BILL ANALYSIS
SB 1456
Page 1
SENATE THIRD READING
SB 1456 (Kuehl)
As Amended August 23, 2004
Majority vote
SENATE VOTE : Vote not Relevant
ENVIRONMENTAL SAFETY 5-2
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|Ayes:|Laird, Chu, Levine, |
| |Lowenthal, Hancock |
| | |
|-----+--------------------------|
|Nays:|Aghazarian, Leslie |
| | |
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SUMMARY : Clarifies the medical staff's right of self-governance
and makes various findings and declarations. Specifically, this
bill :
1)Requires the medical staff's right of self-governance to
include, but not be limited to, all of the following:
a) Establishing in medical bylaws, rules or regulation,
criteria and standards consistent with the medical peer
review process, for medical staff membership and
privileges;
b) Establishing in medical staff bylaws, rules or
regulations, clinical criteria and standards to oversee and
manage quality assurance, utilization review, and other
medical staff activities including, but not limited to,
periodic meetings of the medical staff and its committees
and departments and review and analysis of patient medical
records;
c) Selecting and removing medical staff officers;
d) Assessing medical staff dues and utilizing the medical
staff dues as appropriate for the purposes of the medical
staff;
e) The ability to retain and be represented by independent
legal counsel at the expense of the medical staff, provided
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that medical staff at the University of California have the
right to retain and be represented by independent legal
counsel at the expense of the medical staff upon approval
by the Regents of the University of California or their
designee in accordance with the bylaws of the Regents,
which approval shall not be unreasonably denied; and,
f) Initiating, developing, and adopting medical staff
bylaws, rules and regulation, and amendments thereto,
subject to approval of the hospital governing board, which
approval shall not be unreasonably withheld.
2)Prohibits the medical bylaws from interfering with the
independent rights of the medical staff to do any of the
following, but requires the procedures for:
a) Selecting and removing medical staff officers;
b) Assessing medical staff dues and utilizing medical staff
dues as appropriate for the purposes of the medical staff;
and,
c) The ability to retain and be represented by independent
legal counsel at the expense of the medical staff.
3)Requires, that with respect to any dispute arising, the
medical staff and hospital governing board to meet and confer
in good faith to resolve the dispute. Allows a superior court
of any county to issue an injunction, writ of mandate, or
other appropriate order whenever a person or entity has
engaged in or is about to engage in any acts or practices that
hinder, restrict, or otherwise obstruct the ability of the
medical staff to exercise its rights, obligations, or
responsibilities, as specified.
4)Makes legislative findings and declarations on the following:
a) That providing quality medical care in hospitals depends
on the mutual accountability, interdependence, and
responsibility, of the medical staff and the hospital
governing body for the proper performance of their
respective obligations;
b) That the governing board of a hospital must act to
protect the quality of medical care provided and the
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competency of its medical staff, and the responsible
governance of the hospital in the event that the medical
staff fails in any of its substantive duties or
responsibilities, and nothing in this bill undermines their
authority. The final authority of the hospital governing
board may be exercised for the responsible governance of
the hospital or for the conduct of the business affairs of
the hospital but such final authority may only be exercised
with a reasonable and good faith belief that the medical
staff has failed to fulfill a substantive duty or
responsibility in matters pertaining to the quality of
patient care. Specifies that it would be a violation of
the medical staff's self-governance and independent rights
for the hospital governing board to assume a duty or
responsibility of the medical staff precipitously,
unreasonably, or in bad faith; and,
c) That the specific actions that would constitute bad
faith or unreasonable action on the part of either the
medical staff, or hospital governing board will always be
fact specific and cannot be precisely described in statute,
and that the provisions set forth herein do nothing more
than provide for the basic independent rights and
responsibilities of a self-governing medical staff.
Specifies that a successful relationship between a
hospital's medical staff and governing board depends on the
mutual respect for the rights and responsibilities of the
other.
5)Makes the bill's enactment contingent on the passage of SB
1325.
EXISTING LAW :
1)Provides for the licensing and regulation of physicians and
surgeons by the Medical Board of California in the Department
of Consumer Affairs.
2)Requires a licensed general or specialized hospital with five
or more physicians on its medical staff to have rules adopted
by its board of directors to govern the operation of the
hospital, and the rules to include the following:
a) Provision for the organization of licensed physicians
within the hospital into a formal medical staff with
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appropriate officers and bylaws, and with staff
appointments on an annual or biennial basis;
b) Provision that membership on the medical staff shall be
restricted to physicians and other licensed practitioners
competent in their respective fields and worthy in
professional ethics. Prohibits the division of profits
from professional fees and such division is cause for
exclusion from the staff;
c) Provision that the medical staff is self-governing with
respect to the professional work performed in the hospital;
that the medical staff meet periodically and review and
analyze at regular intervals their clinical experience; and
the medical records of patients to be the basis for such
review and analysis; and,
d) Provision that adequate and accurate medical records be
prepared and maintained for all patients.
3)Requires a licensed general or specialized hospital, having
less than five physicians on its medical staff to have rules
adopted by its board of directors to govern the operation of
the hospital, and the rules to include the following
provisions:
a) That membership on the medical staff shall be restricted
to physicians and other licensed practitioners competent in
their respective fields and worthy in professional ethics.
Division of profits from professional fees in any manner is
prohibited and any such division is cause for exclusion
from the staff; and,
b) That adequate and accurate medical records be prepared
and maintained for all patients.
4)States that it is unprofessional conduct if the rules for the
medical staff and hospital are not adopted.
FISCAL EFFECT : According to the Assembly Appropriations
Committee staff, this bill will have minor, if any, state costs.
COMMENTS : This bill is substantially similar to the provisions
of SB 1325 (Kuehl), pending with the Governor, but includes
clarifying amendments dealing with the medical staff of
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University of California (UC) hospitals. The amendments
indicate that UC medical staff's right to retain and be
represented by independent legal counsel must be approved by the
Regents of the UC or its designee in accordance with the bylaws
of the Regents. UC believes these amendments are necessary to
address the unique relationship between the University and its
faculty physicians and make this bill consistent with the bylaws
governing the University. UC specifies that its faculty
physicians enjoy certain rights and privileges that are not
common to other medical staff including access to legal counsel
under the UC Regents' Bylaws and Standing Orders, the provision
of medical malpractice insurance, and benefit of internal
grievance processes designed to address and resolve quality
issues and concerns. Without the amendments, the provisions of
the SB 1325 would have an adverse impact on the relationship of
faculty physicians and the UC Board of Regents or its designees.
Analysis Prepared by : Rosielyn Pulmano / HEALTH / (916)
319-2097
FN: 0008644