BILL ANALYSIS
Senate Appropriations Committee Fiscal Summary
Senator Christine Kehoe, Chair
526 (Fuentes)
Hearing Date: 8/24/2009 Amended: 8/19/2009
Consultant: Bob Franzoia Policy Vote: B&P 6-2
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BILL SUMMARY: AB 526 would enact the Public Protection and
Physician Health Program Act of 2009, which would, until January
1, 2021, establish the 12-14 member Physician Health Oversight
Committee. This committee would be required to hold its first
meeting by March 1, 2010 and to adopt rules and regulations by
June 30, 2010. This bill would authorize the committee to
contract with any qualified physician health program for
purposes of care and rehabilitation of physicians with alcohol
or drug abuse or dependency problems or mental disorders. This
bill would impose requirements on the program including
monitoring the status and compliance of physicians who enter
treatment for a qualifying illness pursuant to written voluntary
agreements, and would require the committee to monitor
compliance with these requirements. This bill would provide
that a voluntary agreement to receive treatment would not be
subject to public disclosure or disclosure to the Medical Board
of California (MBC), except as specified. This bill would
require the MBC to increase physician and applicant licensure
and renewal fees and would establish the Public Protection and
Physician Health Program Trust Fund, which would be available
upon appropriation.
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Fiscal Impact (in thousands)
Major Provisions 2009-10 2010-11 2011-12 Fund
Public Protection and
Physician Health Program $1,200 to $1,400* annually,
likely more Special**
- fee revenue Up to $250*** ($1,375)
($1,375)Special**
* Fiscal year cost estimate based on previous MBC diversion
program which sunset June 30, 2008; audit information indicates
that program was underfunded
** Public Protection and Physician Health Program Trust Fund
established by this bill
*** Estimated contract startup costs; unknown fund source,
likely a private loan
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STAFF COMMENTS: This bill meets the criteria for referral to the
Suspense File.
The MBC diversion program was created in 1980 with the intent
"that the Medical Board of California seek ways and means to
identify and rehabilitate physicians and surgeons with
impairment due to abuse of dangerous drugs or alcohol, or due to
mental illness or physical illness, affecting competency so that
physicians and surgeons so afflicted may be treated and returned
to the practice of medicine in a manner which will not endanger
the public health and safety."
Although the enabling language made reference to physicians with
mental or physical
illness, the diversion program had been structured to monitor
substance-abusing physicians. Participants in the diversion
program included physicians who voluntarily
sought help (self referrals), physicians who were referred by
the MBC's enforcement
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AB 526 (Fuentes)
program during investigation of a complaint (board-referred),
and physicians who were
ordered to participate by MBC's Division of Medical Quality
(DMQ) as a term of probation in a formal disciplinary order
(board-ordered). Each participant was required to enter into a
contract with the program and agree to abstain from the use of
drugs and alcohol, submit to random bodily fluids testing,
attend support group meetings with similarly impaired
physicians, undergo psychotherapy and/or substance abuse
treatment, retain a "worksite monitor," and cease practicing
medicine if so instructed by the program due to relapse or other
noncompliance with the terms of the contract.
Twelve MBC staff administered the program. Although several of
the program's components (including bodily fluids collection,
laboratory testing, and facilitation of support group meetings)
were contracted, the case management function of the program and
program administration were performed by the MBC at $1,200,000
to $1,400,000 annually and paid through licensing fees paid by
all California physicians. As of June 30, 2005, 232 physicians
were participating in the program though participation was near
300 at one time.
Each of five audits found the program was not adequately
monitoring participants though the MBC implemented
recommendations of the auditor each time. After the June 2007
Bureau of State Audits report, the MBC voted not to support
continuation of the program. This program sunset on July 1,
2008 and was repealed on January 1, 2009.
For this bill, the 12-14 member committee (participation by the
California Psychiatric Association and its two selected members
is optional) would be required to adopt any rules and
regulations to implement the provisions of this bill. The rules
and regulations shall include appropriate minimum standards and
requirements for referral to treatment, and monitoring of
participants in the program. The committee may contract with an
entity meeting minimum standards and requirements on an interim
basis prior to the adoption of rules and regulations. Costs to
develop rules and regulations, to contract, and to provide
initial outreach are unknown, but are likely significant.
This bill would increase the biennial renewal fee of a
physician's certificate by $22 or an amount equal to 2.5 percent
of this same fee as set in Business and Professions Code 2435,
whichever is greater. (The fee in statute is $790; 2.5 percent
would be $19.75.) All costs of the committee and the program
shall be paid out of the revenue collected by this fee. It is
unlikely the MBC would begin collecting this fee prior to July
1, 2010 when rules and regulations are to have been adopted.
Staff notes that while the funds in the Public Protection and
Physician Health Program Trust Fund, as created by this bill,
would be available upon appropriation by the Legislature, the
appropriation appears to be the only oversight of the program.
No state regulatory agency is provided an oversight role.