BILL NUMBER: AB 646	AMENDED
	BILL TEXT

	AMENDED IN ASSEMBLY  MAY 5, 2009
	AMENDED IN ASSEMBLY  APRIL 13, 2009

INTRODUCED BY   Assembly Member Swanson
   (Coauthors: Assembly Members Beall, Buchanan, Chesbro, Coto, De
Leon,  Evans,  Fong, Fuentes,  Furutani,  Hall,
Jeffries, Lieu, Bonnie Lowenthal, Ma, Mendoza, Nava, Portantino,
Price,  Ruskin,  Salas, Skinner, and Torres)
   (Coauthors: Senators DeSaulnier and Wiggins)

                        FEBRUARY 25, 2009

   An act to amend Section 2401 of, and to repeal Section 2401.1 of,
the Business and Professions Code, relating to healing arts.


	LEGISLATIVE COUNSEL'S DIGEST


   AB 646, as amended, Swanson. Physicians and surgeons: employment.
   Existing law, the Medical Practice Act, restricts the employment
of licensed physicians and surgeons and podiatrists by a corporation
or other artificial legal entity, subject to specified exemptions,
and makes it a crime to practice medicine without a license. Existing
law establishes  ,  until January 1, 2011, a pilot project
to allow qualified district hospitals that, among other things,
provide more than 50 percent of patient days to the care of Medicare,
Medi-Cal, and uninsured patients, to employ a physician and surgeon,
if the hospital does not interfere with, control, or otherwise
direct the professional judgment of the physician and surgeon. The
pilot project authorizes the direct employment of a total of 20
physicians and surgeons by those hospitals to provide medically
necessary services in rural and medically underserved communities,
and specifies that each qualified district hospital may employ up to
2 physicians and surgeons, subject to specified requirements.
   This bill would delete  the   that 
pilot project  , and would instead authorize a
health care district, as defined,  or a public or an
independent community nonprofit hospital or clinic located in a
medically underserved area, as specified,  to employ
physicians and surgeons if  specified requirements are met
and the district, hospital, or clinic does not interfere with,
control, or otherwise direct the professional judgment of a physician
and surgeon   the health care district's service area
includes a Medically Underserved Area (MUA) or a Medically
Underserved Population (MUP), or has been federally designated as a
Health Professional Shortage Area (HPSA); and the chief executive
officer of the district provides specified documentation to the
Medical Board of California. Upon receipt of that documentation, the
bill would require the board to approve the employment of up to 5
primary or specialty care physicians and surgeons by the district,
and, upon receipt of additional documentation after that employment,
to approve an additional 5 primary or specialty care physicians and
surgeons. The bill would provide that a district may, until December
31, 2020, enter into, renew, or extend any employment contract with a
physician and surgeon for up to 10 years. The bill would require the
Office of Statewide Health Planning and Development, in consultation
with the State Department of Public Health and the board, to report
to the Legislature by June 1, 2018,   with regard to the
efficacy of the employment of physicians and surgeons by health care
districts, as specified  .
   Vote: majority. Appropriation: no. Fiscal committee:  no
  yes  . State-mandated local program: no.


THE PEOPLE OF THE STATE OF CALIFORNIA DO ENACT AS FOLLOWS:

  SECTION 1.  Section 2401 of the Business and Professions Code is
amended to read:
   2401.  (a) Notwithstanding Section 2400, a clinic operated
primarily for the purpose of medical education by a public or private
nonprofit university medical school, which is approved by the
Division of Licensing or the Osteopathic Medical Board of California,
may charge for professional services rendered to teaching patients
by licensees who hold academic appointments on the faculty of the
university, if the charges are approved by the physician and surgeon
in whose name the charges are made.
   (b) Notwithstanding Section 2400, a clinic operated under
subdivision (p) of Section 1206 of the Health and Safety Code may
employ licensees and charge for professional services rendered by
those licensees. However, the clinic shall not interfere with,
control, or otherwise direct the professional judgment of a physician
and surgeon in a manner prohibited by Section 2400 or any other
provision of law.
   (c) Notwithstanding Section 2400, a narcotic treatment program
operated under Section 11876 of the Health and Safety Code and
regulated by the State Department of Alcohol and Drug Programs, may
employ licensees and charge for professional services rendered by
those licensees. However, the narcotic treatment program shall not
interfere with, control, or otherwise direct the professional
judgment of a physician and surgeon in a manner prohibited by Section
2400 or any other provision of law.
   (d)  (1)    Notwithstanding Section 2400, a
health care district  that is  operated pursuant to
Division 23 (commencing with Section 32000) of the Health and Safety
Code may employ physicians and surgeons, and may charge for
professional services rendered by a physician and surgeon, if the
physician and surgeon in whose name the charges are made approves the
charges  . However, the district shall not interfere with,
control, or otherwise direct a physician and surgeon's professional
judgment in a manner prohibited by Section 2400 or any other
provision of law.   (e)   
 Notwithstanding Section 2400, a public or an independent
community nonprofit hospital or clinic located in a medically
underserved area, as generally described in Part 5 of Chapter 1 of
Title 42 of the Code of Federal Regulations, or an area where unmet
priority needs for physicians and surgeons exist, as determined by
the California Healthcare Workforce Policy Commission pursuant to
Section 128225 of the Health and Safety Code, with a patient census
that consists of more than 50 percent medically underserved
populations, as defined in Section 127928 of the Health and Safety
Code, may employ physicians and surgeons, and may charge for
professional services rendered by a physician and surgeon, if the
physician and surgeon in whose name the charges are made approves the
charges.   , and if all of the following conditions are
met:  
   (A) The service area of the health care district includes a
Medically Underserved Area (MUA) or a Medically Underserved
Population (MUP), or has been federally designated as a Health
Professional Shortage Area (HPSA).  
   (B) (i) The chief executive officer of the health care district
documents that the district has been actively attempting and unable
to recruit a primary or specialty care physician and surgeon for any
12 consecutive month period, beginning on or after July 1, 2008.
 
   (ii) The chief executive officer submits an application to the
board certifying the district's inability to recruit one or more
physicians and surgeons, including all relevant documentation,
certifying that the inability to recruit primary or specialty care
physicians and surgeons has negatively impacted patient care in the
community, and that the employment of physicians and surgeons by the
district would meet a critical, unmet need in the community based
upon a number of factors, including, but not limited to, the number
of patients referred for care outside of the community, the number of
patients who experienced delays in treatment, the length of
treatment delays, and negative patient outcomes.  
   (2) Upon receipt and review of the certification of the district's
inability to recruit a physician and surgeon as specified in
subparagraph (B) of paragraph (1), the board shall approve and
authorize the employment of up to five primary or specialty care
physicians and surgeons by the district.  
   (3) Upon receipt and review of subsequent certification of the
need for additional primary or specialty care physicians and surgeons
by the district, the board shall approve and authorize the
employment of up to five additional primary or specialty care
physicians and surgeons by the district.  
   (4) Employment contracts with physicians and surgeons issued
pursuant to this subdivision shall be for a period of not more than
10 years, but may be renewed or extended. Districts may enter into,
renew, or extend employment contracts with physicians and surgeons
pursuant to this subdivision until December 31, 2020.  
   (5) The Office of Statewide Health Planning and Development, in
consultation with the State Department of Public Health and the
board, shall conduct an efficacy study of the program under this
subdivision to evaluate improvement in physician and surgeon
recruitment and retention in the districts participating in the
program, impacts on physician and surgeon and health care access in
the communities served by these districts, impacts on patient
outcomes, degree of patient and participating physician and surgeon
satisfaction, and impacts on the independence and autonomy of medical
decisionmaking by employed physicians and surgeons. This study shall
be completed and its results reported to the Legislature no later
than June 1, 2018.  
   (f) The hospitals or clinics 
    (e)     A health care district 
authorized to employ physicians and surgeons pursuant to subdivision
 (e)   (d)  shall not interfere with,
control, or otherwise direct a physician and surgeon's professional
judgment in a manner prohibited by Section 2400 or any other
provision of law. Violation of this prohibition is punishable as a
violation of Section 2052, by a fine not exceeding ten thousand
dollars ($10,000), by imprisonment in the state prison, by
imprisonment in a county jail not exceeding one year, or by both the
fine and either imprisonment. This subdivision is declaratory of
existing law, and, as such, does not create a new crime or expand the
scope of any existing crime.
  SEC. 2.  Section 2401.1 of the Business and Professions Code is
repealed.