BILL ANALYSIS                                                                                                                                                                                                    




                   Senate Appropriations Committee Fiscal Summary
                           Senator Christine Kehoe, Chair

                                           674 (Negrete-McLeod)
          
          Hearing Date:  5/4/2009         Amended: 4/28/2009
          Consultant:  Bob Franzoia       Policy Vote: BP&ED 8-0
          _________________________________________________________________ 
          ____
          BILL SUMMARY: SB 674, relating to healing arts, would do the  
          following:
          - Require the Medical Board of California (MBC) to adopt  
          regulations by July 1, 2010, regarding the appropriate level of  
          physician availability needed within clinics and other settings  
          using certain laser or intense pulse light devices for cosmetic  
          procedures.
          - Modify the definition of "outpatient setting" to include  
          facilities that offer in vitro fertilization and assisted  
          reproduction technology treatments.
          - Delete existing MBC notice and identification requirements and  
          instead require that every outpatient setting that is accredited  
          be periodically inspected by the MBC or the accreditation  
          agency.
          - Make an evaluation of approved accreditation agencies by the  
          MBC mandatory.
          - Require the accrediting agency to immediately report to the  
          MBC if the outpatient setting's certificate for accreditation  
          has been denied.
          - Require the MBC, absent inquiry, 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          setting's accreditation, certification, or license has been  
          revoked, suspended, or placed on probation, or the setting has  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.
          - Include, as part of the submission 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.
          - Require the Department of Public Health, when conducting an  
          inspection of an acute care hospital, to inspect the peer review  
          process utilized by the hospital.
          _________________________________________________________________ 
          ____
                            Fiscal Impact (in thousands)

           Major Provisions         2009-10      2010-11       2011-12     Fund
           Regulations            Up to $50                        Special*











          Outpatient facility inspections   $170        $464       
          $350Special* 
                                                        
          * Medical Board of California Contingent Fund
          _________________________________________________________________ 
          ____

          STAFF COMMENTS: This bill meets the criteria for referral to the  
          Suspense File.
          
          This bill would be effective 1/1/2010 and would require the MBC  
          to adopt regulations by 7/1/2010.  This timeline may not provide  
          the MBC sufficient time and may increase costs.  Staff  
          recommends the bill be amended to require the regulations be  
          adopted by 1/1/2011.

          This bill amends Health and Safety Code 1248 to add:
             (b) (2) Outpatient setting also means facilities that offer  
          in vitro fertilization, as defined
          in subdivision 9b) of Section 1374.55, or facilities that offer  
          assisted reproduction

          Page 2
          SB 674 (Negrete McLeod)

          technology treatments.

          The MBC is budgeted for 16 inspector positions as part of its  
          probation monitoring program.  Currently, there are 1,230  
          outpatient settings that would be inspected every three years  
          (and as often as necessary to ensure the quality of care  
          provided).  This bill would add an estimated 65 outpatient  
          settings that offer in vitro fertilization or assisted  
          reproduction technology treatments for a total of 432  
          inspections annually.  This number of inspections would require  
          an estimated three inspectors and two administrative and support  
          staff.  As part of their duties, the inspectors would assist in  
          maintaining the MBC website and the inspection log on the  
          Consumer Affairs System with periodic findings.  This would  
          involve a one time cost of $15,000 for a contract to put all  
          outpatient settings online or a separate database and to  
          establish enforcement tracking records for those settings  
          inspected.