BILL ANALYSIS
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|Hearing Date:April 20, 2009 |Bill No:SB |
| |674 |
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SENATE COMMITTEE ON BUSINESS, PROFESSIONS AND ECONOMIC DEVELOPMENT
Senator Gloria Negrete McLeod, Chair
Bill No: SB 674Author:Negrete McLeod
As Amended:April 2, 2009 Fiscal: Yes
SUBJECT: Healing arts.
SUMMARY: Requires for purposes of advertising that a health care
practitioner, as specified, include specific professional
designation following the health care practitioner's name.
Requires a health care practitioner who is working in an
outpatient setting or clinic, as defined, to disclose their type
of license, instead of license status, on a name tag or verbally
disclose such information to patients. Requires the Medical Board
of California (MBC) to adopt regulations on or before July 1, 2010
on the appropriate level of physician availability necessary
within clinics using laser or intense pulse light devices for
elective cosmetic surgery. Requires the MBC to post on its
Internet Website a fact sheet to educate the public about cosmetic
surgery, and the risks involved with such surgeries. Makes a
number of changes regarding the approval, oversight and inspection
of outpatient settings, as defined, by the MBC and accreditation
agencies approved by the MBC, and in developing a plan of
corrective action for any deficiencies found by the accreditation
agencies or the MBC during inspections, or otherwise. Includes in
the existing law definition of outpatient settings fertility
clinics that offer in vitro fertilization or assisted reproduction
technology (ART) treatments. Requires the Department of Public
Health (DPH), as part of its periodic inspections, inspect the
peer review process utilized by acute care hospitals.
Existing law, the Business and Professions Code:
1)Provides that it is unlawful for health care licensees to
disseminate or cause to be disseminated any form of public
communication, as defined, containing false, fraudulent,
misleading, deceptive statement, or image, as specified, to
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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 misdemeanor and that such
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.
2)Authorizes advertising by health care licensees to include
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.
3)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.
4)Requires a health care practitioner to disclose, while working,
his or her name and license status on a specified name tag at
least 18-point type but provides 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.
5)Requires the MBC in conjunction with the Board of Registered
Nursing (BRN), and in consultation with the Physician Assistant
Committee (PAC) and professionals in the field, to review issues
and problems relating to the use of laser or intense light pulse
devices for elective cosmetic procedures by physicians and
surgeons, nurses, and physician assistants.
6)Specifies that the review conducted by the MBC, the BRN and the
PAC shall include the appropriate level of physician supervision
needed, the appropriate level of training to ensure competency,
guidelines for standardized procedures and protocols that
address patient selection, education, instruction and informed
consent, use of topical agents, and procedures to be followed in
the event of complications or side effects from treatment and
procedures for governing emergency and urgent care situations.
7)Requires the MBC and the BRN to promulgate regulations to
implement changes determined to be necessary with regard to the
use of laser or intense pulse light devices for elective
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cosmetic procedures by physicians and surgeons, nurses and
physicians assistants.
8)Requires the MBC to post on its Internet Web site specified
information in its possession, custody or control regarding
physicians and surgeons.
9)Declares that in this state, significant surgeries are being
performed in unregulated out-of-hospital settings and that
without appropriate oversight some of these settings may be
operating in a manner which is injurious to the public health,
welfare and safety, and although health professionals delivering
health care services in these settings are licensed, further
quality assurance is needed to ensure that health care services
are safe and effectively performed in these settings.
10)Provides that no physician or surgeon may perform procedures in
an outpatient setting, as defined, using anesthesia, unless
accredited pursuant to the Health and Safety Code, Section 1248
et seq.
Existing law, the Health and Safety Code, Section 1248 et seq.:
1)Defines "outpatient setting" as any facility, clinic, unlicensed
clinic, center, office, or other setting that is not part of a
general acute care facility where anesthesia is used.
2)Defines "accrediting agency" as a public or private organization
that is approved to issue certificates of accreditation to
outpatient settings by the MBC pursuant to specified
requirements.
3)Requires the MBC to adopt standards for accreditation of
outpatient settings, as defined, and in approving accreditation
agencies to perform accreditation of outpatient settings, ensure
that the certification program shall, at a minimum, include
standards for specified aspects of settings' operations.
4)Requires the MBC to obtain and maintain a list of all
accredited, certified, and licensed outpatient settings, and to
notify the public, upon inquiry, whether a setting is
accredited, certified, or licensed, or whether the setting's
accreditation, certification, or license has been revoked.
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5)Requires accreditation of an outpatient setting to be denied by
the accreditation agency if the outpatient setting does not meet
specified standards and allows the outpatient setting to reapply
for accreditation at any time after receiving notification of
denial.
6)Authorizes the MBC or an accrediting agency to, upon reasonable
prior notice and presentation of proper identification, enter
and inspect any outpatient setting that is accredited by an
accreditation agency at any reasonable time to ensure compliance
with, or investigate an alleged violation of any standard of
accrediting agency or any provision of the specified law.
7)Authorizes the MBC to evaluate the performance of an approved
accreditation agency no less than every three years, or in
response to a complaint against an agency, or complaints against
one or more outpatient settings accreditation by an agency that
indicated noncompliance by the agency with standards approved by
the MBC.
8)Provides that before suspending or revoking a certificate of
accreditation, the accrediting agency shall provide the
outpatient setting with notice of deficiencies and reasonable
time to supply information demonstrating compliance with the
standards of the accrediting agency as well as the opportunity
for a hearing on the matter upon request of the outpatient
setting.
9)Defines treatment for infertility as procedures consistent with
established medical practices in the treatment of infertility by
licensed physicians and surgeons including, but not limited to,
diagnosis, diagnostic tests, medication, surgery, and gamete
intrafallopian transfer. Defines in vitro fertilization as the
laboratory medical procedures involving the actual in vitro
fertilization process.
10)Defines acute care hospital as a health facility having a duly
constituted governing body with overall administrative and
professional responsibility and an organized medical staff that
provides 24-hour inpatient care, including the following basic
services: medical, nursing, surgical, anesthesia, laboratory,
radiology, pharmacy, and dietary services.
11)Requires DPH to license and inspect health facilities,
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including acute care hospitals. Requires DPH to conduct
periodic inspections of acute care hospitals no less than once
every three years.
This bill, within the Business and Professions Code:
1)Requires that any advertising by a chiropractor, dentist,
physician and surgeon, osteopathic physician and surgeon,
podiatrist, registered nurse, licensed vocational nurse,
psychologist, optometrist, physician assistant and naturopathic
doctor include specific professional designation following the
health care practitioner's name.
2)Defines advertisement for purposes of #1) above to include
communication by means of mail, television, radio, motion
picture, newspaper, book, directory, Internet or other
electronic communication. Excludes from the definition of
advertisement the following: medical directory released by a
health care service plan or a health insurer, a billing
statement from a health care practitioner to a patient, or
appointment reminder from a health care practitioner to a
patient. Also excludes from the requirement in #1) above any
advertisement or business card disseminated by a health care
service plan relating to contracted providers, as specified.
3)Specifies that the requirement in #1) does not apply until
January 1, 2011 to any advertisement that is published annually
and prior to July 1, 2010.
4)Clarifies that a health care practitioner who is working in an
outpatient setting or clinic, as defined, must disclose their
type of license, instead of the existing law's requirement of
disclosing license status, on a name tag or verbally to
patients.
5)Requires the MBC to adopt regulations on or before July 1, 2010,
regarding the appropriate level of physician availability needed
within clinics or other settings using laser or intense pulse
light devices for elective cosmetic procedures. Specifies that
the regulations to be adopted will not apply to laser or intense
pulse light devices approved by the federal Food and Drug
Administration for over-the-counter use by a health care
practitioner or by an unlicensed person on himself or herself.
6)Requires the MBC to post on its Internet Website an easy to
understand fact sheet to educate the public about cosmetic
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surgery and procedures, including their risks. Requires the
fact sheet to include a comprehensive list of questions for
patients to ask their physician and surgeon regarding cosmetic
surgery.
This bill, within the Health and Safety Code, Section 1248 et
seq.:
1)Includes in the existing definition of "outpatient setting"
facilities those that offer in vitro fertilization or ART
treatments.
2)Requires as part of the standards for operation and approval of
an outpatient setting that the outpatient setting submit for
approval by an accrediting agency at the time of accreditation,
a detailed plan, standardized procedures, and protocols to be
followed in the event of serious complications or side effects
from surgery, as specified.
3)Requires the MBC to notify the public whether a setting is
accredited, certified, or licensed, or the setting's
accreditation, certification, or license has been revoked,
suspended or placed on probation, or the setting has received a
reprimand by the accreditation agency.
4)Requires an accrediting agency to immediately report to the MBC
if an outpatient setting's certificate for accreditation has
been denied.
5)Requires that every outpatient setting which is accredited to be
periodically inspected by the MBC or the accrediting agency.
Requires that the frequency of inspections depends upon the type
and complexity of the outpatient setting to be inspected, and
that inspections be conducted no less than once every three
years and as often as necessary to ensure the quality of care
provided.
6)Requires reports on the results of each inspection to be kept on
file with the MBC or the accrediting agency along with the plan
of correction and the outpatient setting comments and that the
inspection report may include a recommendation for
re-inspection, and that all inspection reports, lists of
deficiencies, and plans of correction be public records open to
public inspection.
7)Deletes the requirement that the MBC or the accrediting agency
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give reasonable prior notice and present proper identification
prior to an inspection.
8)Requires rather than just authorize the MBC to evaluate the
performance of an approved accreditation agency no less than
every three years.
9)Provides that the outpatient setting shall agree with the
accrediting agency upon a plan of correction when they receive a
notice of any deficiencies from the accreditation agency and
that during the time of correction, the list of deficiencies and
the plan of correction shall be conspicuously posted in a clinic
location accessible to public view.
10)Requires DPH, during its routine state periodic inspection of
an acute care hospital, as specified, to also inspect the peer
review process utilized by the hospital.
FISCAL EFFECT: Unknown. This bill has been keyed "fiscal" by
Legislative Counsel.
COMMENTS:
1)Purpose. The Author is the sponsor of this measure. The Author
states that
this bill attempts to guarantee the public's safety by
strengthening the regulation and oversight of fertility clinics
and surgical centers performing cosmetic procedures, and ensures
that quality of care standards are in place at these clinics and
checked by the appropriate credentialing agency. The Author
points out that recent events involving a woman who gave birth
to octuplets revealed that fertility clinics operate with little
or no state oversight. A clinic that assists women in any
reproductive technology should operate under specified
standards, guidelines and procedures and since most of these
clinics are physician-owned, this bill would require these
clinics to be accredited by an accrediting agency approved by
the Medical Board of California.
In addition, the Author indicates that the number of cosmetic
procedures performed in the United States is increasing at an
alarming rate. According to the American Society of Plastic
Surgeons (ASPS), over 12 million cosmetic procedures were
performed in 2008, and $10.3 billion were spent on cosmetic
procedures in the United States. Consumers are also inundated
everyday with advertisements on how to look and feel better
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fast. Medical spas, or facilities offering botox injections,
laser hair removal, and microdermabrasion are increasing in
popularity and are emerging in malls, city office buildings and
store fronts across the country. Although the Federal Food and
Drug Administration oversees the safety of machines and
skin-care products used, there is little regulation of these
medical spas to guarantee that practitioners in these facilities
are administering treatments safely and patients are aware of
the potential risks associated with any treatments.
The Author also points out that the statistics on these procedures
belie the potential risks associated with any type of surgery.
To illustrate the magnitude of the risks that could be
associated with cosmetic surgery, the Author cites the Donda
West story. Donda West, the mother of famous artist Kanye West,
died less than 24 hours after undergoing a 5 1/2 -hour operation
which involved significant liposuction, a partial reduction of
her right breast and implants on both breasts. Although the
autopsy report revealed that, "Ms. West died from some
pre-existing coronary artery disease and multiple postoperative
factors following surgery," it is unclear if and what
post-operative care and monitoring she was given. In addition,
news reports also revealed that although Donda West's
preoperative screening by her doctor, Dr. Adams, indicated a
possible heart condition and other factors, Dr. Adams decided to
proceed with the surgery in which complications resulted.
2)Background.
a) Popularity of Plastic Surgery. ASPS' website states that
the 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 decision. The fact sheet included an explanation of
the different kinds of doctors who provide services, the
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various issues that consumers should be aware 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 the MBC to also post on
its website a fact sheet for consumers.
b) 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:
i) SB 1423 (Figueroa, Chapter 873, Statutes of 2006)
required the 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.
ii) 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 the MBC with specified information,
including training, board certifications, and number of
procedures performed, and requires the 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.
iii) SB 836 (Figueroa, Chapter 856, Statutes of 1999)
expanded and revised the prohibition against fraudulent
advertising by health practitioners.
iv) SB 837 (Figueroa, 1999) would have required cosmetic
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surgery procedures to be performed in a licensed acute care
hospital or in a licensed or accredited outpatient surgery
setting. SB 837 died in the Assembly Appropriations
Committee.
c) Accredited Outpatient Settings vs. Licensed Clinics. The
Health and Safety Code makes a distinction between clinics
licensed by the Department of Public Health (DPH) and
outpatient settings that are accredited by an outside
accrediting agency under the oversight of the MBC. Clinics
licensed by the DPH are non-physician owned, while clinics
accredited by an accreditation agency approved by the MBC are
physician owned and operated. DPH-licensed clinics include a
clinic that is not part of a hospital and provides ambulatory
surgical care for patients who remain less than 24-hours. As
part of their licensure, clinics under DPH's jurisdiction
undergo inspection and must have in place minimum standards
of safety and staffing. On the other hand, clinics that are
physician-owned and are accredited by an accreditation agency
approved by the MBC and are commonly referred to as
outpatient settings. Outpatient settings is defined as a
facility where anesthesia is used in doses that when
administered does not have the probability of placing the
patient at risk for loss of the patient's life. These
clinics are accredited by one of four accreditation bodies
that are approved by the MBC. These accrediting agencies
must ensure that certification programs include standards for
the operation of outpatient settings such as safety and
emergency training requirements, licensure or certification
of allied health staff, provision of onsite equipment,
medication and trained personnel in a medical emergency,
permit surgery only by a licensee who has admitting
privileges at a local accredited or licensed acute care
hospital, as defined, and a system for patient care and
monitoring procedures The four accrediting agencies approved
by the MBC are the American Association for Accreditation of
Ambulatory Surgery Facilities Inc., Accreditation Association
for Ambulatory Health Care, the Institute for Medical Quality
and the Joint Commission.
Existing law's distinction on which clinics are licensed by the
DPH and fall under the jurisdiction of the MBC is unclear and
has been the subject of litigation. In Capen v. Shewry
(2007) 147 Cal.App.4th 680, the issue before the court was
whether a surgical clinic that is wholly owned and operated
by a licensed physician, in which non-owner, non-lessee,
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physicians will practice is required to obtain a license from
DPH. The facts of the case reveal that the plaintiff, Dr.
Capen, is a licensed physician who is building a surgical
clinic that he will wholly own and operate, in which
non-owner, non-lessee physicians will practice. He was
informed by DPH (then DHS) that a license is required of the
clinic because of the physicians who do not share in its
ownership and operation. Dr. Capen sued DHS and argued that
the existing law provisions governing the authority of DPH to
license facilities is ambiguous. At issue in Capen is
Section 1204 (b)(1) of the Health and Safety Code which
states that "a surgical clinic is a clinic that is not part
of a hospital and that provides ambulatory surgical care for
patients who remain less than 24 hours. A surgical clinic
does not include any place or establishment owned or leased
and operated as a clinic or office by one or more physicians
or dentists in individual or group practice, regardless of
the name used publicly to identify the place or
establishment, provided, however, that physicians or dentists
may, at their option, apply for licensure." The court
indicated that the provisions of Section 1204(b)(1) where
clinics "owned or leased by one or more physicians in
individual or group practice" was ambiguous because it could
be interpreted to require an ownership or lease interest
either by one physician in group practice or by all of the
physicians in the group. As a result, the court held that
Section 1204(b)(1) is void since it did not follow the
Administrative Procedure Act. The Court concluded that
physician-owned-and-operated surgical clinics are not subject
to licensing by DPH and are to be regulated by the MBC . In
an effort to clarify MBC's authority over outpatient settings
after Capen, MBC submitted a letter on October 18, 2007 to
Judge Coleman Blease, who issued the opinion in the Capen
case. MBC stated that "the law does not give the MBC the
authority to regulate clinics owned and operated by
physicians. It just gives the MBC the authority to approve
accrediting agencies that are in compliance with the
standards set forth in Health and Safety Code Section 1248
et.seq."
d) Recent Review by the MBC, BRN and PAC of Issues Involving
Use of Certain Cosmetic Procedures. SB 1423 (Figueroa,
Chapter 873, Statutes of 2006) required the MBC in
conjunction with 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.
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The MBC and the BRN have held meetings, discussions and
heard testimony from a number of organizations representing
nurses, physicians, physician assistants, patients and the
laser industry. The discussions included recommendations on
training of personnel that use laser equipment, the
appropriate level of physician supervision at these
facilities, the appropriate advertising to inform patients of
the practitioners' credentials and degrees, who should own or
control these facilities, liability and establishing
standardized procedural rules. The discussions and meetings
revealed that there is frequent disregard of the law in the
use of laser or intense pulse light devices in the treatment
of patients.
Two statements were approved by both boards in these
discussions; the first outlines the responsibilities of
physicians in cosmetic procedures, including the supervision
of allied health staff performing laser procedures, and the
second is a revised statement to better inform consumers on
cosmetic procedures, currently available on MBC's website but
includes the following, "An appropriate examination must be
conducted before treatments are performed. This exam must be
conducted by a physician, or the doctor may delegate the
examination to licensed nurse practitioners or physician
assistants. Physicians may not delegate this examination to
registered nurses."
e) Assisted Reproductive Technology. According to the
Centers for Disease Control (CDC), ART includes all fertility
treatments in which both eggs and sperm are handled. In
general, ART procedures involve surgically removing eggs from
a woman's ovaries, combining them with sperm in the
laboratory, and returning them to the woman's body or
donating them to another woman. CDC points out that of the
approximately 62 million women of reproductive age in 2002,
about 1.2 million, or 2%, had an infertility-related medical
appointment within the previous year, and 8% had an
infertility-related medical visit at some point in the past.
Infertility services include medical tests to diagnose
infertility, medical advice and treatments to help a woman
become pregnant, and services other than routine prenatal
care to prevent miscarriage. CDC also states that the number
of infants born after ART doubled in the United States from
1996-2004, and in 2005, more than 134,000 ART procedures were
performed and approximately 52,000 infants were born as a
result of these procedures. According to a CDC 2008 report,
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infants conceived with ART are two to four times more likely
to have certain types of birth defects than children
conceived naturally.
The Fertility Clinic Success Rate and Certification Act of
1992, or Wyden Act, is federal legislation that was
implemented to ensure the quality of ART services and to
furnish consumers with reliable information on pregnancy
success rates of individual ART clinics. The Wyden Act
requires each ART program to report annually to the Secretary
of the Health and Human Services Agency through the CDC,
regarding pregnancy success rates and each embryo laboratory
used by the program and whether certified under the Wyden
Act. According to the 2006 ART report, there are over 60
fertility clinics that reports success rates to the CDC.
f) Recent Legislation on Fertility Clinics in Other States.
Recent events involving the birth of octuplets by a Southern
California woman has sparked legislation in several states
relating to fertility clinics. For example, in Georgia, The
Ethical Treatment of Human Embryos Act was introduced. This
bill defines an embryo as a biological human being and
prohibits destruction of frozen embryos. Currently,
Louisiana is the only state in the nation with a similar law
prohibiting discarding of human embryos. In Missouri, HB 810
was introduced and seeks to enact guidelines from the
American Society of Reproductive Medicine (ASRM). The
guidelines include a recommendation on the number of embryos
that should be implanted on a woman based on her age and
prognosis for a successful pregnancy. In most cases, ASRM
guidelines call for two or
three embryos, though women older than 40 could be implanted
with up to five embryos.
g) Industry Standards for ART. Currently there are two
organizations that physicians who practice reproductive
medicine generally belong. One is the ASRM and the other is
the Society for Reproductive Technology, an affiliate of
ASRM. Both organizations provide practice guidelines and
minimum standards regarding assisted hatching, blastocyst
transfer and gamete and embryo donation. It should be noted
that the guidelines adopted by ASRM and SART are not
mandatory guidelines. In addition, it appears that about 20%
of clinics that belong to either organizations adhere to the
guidelines, and usually the only penalty for violating the
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guidelines is expulsion from the professional organization.
h) Informational Hearing on the Peer Review Process - Lack of
Oversight. On March 9, 2009, this Committee held an
informational hearing on physician per review entitled "Is
the Physician Peer Review A Broken System?" The
informational hearing provided a brief overview of peer
review in California and included discussions on how
hospitals and other entities conduct peer review. The
hearing also included a discussion on a legislatively
mandated report on peer review authored by Lumetra which
pointed out that the peer review process in California is
broken and in need of a major fix for it to truly serve the
people. In addition, DPH testified during the hearing on its
oversight of acute care hospitals and the peer review
process.
1.Similar Legislation This Session.
a) AB 583 (Hayashi) requires health care practitioners to
display their educational degree, license type and status,
and board certification on either their nametag or in their
offices, as specified. Requires supervising physicians and
surgeons to post their hours in each office. AB 583 passed
out of the Assembly Business and Professions Committee and is
pending on the Assembly Floor.
b) AB 832 (Jones) requires surgical clinics, as defined, to
be licensed by DPH. AB 832 is pending in Assembly Health
Committee.
2.Prior Related Legislation.
a) SB 1454 (Ridley- Thomas) of 2008 is substantially related
to the provisions of this bill and would have, among other
provisions, made a number of changes regarding the approval,
oversight and inspection of outpatient settings, as defined,
by the MBC and accreditation agencies approved by the MBC,
and in developing a plan of corrective action for any
deficiencies found by the accreditation agencies or the MBC
during inspections, or otherwise. SB 1454 died on the
Assembly Floor.
b) AB 2968 (Carter) of 2008 would have enacted the Donda West
Law, which would prohibit elective cosmetic surgery on a
patient unless, prior to surgery, the patient has completed a
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physical examination by, and has received written clearance
for the procedure from, a licensed physician and surgeon. AB
2968 was vetoed by the Governor because of the budget delay.
c) AB 2122 (Plescia) of 2008 would have established the
California Outpatient Surgery Patient Safety and Improvement
Act which requires surgical clinics to meet prescribed
licensing requirements and standards, including compliance
with Medicare conditions of participation. AB 2122 was held
in the Assembly Appropriations suspense file.
d) AB 543 (Plescia) of 2007 would have required surgical
clinics to meet specified operating and staffing standards,
including compliance with Medicare conditions of
participation. Would have required surgical clinics to limit
surgical procedures, as specified, and to develop and
implement policies and procedures consistent with Medicare
conditions of participation, including interpretive
guidelines. AB 543 was vetoed by Governor Schwarzenegger
because among other things the bill did not establish
appropriate time limits for performing surgery under general
anesthesia and directed DPH to pursue legislation that
establishes licensure standards for these facilities that are
consistent with federal requirements and protect the health
and safety of patients.
e) AB 2308 (Plescia) of 2006 would have required the
Department of Health Services (now DPH) to convene a
workgroup to develop licensure criteria to protect patients
receiving care in surgical clinics, and to submit workgroup
conclusions and recommendations to the appropriate policy
committees of the Legislature no later than March 1, 2007.
AB 2308 would have revised existing law to replace the term
"licensed surgical clinic" with "ambulatory surgical centers"
or "ASCs". AB 2308 was vetoed by the Governor.
3.Arguments in Opposition. The American Nurses
Association/California opposes this bill and states that
authorizing a health care practitioner to verbally disclose
their license does not inform the patient of who is caring for
them. In addition, it states that there is no need to require
additional regulations for laser procedures or intense pulse
light devices and that the appropriate remedy is to enforce
existing law.
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SUPPORT AND OPPOSITION:
Support: None on file as of April 10, 2009.
Opposition: None on file as of April 10, 2009.
Consultant: Rosielyn Pulmano