BILL ANALYSIS Ó
SB 1177
Page 1
Date of Hearing: August 3, 2016
ASSEMBLY COMMITTEE ON APPROPRIATIONS
Lorena Gonzalez, Chair
SB 1177
(Galgiani) - As Amended August 1, 2016
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|Policy |Business and Professions |Vote:|13 - 0 |
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Urgency: No State Mandated Local Program: NoReimbursable: No
SUMMARY:
This bill authorizes the Medical Board of California (MBC) to
establish a Physician and Surgeon Health and Wellness Program,
which seeks to provide interventions to support doctors in their
recovery from substance abuse. Specifically, this bill:
1)Authorizes the program, and requires the board, if the program
is established, to contract with a private third-party entity
to administer the program.
2)Requires program participants to enter into an individual
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agreement with the program that includes, among other things,
a requirement to pay their own treatment and monitoring
expenses.
3)Creates a Physician and Surgeon Health and Wellness Program
Account within the Contingent Fund of the MBC to fund the
program.
4)Requires the board to adopt regulations defining program fees,
and requires fee revenue to be available, upon appropriation
by the Legislature, for the support of the program.
5)Authorizes startup costs to be funded through the Contingent
Fund of the MBC.
FISCAL EFFECT:
1)Assuming approximately 400 to 500 licensees will participate
in the program, and assuming an annual cost of $4,000 per
individual (based on current DCA diversion contract rate per
participant), the cost would be approximately $1.6 million to
$2 million per year to contract with a third-party vendor to
administer the program (Physician and Surgeon Health and
Wellness Program Account, created by this bill and funded by
fees adopted pursuant to this bill). The actual treatment
costs are required to be paid privately by program
participants, and are not included here.
2)Approximately $105,000 per year, plus an additional $8,000 for
the first year of funding, for staff to set up and initiate
the program and then to provide ongoing support and coordinate
with the third-party vendor to implement the program
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(Contingent Fund of the MBC for first year; Physician and
Surgeon Health and Wellness Program Account on an ongoing
basis thereafter).
3)Unknown, likely minor, one-time information technology costs
(Contingent Fund of the MBC).
COMMENTS:
1)Purpose. According to the author, this bill is intended to
improve 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 action to protect patients. This bill is
sponsored by the California Medical Association.
2)Background. Healthcare professionals are at particular risk
for substance misuse, abuse, and addiction. 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, but available literature estimates that
between 10 to 15 percent of health care professionals are
afflicted with alcohol or drug addiction.
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
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provide the ability for certain enrollees to "divert"
automatic discipline from enforcement entities. Seven
health-related DCA boards are authorized under current law to
administer diversion programs.
The MBC administered a diversion program until 2008, which
re-routed physicians with substance use problems out of the
enforcement program and into a monitoring program intended to
assist them in their recovery. A number of audits identified
mismanagement, including MBC's difficulty with establishing
and maintaining sufficient quality controls in administering
the program, insufficient staff, inadequate monitoring and
reporting mechanisms, and deficient guidance.
This bill does not explicitly divert physicians from
discipline, but it does provide that participation is on a
confidential basis, except in specified circumstances. In
addition, the creation of a program allows MBC the option of
referring to the program as a condition of probation. It also
attempts to address issues raised in the audit by requiring
the program be administered by a contractor and requiring the
program conform with specified standards.
3)Prior Legislation. Since the dissolution of the prior program,
there have been several legislative attempts to reestablish a
program.
a) AB 2436 (Gonzalez) of 2014, would have authorized the
Medical Board of California (MBC) to establish a voluntary
and confidential program. That bill was held on this
Committee's suspense file.
b) SB 1483 (Steinberg) of 2012 would have required the
Department of Consumer Affairs to contract with a vendor to
administer a physician health program. That bill was held
on this Committee's Suspense file.
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c) AB 214 (Fuentes) in 2008 established a voluntary program
within the Department of Public Health, and was vetoed due
to concerns that physician oversight would be fragmented
without MBC involvement.
d) AB 526 (Fuentes) in 2009 would have established a
voluntary program within the State and Consumer Services
Agency. This bill was held on the Senate Appropriations
Committee Suspense file.
e) SB 1441 (Ridley-Thomas), Chapter 548, Statutes of 2008,
created the Substance Abuse Coordination Committee (SACC)
and required the committee to formulate uniform and
specific standards in specified areas that each healing
arts board must use in dealing with substance-abusing
licensees, whether or not a board chooses to have a formal
diversion program.
1)Support. Medical providers, the Drug Policy Alliance, and the
MBC support this bill. Supporters believe this bill is a
reasonable approach to deal with physician substance abuse
that allows physicians to confront their problems and recover
from substance abuse, thereby improving patient safety. The
MBC notes it complies with the Uniform Standards developed by
an expert DCA committee, and would require any physician
participant who terminates or withdraws from the program to be
reported to the Board.
2)Opposition. Consumer groups, including the Center for Public
Interest Law and Consumers Union, as well as the Consumer
Attorneys of California oppose, citing concern 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.
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Analysis Prepared by:Lisa Murawski / APPR. / (916)
319-2081