BILL ANALYSIS
AB 501
Page 1
Date of Hearing: April 21, 2009
ASSEMBLY COMMITTEE ON BUSINESS AND PROFESSIONS
Mary Hayashi, Chair
AB 501 (Emmerson) - As Amended: April 13, 2009
SUBJECT : Physicians and surgeons.
SUMMARY : Permits the Medical Board of California to issue a
limited license to an applicant for a physician and surgeon's
license, sets the terms of use of the title "Dr." and "M.D.,"
makes changes the physician and surgeon license fee cap and to
the Contingent Fund, and requests a financial audit of the MBC.
Specifically, this bill :
1)Permits the MBC to issue a limited license to an applicant for
a physician and surgeon's license who is otherwise eligible
for that license but is unable to practice some aspects of
medicine safely due to a disability.
2)Permits the MBC to require the applicant for the limited
license to obtain an independent clinical evaluation of his or
her ability to practice medicine safely as a condition of
receiving a limited license.
3)Requires the applicant to pay the initial license fee and sign
an agreement in which the applicant agrees to limit his or her
practice in the manner prescribed by the reviewing physician
and agreed to by the MBC.
4)Permits a graduate of an approved medical school who is
enrolled in an approved postgraduate training program to use
the words "doctor" or "physician," the letters or prefix
"Dr.," or the initials "M.D." while under instruction and
under the supervision of a licensed physician and surgeon at
that postgraduate training program.
5)Permits a graduate of an approved medical school who does not
have a valid, unrevoked, and unsuspended certificate as a
physician and surgeon to use the initials "M.D." as long as he
or she does not:
a) Imply that he or she is a physician and surgeon or
entitled to practice medicine in California; or,
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b) Represent him or herself as a physician and surgeon.
6)Establishes a cap on the MBC's licensing fee.
7)Increases the amount of reserve allowed in the MBC's
Contingent Fund (fund) from two months' to up to four months'
operating expenditures.
8)Requires an audit of the MBC's financial status by January 1,
2012, funded from existing resources.
EXISTING LAW :
1)Provides for the licensure and regulation of physicians and
surgeons by the MBC.
2)Authorizes the MBC to issue a probationary license subject to
specified terms and conditions, including restrictions against
engaging in certain types of medical practice.
FISCAL EFFECT : Unknown
COMMENTS :
Purpose of this bill . According to the author's office, "This
bill is needed to allow the MBC to issue a limited license to an
applicant who is otherwise eligible for a medical license in
California but is unable to practice all aspects of medicine
safely due to a disability.
"Currently the law requires the [licensing] fee to be exactly
$790, leaving the MBC without the option to lower the fee when
needed in order to comply with the limits on the reserve allowed
in the fund?. The fee cap would allow the MBC to adjust the fee
as needed.
"The current two month limit on the fund is rigid in that it
limits the MBC's ability to implement programs. A reserve fund
of two to four months would allow more room to effectively
maintain compatibility with the state audit while also allowing
the MBC to implement programs as necessary."
Background - Limited license : Current law does not allow the
MBC to issue an initial limited medical license; however, the
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MBC may issue an initial probationary license with restrictions
against engaging in certain types of practice. Probation is a
disciplinary action, usually done when a doctor is negligent and
harms a patient. This type of license is an administrative
action that occurs at the point when a license is issued, when
physicians have conditions impairing their ability to practice
safely but the board doesn't have evidence to deny their
applications. A limited license, as authorized by this bill,
would not have disciplinary associations.
In 2008, the Bakersfield Californian wrote an article about Dr.
John Melville, a board certified physician in pediatrics and
internal medicine who could not work in California because of
his cerebral palsy. As a member of the National Health Service
Corps, a federal program that sends doctors to underserved areas
in exchange for paying for college, he tried getting a job in
rural Kern County, but the MBC would not grant him an
unrestricted license to practice because of his disability.
"When he walks, he limps slightly and stumbles. His words come
out slurred and louder than he intends. His hands jerk, contort.
Melville recognizes his limitations and voluntarily refrains
from procedures involving sharp objects, like administering
injections and IV medication, he said.
"'If a physician has a condition impairing his/her ability to
practice medicine safely without sufficient evidence to deny the
application, a probationary license may be issued,' an MBC
spokesman said. While Melville could be given a probationary
license, not probation, which would still be reported on the
board's Web site and to the National Practitioner Data Bank, a
resource used in background investigations.
Although the MBC does not have the authority to issue a limited
medical license, it can limit a license of an existing licensee.
"Five California physicians have active licenses with voluntary
limitations on practice," an MBC spokesman said. "Board staff
couldn't recall a single instance when a physician harmed a
patient because of a disability."
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Background - Fee cap, Contingent Fund, and audit : Current law
requires the MBC to maintain a fund balance that would cover
expenditures for approximately two months. According to a 2007
State Auditor (SA) report, for fiscal years 2003-04 through
2005-06, the MBC maintained year-end fund balances that covered
2.4 to 3.3 months of the next year's estimated expenditures.
However, in fiscal year 2006-07 the fund balance grew by $6.3
million to $18.5 million, enough to cover 4.3 months of
expenditures, and as of June 30, 2008, the MBC's fund had grown
to $23.9 million, or 5.6 months, of reserves.
The State Auditor issued a report in October 2007 that
recommended the MBC seek a legislative amendment to Section 2435
of the code to include language that allows it the flexibility
to adjust physicians' license fees to maintain its fund balance
at or near the mandated level. AB 547 (Ma) of 2008 included
this language, but the Governor vetoed the bill.
Prior to passage of Senate Bill 231 (Figueroa, Chapter 674,
Statutes 2005), the MBC had the flexibility of setting a fee
within the cap set by law to ensure the MBC's fund condition
remained near the stated guidelines. This bill would reinstate
the MBC's ability to manage these fees. In tandem, the MBC is
seeking to increase its fund authority to four months' operating
expenditures, which may limit the necessity of adjusting fees
downward. Further, most Department of Consumer Affairs boards
are required to maintain a 24 month reserve, placing the MBC at
the lowest end of the fund spectrum. The MBC asserts that it
needs an increased fund balance to manage significant upcoming
expenses, including the reestablishment or expansion of several
programs, replacing its information technology infrastructure,
and managing its office expenses related to its recent
relocation.
The MBC is requesting an audit to ensure its licensees that it
is managing its funds appropriately.
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Previous legislation . AB 547 (Ma) of 2008 included language
giving the medical board the flexibility to set initial
licensing and renewal fees up to a maximum of $790. The
Governor vetoed a substantial number of bills that year with the
same message that, due to the delay in passing the 2008-2009
State Budget, he would only sign bills that were "the highest
priority for California." AB 547 was vetoed for this reason.
REGISTERED SUPPORT / OPPOSITION :
Support
Medical Board of California (sponsor)
Opposition
None on file.
Analysis Prepared by : Sarah Huchel / B. & P. / (916) 319-3301