BILL ANALYSIS                                                                                                                                                                                                    



                                                                       



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                                 THIRD READING


          Bill No:  AB 501
          Author:   Emmerson (R)
          Amended:  05/26/09 in Assembly
          Vote:     21

           
           SENATE BUS., PROF. & ECON. DEV. COMMITTEE  :  10-0, 6/29/09
          AYES:  Negrete McLeod, Wyland, Aanestad, Corbett, Correa,  
            Florez, Oropeza, Romero, Walters, Yee

           SENATE APPROPRIATIONS COMMITTEE  :  11-0, 7/6/09
          AYES:  Kehoe, Cox, Corbett, Hancock, Leno, Price, Runner,  
            Walters, Wolk, Wyland, Yee
          NO VOTE RECORDED:  Denham, Oropeza

           ASSEMBLY FLOOR  :  80-0, 5/28/09 - See last page for vote


           SUBJECT  :    Physicians and surgeons

           SOURCE  :     Medical Board of California


           DIGEST  :    This bill authorizes certain persons who are not  
          licensed physicians and surgeons under the Medical Practice  
          Act to use the words Doctor or physician, the letters or  
          prefix "Dr." or the initials "M.D." as specified, and  
          states that an applicant for a physician's and surgeons'  
          license who is otherwise eligible for that license, but is  
          unable to practice some aspects of medicine safely due to a  
          disability, may receive a limited license.  In addition,  
          this bill requires, no later than January 1, 2012, the  
          Bureau of State Audits to commence a review of the Medical  
                                                           CONTINUED





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          Board of California (MBC's) financial status and the impact  
          of the loan from the Contingent Fund of the MBC to the  
          General Fund made pursuant to the Budget Act of 2008.

           ANALYSIS  :    

          Existing law:

          1. Establishes MBC to license, regulate, and discipline  
             physicians and surgeons, and specifies that the  
             protection of the public is the highest priority of MBC.

          2. Requires MBC to assess licensure and renewal fees on  
             physicians and surgeons.

          3. Specifies that the initial license fee is $790 and the  
             biennial renewal fee is $790, and   allows MBC to  
             increase the amount of the license and the biennial  
             renewal fee under specified conditions.

          4. Requires MBC to maintain a reserve in the Contingent  
             Fund of MBC equal to approximately two months' operating  
             expenditures.

          5. Requires that any person who uses in any sign, business  
             card, or letterhead, or in an advertisement, the words  
             "Doctor" or "physician," the letters or prefix "Dr.,"   
             the initials "M.D.," or any other terms or letters  
             indicating or implying that he or she is a physician and  
             surgeon, physician, surgeon or practitioner, as  
             specified, or that he or she is entitled to practice  
             under the Medical Practice Act, or who represents or  
             holds himself or herself out as a physician and surgeon,  
             physician, surgeon, or practitioner, without a valid,  
             unrevoked, and unsuspended certificate as a physician  
             and surgeon under this chapter is guilty of a  
             misdemeanor.

          6. Requires MBC to assess licensure and renewal fees on  
             physicians and surgeons.

          7. Specifies that the initial license fee is $790 and the  
             biennial renewal fee is $790, and   allows MBC to  
             increase the amount of the license and the biennial  







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             renewal fee in specified conditions.

          8. Requires MBC to maintain a reserve in the Contingent  
             Fund of MBC equal to approximately two months' operating  
             expenditures.

          This bill:

          1. Revises existing law allowing specific persons to use  
             the words "doctor" or physician, the letters of prefix  
             "Dr." or the initials "M.D." if they have graduated from  
             a medical school approved or recognized by MBC and are  
             enrolled in a postgraduate training program approved by  
             MBC.

          2. Allows a graduate of a medical school who does not have  
             a certificate as a physician and surgeon to use the  
             designations in item #1) above if all of the following  
             requirements are met:

             A.    If issued a license to practice medicine in  
                another jurisdiction, but has not had that license  
                revoked or suspended by any jurisdiction.

             B.    Does not otherwise hold himself or herself out  
                as a physician and surgeon entitled to practice  
                medicine in this state except to the extent  
                authorized.

             C.    Does not engage in any of prohibited acts as  
                specified.

          3. States that an applicant for a physician's 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, may receive a limited license if he  
             or she does both of the following:

             A.    Pays the initial license fee.

             B.    Signs an agreement on a form prescribed by MBC,  
                under penalty of perjury, in which the applicant  
                agrees to limit his or her practice in a manner  
                prescribed by the reviewing physician and agreed to  







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                by MBC.

          4. Allows MBC to require the applicant described above to  
             obtain an independent clinical evaluation of his or her  
             ability to practice medicine safely as a condition of  
             receiving a limited license.

          5. Requires MBC to fix the licensing fees for physicians  
             and surgeons, and not to exceed $790.

          6. Clarifies the intent of the Legislature that the reserve  
             that must be maintained by MBC in its Contingent Fund be  
             in an amount no less than two nor more than four months'  
             operating expenditures.

          7. Requires, no later than January 1, 2012, the Bureau of  
             State Audits (BSA) to commence a review of MBC's  
             financial status and the impact of the loan from the  
             Contingent Fund of MBC to the General Fund made pursuant  
             to the Budget Act of 2008.

          8. Requires the BSA to report its findings and declarations  
             to the Joint Legislative Audit Committee on June 1,  
             2012, and requires this review to be funded from the  
             existing resources of MBC during the 2011-2012 fiscal  
             year.

           Background
           
           Use of the term Doctor or "Dr  ."  This bill allows a  
          graduate of a medical school approved or recognized by the  
          MBC, while enrolled in a postgraduate training program  
          approved by MBC, or a graduate of a medical school who does  
          not have a certificate as a physician and surgeon, if  
          certain conditions are met, to use the designations Doctor  
          or "Dr."  Current law limits the use of Doctor or "Dr." and  
          indicates that any person who uses in any sign, business  
          card or letterhead, or in an advertisement, the words  
          "doctor" or "physician," the letters or prefix "Dr." the  
          initials "M.D." or any other terms or letters indicating or  
          implying that he/she is a physician and surgeon, physician,  
          surgeon, or practitioner under the terms of this or any  
          other law, or that he or she is entitled to practice  
          hereunder, or who represents or holds himself or herself  







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          out as a physician and surgeon, physician, surgeon or  
          practitioner under the Medical Practice Act, without having  
          at the time of so doing a valid, unrevoked, and unsuspended  
          certificate as a physician and surgeon, is guilty of a  
          misdemeanor.  Aside from physician and surgeons, existing  
          law has created certain limitations on the use of the term  
          "doctor" or "Dr" for the following practitioners: holders  
          of a certificate to practice podiatric medicine, holders of  
          a doctoral degree in physical therapy, naturopathic  
          doctors, holders of doctoral degree in acupuncture, doctor  
          of chiropractic medicine, dentists, and optometrists.

           Licensure fees  .  Existing law requires MBC to assess  
          licensure and renewal fees on physicians and surgeons, and  
          specifies that the initial license fee is $790 and the  
          biennial renewal fee is $790.  Currently, MBC assesses  
          physicians and surgeons $830 but effective July 1, 2009,  
          these fees will go down to $805.  This reduction reflects  
          the elimination of the physician diversion program.   
          According to the MBC, capping the fees at $790 as provided  
          in this bill will allow it to lower fees when necessary.

           FISCAL EFFECT  :    Appropriation:  No   Fiscal Com.:  Yes    
          Local:  Yes

          According to the Senate Appropriations Committee:

                          Fiscal Impact (in thousands)

           Major Provisions                     2009-10     2010-11     
           2011-12          Fund  

          Felony (penalty of perjury)Unknown, up to $23-$36* per year  
            General
                                   per conviction

          Audit                             Up to $100 in 2011-12      
          Special**

          *$23 is the Legislative Analyst Office estimate of the cost  
          to house an inmate for one year, $36 is the California  
          Department of Corrections and Rehabilitation estimate.

          **Contingent Fund of the Medical Board of California







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           SUPPORT  :   (Verified  7/7/09)

          Medical Board of California (source)
          Loma Linda University School of Medicine
          Stanford School of Medicine
          University of California
          University of Southern California


           ARGUMENTS IN SUPPORT  :    According to the Medical Board of  
          California, the sponsor of this bill, it currently does not  
          have the authority to issue an initial limited medical  
          license.  MBC states that although it is authorized to  
          limit a license of an existing licensee, it does not have  
          that same authority for doctors who come from out of state.  
           This bill is intended to allow the various individuals who  
          are not eligible for a full medical license but can  
          practice safely with a limited license to be issued an  
          initial limited license.  Furthermore, this bill  
          establishes a cap on the licensing fees and allows MBC to  
          lower the fees when necessary.


           ASSEMBLY FLOOR  : 
          AYES:  Adams, Ammiano, Anderson, Arambula, Beall, Bill  
            Berryhill, Tom Berryhill, Blakeslee, Block, Blumenfield,  
            Brownley, Buchanan, Caballero, Charles Calderon, Carter,  
            Chesbro, Conway, Cook, Coto, Davis, De La Torre, De Leon,  
            DeVore, Duvall, Emmerson, Eng, Evans, Feuer, Fletcher,  
            Fong, Fuentes, Fuller, Furutani, Gaines, Galgiani,  
            Garrick, Gilmore, Hagman, Hall, Harkey, Hayashi,  
            Hernandez, Hill, Huber, Huffman, Jeffries, Jones, Knight,  
            Krekorian, Lieu, Logue, Bonnie Lowenthal, Ma, Mendoza,  
            Miller, Monning, Nava, Nestande, Niello, Nielsen, John A.  
            Perez, V. Manuel Perez, Portantino, Price, Ruskin, Salas,  
            Saldana, Silva, Skinner, Smyth, Solorio, Audra  
            Strickland, Swanson, Torlakson, Torres, Torrico, Tran,  
            Villines, Yamada, Bass


          JJA:do  7/7/09   Senate Floor Analyses 

                         SUPPORT/OPPOSITION:  SEE ABOVE







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