BILL ANALYSIS
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|Hearing Date:July 29, 2009 |Bill No:AB |
| |583 |
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SENATE COMMITTEE ON BUSINESS, PROFESSIONS
AND
ECONOMIC DEVELOPMENT
Senator Gloria Negrete McLeod, Chair
Bill No: AB 583Author:Hayashi
As Amended:June 22, 2009 Fiscal: No
SUBJECT: Health care practitioners: disclosure of education and
office hours.
SUMMARY: Revises and recasts existing law to require health care
practitioners to display their license type and, except for nurses,
the highest level of academic degree on any of the following: on a
nametag, the office, or in writing given to a patient; requires a
physician, surgeon, osteopathic physician and surgeon, and doctor of
podiatric medicine who is certified in a medical specialty to disclose
his or her board certification in one of the three ways identified
above; and, requires physicians and surgeons who supervise an office
in addition to their primary practice location to post their hours in
each office.
Existing law:
1)Requires a health care practitioner to disclose, while working, his or
her name and practitioner's license status on a name tag in at least
18-point type or prominently display his or her license in his or
her office, except if a health care practitioner is in a practice or
office where their license is prominently displayed, they may opt to
not wear a name tag.
2)Makes it unlawful for health care licensees to disseminate or cause to be
disseminated any form of public communication, as defined,
containing false, fraudulent, misleading, deceptive statements, or
images, as specified, to induce the provision of services or the
rendering of a product relating to a professional practice or
business for which he or she is licensed, and provides that any
person so licensed who violates this provision is guilty of a
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misdemeanor and that such a violation shall constitute good cause
for revocation or suspension of his or her license or other
disciplinary action including an administrative fine not to exceed
$10,000.
3)Authorizes advertising by health care licensees if it includes certain
general information regarding the practitioner and requires certain
disclosures to be made regarding dentists, physicians and surgeons,
podiatrists and optometrists regarding the advertising of their
education, accreditation, certification or specialty.
4)Specifies requirements for the recognition and advertising, or claims or
statements made by dentists, physicians and surgeons, podiatrists
and optometrists regarding board certification, or recognition by an
accrediting organization, multidisciplinary board or association.
5)Defines "health care practitioner" to include any person who engages in
acts that are the subject of licensure or regulation under Division
2 of the BPC, including but not limited to: physicians, surgeons,
nurses, chiropractors, and dentists.
This bill:
1) Revises and recasts existing law to require health care
practitioners to display their license type and highest level of
academic degree in addition to their name and practitioner's license
status as specified in existing law, on either: their name tag in at
least 18-point type, in writing given to a patient at his or her
initial office visit, or in a prominent display in his or her
office.
2) States that an individual licensed under the Nurse Practice Act
is not required to disclose his or highest level of academic degree.
3) Requires that an individual licensed as a physician and
surgeon, podiatrist or osteopathic physician, who is certified by
any of the following: a) An American Board of Medical Specialties
member board; b) A board or association with equivalent requirements
approved by that person's medical licensing authority; c) A board or
association with an Accreditation Council for Graduate Medical
Education approved postgraduate training program that provides
complete training in that specialty or subspecialty, to disclose the
name of the board or association either on a name tag in at least
18-point type, in writing given to the patient on the patient's
first office visit, or in a prominent display in the office.
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4) Requires a physician and surgeon who supervises an office in
addition to his or her primary practice location to prominently
display in each of those offices a current schedule of the regular
hours when he or she will be present in that office and the office
hours during which he or she will not be present. Requires, if the
office is a part of a group practice with more than one physician
and surgeon, that the office post a current schedule of the hours
when a physician and surgeon is present in the office.
5) Exempts health care practitioners working in hospitals, as
specified and clinical laboratories from the requirement of items
#3) and #4) above.
FISCAL EFFECT: Unknown. This bill has been keyed "non-fiscal" by
Legislative Counsel.
COMMENTS:
1.Purpose. According to the Author's office, "Patients are often
confused on who exactly the health care practitioner is who is
performing treatment or giving health care advice. Patients may not
understand the educational background of a health care
practitioner." With respect to these concerns, the provisions in
this bill are meant to help educate the patient with regard to their
health care practitioners' license types and highest academic
degrees achieved.
2.Background.
2) Popularity of Plastic Surgery. The American Society of Plastic
Surgeons' (ASPS) Website states that about 12.1 million cosmetic
procedures were performed in 2008, representing a $10.3 billion
industry. ASPS indicates that the top five surgical procedures
were breast augmentation, liposuction, nose reshaping, eyelid
surgery, and tummy tuck. Moreover, ASPS points out that there
were 10.7 million minimally-invasive cosmetic procedures 2008.
The top five minimally-invasive procedures were Botox, hyaluronic
acid fillers, chemical peel, laser hair removal, and
microdermabrasion.
Recognizing the need to educate the public when considering
cosmetic surgery, the College of Physicians and Surgeons of
Ontario, Canada posted a fact sheet entitled What You Should Know
About Cosmetic Surgery to assist consumers to make an informed
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decision. The fact sheet included an explanation of the
different kinds of doctors who provide services, the various
issues that consumers should be aware of when considering
cosmetic surgery, and a list of questions to ask before making a
decision about having cosmetic surgery. This bill includes a
provision requiring MBC to also post on its Website a fact sheet
for consumers.
2) Prior Efforts Dealing with Cosmetic Surgery Practices. In
California, cosmetic surgery can be performed by any licensed
physician; from a plastic surgeon to a pediatrician. Many
physicians, who may or may not be trained in cosmetic procedures,
are conducting increasingly complex procedures in settings
outside of hospitals such as outpatient surgery centers and
doctors' offices. It is also common for doctors performing
complex cosmetic surgeries to receive their only training from
weekend courses or instructional videos. Currently, there are no
uniform standards for physician training related to cosmetic
surgery, and the regulation of outpatient settings in which these
surgeries occur need to be strengthened to ensure public safety.
The Legislature attempted to regulate the practice of cosmetic
surgery in previous years with the introduction of several bills
including:
2) SB 1423 (Figueroa, Chapter 873, Statutes of 2006) required
MBC in conjunction with the BRN to promulgate regulations on or
before January 1, 2009 to implement changes relating to the use
of laser or intense pulse light devices for cosmetic procedures
by physicians and surgeons, nurses, and physician assistants.
2) SB 835 (Figueroa, 1999) would have enacted the Cosmetic
Surgery Patient Disclosure Act, which would have required
physicians who perform cosmetic surgery, as defined, to provide
MBC with specified information, including training, board
certifications, and number of procedures performed, and
requires MBC to make this information available to the public
upon request and post the information on the Internet. SB 835
was vetoed by then Governor Davis who indicated that the
methods prescribed by the measure were unduly burdensome.
2) SB 836 (Figueroa, Chapter 856, Statutes of 1999) expanded
and revised the prohibition against fraudulent advertising by
health practitioners.
2) SB 837 (Figueroa, 1999) would have required cosmetic
surgery procedures to be performed in a licensed acute care
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hospital or in a licensed or accredited outpatient surgery
setting. SB 837 died in the Assembly Appropriations Committee.
2) SB 1454 (Ridley-Thomas) Required for purposes of
advertising that a health care practitioner, provide the type
of license under which the licensee is practicing and the type
of degree received upon graduation from professional training
and that a health care practitioner who is practicing in an
outpatient setting, as defined, wear a name tag which includes
his or her name and their license status. Required MBC to
adopt regulations on the appropriate level of physician
supervision necessary within clinics using laser or intense
pulse light devices for elective cosmetic surgery, and that MBC
establish as one of its priorities the investigation of
unlicensed activity within such clinics. SB 1454 died on the
Assembly Floor.
3.Support If Amended. The Medical Board of California , while in
support of the disclosure requirements of this bill, feels that a
more specific description of what is meant by "prominent display" of
the supervising physician's office hours must be outlined in the
bill. Furthermore, the Board argues, "The posting of the Website of
the practitioners' licensing boards is important or at a minimum the
name of the Boards that license the heath care practitioners working
in the office."
4.Arguments in Support. The California Society of Plastic Surgeons
(CSPS) states that oftentimes patients consult with their member
physicians and surgeons after receiving what the patient believes is
a poor outcome. When patients learn that they were treated by a
non-physician or a physician not board certified in plastic surgery
they are surprised. CSPS points out that patients are confused with
the numerous varieties of health care practitioners currently
performing medical procedures. CSPS states that the public is
better served and protected if they are more educated and informed
about each health care professional that may treat them.
Furthermore, the California Medical Association (CMA ) points out
that this will help patients better understand the credentials of
their healthcare practitioners prior to receiving treatment. CMA
also believes that by disclosing their license status and highest
level of degree received, this bill will provide for the truthful
exchange of information between patients and providers. CMA
indicates that the provisions requiring physicians who supervise
more than one office location to post the hours they are present at
each office is said to inform the patients of the availability of
physicians and whether they are being treated by other non-physician
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or midlevel healthcare practitioners.
5.Oppose Unless Amended. The Respiratory Care Board of California
argues that the proposed requirement to disclose the highest level
of academic degree is onerous and unnecessary and has potential to
cause confusion among patients. Further, it is concern that
implementing this requirement for over 16,000 respiratory care
practitioners in the state will be difficult for some employees. It
is requesting an exemption from this requirement, similar to those
provided to nurses.
6.Technical Amendment. On page 2 line 8: "patent's" should read
"patient's".
SUPPORT AND OPPOSITION:
Support:
California Society of Plastic Surgeons Inc (Co-Sponsor)
California Medical Association (Co-Sponsor)
California Psychiatric Association
California Senior Legislature
Association of Northern California Oncologists
Support if Amended:
Medical Board of California
Oppose Unless Amended:
Respiratory Care Board of California
Consultant:Yuliya Zeynalova