BILL ANALYSIS                                                                                                                                                                                                    Ó



                                                                    SB 1177  


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          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