BILL ANALYSIS Ó
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|SENATE RULES COMMITTEE | SB 1177|
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UNFINISHED BUSINESS
Bill No: SB 1177
Author: Galgiani (D)
Amended: 8/18/16
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
SENATE BUS., PROF. & ECON. DEV. COMMITTEE: 7-0, 8/25/16
(pursuant to Senate Rule 29.10)
AYES: Hill, Bates, Gaines, Galgiani, Jackson, Mendoza,
Wieckowski
NO VOTE RECORDED: Block, Hernandez
SENATE FLOOR: 39-0, 6/2/16
AYES: Allen, Anderson, Bates, Beall, Berryhill, Block,
Cannella, De León, Fuller, Gaines, Galgiani, Glazer, Hall,
Hancock, Hernandez, Hertzberg, Hill, Hueso, Huff, Jackson,
Lara, Leno, Leyva, Liu, McGuire, Mendoza, Mitchell, Monning,
Moorlach, Morrell, Nguyen, Nielsen, Pan, Pavley, Roth, Stone,
Vidak, Wieckowski, Wolk
NO VOTE RECORDED: Runner
ASSEMBLY FLOOR: 78-0, 8/23/16 - See last page for vote
SUBJECT: Physician and Surgeon Health and Wellness Program
SOURCE: California Medical Association
DIGEST: This bill authorizes the Medical Board of California
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(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 and authorizes MBC to contract with an
independent entity to administer the PHWP.
Assembly Amendments ensure that physicians who enroll in the
PHWP are not able to avoid enforcement action for substance
abuse related offenses by allowing confidentiality of
self-referrals to be breached if an investigation of a substance
abuse offense occurs after enrollment in the Program, ensure
that entity running the Program through a contract with MBC is
able to report the physician's name for additional offenses
outlined in the Uniform Standards, and make further changes to
ensure the PHWP conforms to the Uniform Standards.
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
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
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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 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.
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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
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,
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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
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,
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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 Assembly Appropriations Committee, assuming
approximately 400 to 500 licensees will participate in the PHWP,
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 for
MBC to contract with a third-party vendor to administer PHWP.
This bill will also result in approximately $105,000 per year,
plus an additional $8,000 for the first year of funding, for
staff to set up and initiate the PHWP and then to provide
ongoing support.
SUPPORT: (Verified8/25/16)
California Medical Association (source)
California Chapter of the American College of Emergency
Physicians
California Health Advocates
California Hospital Association
California Primary Care Association
Medical Board of California
Union of American Physicians and Dentists
OPPOSITION: (Verified8/25/16)
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Center for Public Interest Law
Consumers Union's Safe Patient Project
ARGUMENTS IN SUPPORT: Supporters state 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 note that this bill will 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. MBC writes
that the PHWP proposed in this bill is not a diversion program,
will not divert physicians from discipline and notes that this
bill requires compliance with the Uniform Standards as well as
requires any participant who is terminated or withdraws from the
PHWP to be reported to MBC, very important elements to the
Board.
ARGUMENTS IN OPPOSITION: Consumers Union's Safe Patient
Project (CU SPP) is concerned that this bill wwill 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. According to the group, "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." CU SPP additionally
writes that the Program included in this bill for substance
abusing physicians should not be associated with the California
Medical Association (CMA) or with any nonprofit associated with
the CMA or with any entity associated with past administrators.
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According to CU SPP, "This 'fox guarding the chicken house'
approach led to the failed model the MBC used in the past and
should not be repeated."
ASSEMBLY FLOOR: 78-0, 8/23/16
AYES: Achadjian, Alejo, Travis Allen, Arambula, Atkins, Baker,
Bigelow, Bloom, Bonilla, Bonta, Brough, Brown, Burke,
Calderon, Campos, Chang, Chau, Chávez, Chiu, Chu, Cooley,
Cooper, Dababneh, Dahle, Daly, Dodd, Eggman, Frazier, Beth
Gaines, Gallagher, Cristina Garcia, Eduardo Garcia, Gatto,
Gipson, Gomez, Gonzalez, Gordon, Gray, Grove, Hadley, Harper,
Roger Hernández, Holden, Irwin, Jones, Jones-Sawyer, Kim,
Lackey, Levine, Linder, Lopez, Low, Maienschein, Mathis,
Mayes, McCarty, Medina, Melendez, Nazarian, Obernolte,
O'Donnell, Olsen, Patterson, Quirk, Ridley-Thomas, Rodriguez,
Salas, Santiago, Steinorth, Mark Stone, Thurmond, Wagner,
Waldron, Weber, Wilk, Williams, Wood, Rendon
NO VOTE RECORDED: Mullin, Ting
Prepared by:Sarah Mason / B., P. & E.D. / (916) 651-41048/25/16
18:00:22
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