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 ----------------------------------------------------------------- |Policy |Business and Professions |Vote:|13 - 0 | |Committee: | | | | | | | | | | | | | | ----------------------------------------------------------------- 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 SB 1177 Page 2 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 SB 1177 Page 3 (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 SB 1177 Page 4 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. SB 1177 Page 5 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. SB 1177 Page 6 Analysis Prepared by:Lisa Murawski / APPR. / (916) 319-2081