BILL ANALYSIS
AB 501
Page 1
ASSEMBLY THIRD READING
AB 501 (Emmerson)
As Amended April 13, 2009
Majority vote
BUSINESS & PROFESSIONS 11-0APPROPRIATIONS 16-0
-----------------------------------------------------------------
|Ayes:|Hayashi, Emmerson, |Ayes:|De Leon, Nielsen, |
| |Conway, Eng, Hernandez, | |Ammiano, |
| |Nava, Niello, | |Charles Calderon, Davis, |
| |John A. Perez, Price, | |Duvall, Fuentes, Hall, |
| |Ruskin, Smyth | |Harkey, Miller, |
| | | |John A. Perez, Price, |
| | | |Skinner, Solorio, Audra |
| | | |Strickland, Torlakson |
|-----+--------------------------+-----+--------------------------|
| | | | |
-----------------------------------------------------------------
SUMMARY : Permits the Medical Board of California (MBC) 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 to the physician and surgeon license fee cap and
to the Contingent Fund (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
AB 501
Page 2
"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,
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 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.
FISCAL EFFECT : According to the Assembly Appropriations
Committee:
1)No direct fiscal impact to authorize counselors meeting
specified oversight, training, and supervisory requirements to
conduct rapid HIV testing via skin punctures.
2)Minor savings to the extent rapid skin tests become less
administratively burdensome and costly to employers who are
required to provide approximately $2,500 in training per
employee to meet current phlebotomy training requirements.
3)Minor savings in testing costs to the extent this bill results
in a shift from a more expensive oral swab test ($12) to a
less expensive skin puncture test ($7). Due to recent budget
cuts, the statewide budget for HIV testing has been reduced
from $10.4 million to $9.8 million. This bill helps ensure
more people are tested with fewer resources.
4)Major potential savings per 10 infections prevented. $3
million in public savings will accrue to the extent this bill
results in informing 10 additional HIV-positive individuals of
AB 501
Page 3
their status who would otherwise not be tested. This estimate
assumes a $300,000 cumulative lifetime savings per individual
as quantified by research. Research indicates many HIV
positive individuals, once informed of their status, make
behavior changes that reduce transmission of the virus.
COMMENTS : Current law does not allow the MBC to issue an
initial limited medical license; however, the 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.
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."
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 SA 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
AB 501
Page 4
physicians' license fees to maintain its fund balance at or near
the mandated level. AB 547 (Ma) of 2008 included this language,
but Governor Schwarzenegger 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 re-establishment 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.
Analysis Prepared by : Sarah Huchel / B. & P. / (916) 319-3301
FN: 0000574