and deficient guidance. The MBC did not
make all of the recommended changes from the various audits.
The program was discontinued July 1, 2008.
Uniform Standards Regarding Substance-Abusing Healing Arts
Licensees (Uniform Standards). Senate Bill 1441
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(Ridley-Thomas), Chapter 548, Statutes of 2008, created the
SACC. The SACC was required to formulate uniform and specific
standards in specified areas that each healing arts board should
use when dealing with licensees with substance use problems,
regardless if the board decided to have a formal program. The
standards were finalized in April of 2011. Since then, there
have been three separate legal opinions that concluded that the
use of the Uniform Standards by the DCA's healing arts boards is
mandatory. The standards outline how the boards should address
the following:
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
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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 MBC stated at its October 29, 2015 board meeting that any
PHWP operated by the MBC should comply with the Uniform
Standards. It further stated in its letter of support that it
interprets the PHWP described in this bill as being compliant
with the Uniform Standards.
Prior Related Legislation. AB 2346 (Gonzalez) of 2014, would
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have authorized MBC to contract with a third party to establish
a voluntary Physician Health Program. (NOTE: The bill was held
under submission in the Assembly Committee on Appropriations.)
SB 1483 (Steinberg) of 2012, would have created the Physician
Health, Awareness, and Monitoring Quality Act (PHAMQ Act) and
established a Physician Health Program for physicians, medical
students, and medical residents seeking treatment for alcohol or
substance abuse, a mental disorder, or other health conditions.
Created a Physician Health, Awareness, and Monitoring Quality
Oversight Committee within the DCA and vested it with the duties
and responsibilities for the program, including entering into
contracts. (NOTE: The bill was placed on inactive file on the
Assembly Floor.)
SB 1172 (Negrete McLeod) Chapter 517, Statutes of 2010, required
healing arts boards to order a licensee to cease practice if the
licensee tests positive for any prohibited substance under the
terms of the licensee's probation or diversion program.
AB 526 (Fuentes) of 2009, would have established a voluntary
Physician Health Program within the State and Consumer Services
Agency to assist physicians and surgeons with alcohol or
substance abuse. (NOTE: The bill was held under submission in
the Senate Committee on Appropriations.)
AB 214 (Fuentes) of 2008, would have established a voluntary
Physician Health Program within the Department of Public Health
to assist physicians and surgeons with alcohol or substance
abuse. (NOTE: The bill was vetoed by Governor Schwarzenegger
who stated in his veto message, "separating the operation of
such programs from the [MBC] is inappropriate. Ideally,
diversion programs would always lead to success, but the reality
is that not everyone succeeds in recovery. It is critical that
the licensing agency be directly involved in monitoring
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participation in diversion programs to protect patients and
enable timely enforcement actions.")
SB 1441 (Ridley-Thomas) Chapter 548, Statutes of 2008,
established the SACC within the DCA to develop uniform standards
and controls for programs dealing with licensees with substance
abuse problems.
AB 2443 (Nakanishi) of 2008, would have required the MBC to
establish a program to promote the well-being of physicians and
surgeons. (NOTE: The bill was vetoed by Governor
Schwarzenegger who stated in his veto message, "This bill, while
well-intentioned, detracts from the mission and purpose of the
MBC. The [MBC] should be focused on successfully implementing
its current licensure, regulatory and enforcement activities
before attempting to offer new programs outside its highest
priority - protecting the health and safety of consumers.")
SB 761 (Ridley-Thomas) of 2007, would have extended the sunset
date of the PDP to July 1, 2010. (NOTE: The bill was held
under submission in the Assembly Committee on Appropriations.)
SB 231 (Figueroa) Chapter 674, Statutes of 2005, established a
January 1, 2009, sunset date for the physician diversion
program.
ARGUMENTS IN SUPPORT:
The California Medical Association , sponsors of this bill,
write, "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 disorders. In fact, California is just one
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of a few states nationwide that does not provide a pathway for
physicians and surgeons to address substance abuse and mental
health problems. Because there is no program in California,
many who suffer from these conditions often do not know where to
turn for help. A statewide system will increase awareness and
coordination of reliable treatment options."
The California Chapter of the American College of Emergency
Physicians writes in support, "Studies show that burnout is
common among physicians, and even more so among emergency
physicians, with rates as high as 60%... It's not at all
surprising that burnout, left unchecked, can lead to serious
consequences, such as substance abuse and even suicide. That's
why it's crucial to provide support for those suffering from its
effects."
The California Academy of Family Physicians writes in their
letter of support, "?the MBC operated a Diversion Program for
physicians and surgeons?[that] allowed for participation in the
program in lieu of discipline. The program proposed under [this
bill] would not be a diversion program; participation would not
preclude the MBC from taking disciplinary actions deemed
necessary, thereby strengthening consumer protections."
The California Health Advocates also supports the bill and
writes, "California's Physicians and Surgeons face a myriad of
work related stresses and it is important that we do more to
protect their well-being because they keep the rest of us
healthy. [This bill] will authorize the [MBC] to establish a
Physician and surgeon Health and Wellness Program for the early
identification and appropriate interventions to support a
physician and surgeon in his or her rehabilitation from
substance abuse, physical or mental illness and burnout. The
creation of this type of wellness program is long overdue."
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The California Hospital Association writes, "CHA feels this bill
would achieve legislation that is supportive of early
intervention, offers flexible treatment options and achieves the
goals of retaining valuable members of the medical community
while protecting the public."
The California Society of Addiction Medicine supports the bill
and writes, "As physicians, CSAM understands the importance of
protecting patients. No other progression swears an oath of
allegiance to their clients' wellbeing quite like the
Hippocratic Oath. To protect our patients we must find the most
effective way to safeguard them from healthcare professionals
who abuse alcohol and other drugs."
The Drug Policy Alliance writes, "California is one of only a
handful of states with no such program in place. We support
creating this kind of program because national scientific
evidence proves that the public is safer when doctors who need
help with physical and mental health conditions can access that
help and be monitored by such a program."
The Medical Board of California supports the bill and writes,
"This bill would require the PHWP to comply with the Uniform
Standards and would require any physician participant who
terminates or withdraws from the PHWP to be reported to the
Board. These are both very important elements for consumer
protection."
The Union of American Physicians and Dentists writes, "There is
a tragic irony in California being one of the only states in
America to not provide their professional healthcare providers
with a holistic support and rehabilitation program for substance
abuse, stress, and other health issues. It is imperative
California works to provide our physicians and surgeons with the
same type of robust assistance and care we provide to other
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professional classes."
The Western Occupational and Environmental Medical Association
writes in support, "Similar programs exist in most other states,
and in California, physicians are the only medical professionals
without access to a program that provides support and
rehabilitation for substance abuse, stress, or other issues.
The Physician Health Program would fill that void."
ARGUMENTS IN OPPOSITION:
The Center for Public Interest Law opposes the bill and writes,
"At a minimum,?it is critical that the bill be amended to ensure
patients are adequately protected?CPIL recommends the following
amendments:
1) The bill should be amended to require MBC to appoint a
standing committee of [MBC] members to meet quarterly, in
public to review data provided by the administering entity,
and any audits performed with respect to the program as
required by Uniform Standard #15. The committee should be
comprised of three public members and two licensee members
of the [MBC], evaluate the programs' compliance with the
Uniform Standards, and report its finding to the [MBC].
2) The bill should impose a sunset date on the program two
years after it is implemented so that the Legislature may
evaluate the program and ensure MBC is maintaining its
public protection mandate.
3) Section 2340.4(h) should be amended to clarify that the
[MBC] may terminate the contract with the administering
entity if it determines the administering entity is not in
compliance with the Uniform Standards, the requirements of
the program, or any contract entered into with the [MBC]."
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The Consumer Attorneys of California writes in opposition, "Our
organization appreciates that the CMA and other physician groups
acknowledge that drug and alcohol dependency among physicians is
a serious matter that deserves attention by the Legislature.
Unfortunately, [this bill] falls short of the steps needed to
ensure that this dangerous problem is addressed in a way that
provides accountability, correction and, above all else,
assurance that patients are protected from negligent treatment
by doctors under the influence."
The Consumers Union writes in opposition to the bill, "We are
concerned that this 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. As soon as a physician is required to enter a
substance abuse-related program, that information should be
publicly reported on the MBC website. Further, substance
abusing physicians who have been referred by the MBC into
treatment should be required to disclose that to their patients.
Additionally, whether or not substance abuse is involved, all
physicians should be subject, at minimum, to the same MBC public
reporting requirements, i.e. the involvement of substance abuse
should never be a cause to allow secrecy or reduce public
reporting requirements, such as information about actions taken
by the board on doctors' online profiles."
AMENDMENTS:
1)In order to ensure that physicians who enroll in the PHWP do
not avoid enforcement action from the MBC for substance abuse
related offenses, the bill should be amended to allow for
confidentiality of self-referrals to be breached if an
investigation of a substance abuse offense occurs after
enrollment in the program as follows:
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2340.2 (d) Provide for the confidential participation by a
physician and surgeon with substance abuse issues who do not
have a restriction on his or her practice related to those
substance abuse issues. If an investigation of a physician
occurs after the physician has enrolled in the program, the
board may inquire of the program if the physician is enrolled
in the program.
2)In order to ensure that the provisions of this bill allow the
administering entity the ability to report the physician's
name to the MBC for additional offenses outlined in the
Uniform Standards, the bill should be amended as follows:
2340.4 (f) The administering entity shall have a system for
immediately reporting a to the board a physician s and surgeon s
including but not limited to those who withdraw s or are is
terminated from the program. to the board.
3)To address the conflict in language listed in subdivision (d)
and (e), the bill should be amended as follows:
2340.6 (d) Nothing in this section prohibits, requires, or
otherwise affects the discovery or admissibility of evidence
in an action by the board against a physician and surgeon
based on acts or omissions within the course and scope of his
or her practice.
2340.6 (e) Any information received, developed, or maintained
regarding a physician and surgeon in the program shall not be
used for any other purposes.
REGISTERED SUPPORT:
California Medical Association (sponsor)
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California American College of Emergency Physicians
California Academy of Family Physicians
California Health Advocates
California Hospital Association
California Society of Addiction Medicine
Drug Policy Alliance
Medical Board of California
Union of American Physicians and Dentists
Western Occupational and Environmental Medical Association
REGISTERED OPPOSITION:
Center for Public Interest Law
Consumer Attorneys of California
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Consumers Union
1 individual
Analysis Prepared by:Le Ondra Clark Harvey, Ph.D. / B. & P. /
(916) 319-3301