BILL ANALYSIS
SB 674
Page 1
SENATE THIRD READING
SB 674 (Negrete McLeod)
As Amended August 17, 2009
Majority vote
SENATE VOTE :31-2
BUSINESS & PROFESSIONS 10-0 HEALTH 18-0
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|Ayes:|Hayashi, Emmerson, |Ayes:|Jones, Fletcher, Adams, |
| |Conway, Eng, | |Ammiano, Block, Carter, |
| |Hernandez, Nava, Niello, | |Conway, De La Torre, De |
| |John A. Perez, Ruskin, | |Leon, Emmerson, Gaines, |
| |Smyth | |Hayashi, Hernandez, |
| | | |Bonnie Lowenthal, Nava, |
| | | |V. Manuel Perez, Salas, |
| | | |Audra Strickland |
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APPROPRIATIONS 17-0
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|Ayes:|De Leon, Conway, Ammiano, | | |
| |Charles Calderon, Coto, | | |
| |Davis, Duvall, Fuentes, | | |
| |Hall, Harkey, Miller, | | |
| |John A. Perez, Skinner, | | |
| |Solorio, Audra | | |
| |Strickland, Torlakson, | | |
| |Hill | | |
|-----+--------------------------+-----+--------------------------|
| | | | |
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SUMMARY : Requires specified healing arts licensees to include
professional designations behind their names in advertisements;
requires the Medical Board of California (MBC) to adopt
regulations regarding the appropriate level of physician
availability needed within clinics or other settings using laser
or intense pulse light devices for elective cosmetic procedures;
permits MBC to adopt standards that it deems necessary for
outpatient settings that offer in vitro fertilization; and
revises accreditation requirements and procedures.
Specifically, this bill :
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1)Requires the following licensees to include the appropriate
professional initials or other designation immediately after
the licensee's name in advertisements:
a) A chiropractor shall include the designation "DC" or the
word "chiropractor;"
b) A dentist shall include the designation "DDS" or "DMD;"
c) A physician and surgeon shall include the designation
"MD;"
d) An osteopathic physician and surgeon shall include the
designation "DO;"
e) A podiatrist shall include the designation "DPM;"
f) A registered nurse shall include the designation "RN;"
g) A licensed vocational nurse shall include the
designation "LVN;"
h) A psychologist shall include the designation "Ph.D;"
i) An optometrist shall include the designation "Dr." or
"Doctor" and "optometrist," or "Opt. D" or "O.D.;"
j) A physician assistant shall include the designation
"PA;" and,
aa) A naturopathic doctor shall include the designation
"ND;" if the naturopathic doctor uses the designation
"Dr." in an advertisement, he or she must further identify
him or herself " as "Naturopathic Doctor," "Licensed
Naturopathic Doctor," "Doctor of Naturopathic Medicine," or
"Doctor of Naturopathy."
2)Defines "advertisement" to include communication by mail,
television, radio, motion picture, newspaper, book, directory,
Internet, or other electronic communication.
3)Exempts the following from the definition of "advertisement:"
a) A medical directory released by a health care service
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plan or a health insurer;
b) A billing statement from a health care practitioner to a
patient;
c) An appointment reminder from a health care practitioner
to a patient; and,
d) Any advertisement or business card disseminated by a
health care service plan indicating its contracting
providers.
4)States that the new advertising requirements shall apply on
January 1, 2011, to any advertisement that is published
annually and prior to July 1, 2010.
5)Requires the MBC to adopt regulations regarding the
appropriate level of physician availability needed within
clinics or other settings using laser or intense pulse light
devices for elective cosmetic procedures.
6)Specifies that this bill does not modify the prohibition
against the unlicensed practice of medicine.
7)Prohibits the regulations promulgated by MBC for laser or
intense pulse light devices for elective cosmetic procedures
from applying 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.
8)Requires the MBC to post on its Internet Web site an
easy-to-understand fact sheet to educate the public about
cosmetic surgery and its risks, and a comprehensive list of
questions for patients to ask their physician and surgeon
regarding cosmetic surgery.
9)Includes facilities that offer in vitro fertilization in the
definition of "outpatient setting."
10)Requires outpatient settings to submit to an accreditation
agency (agency) detailed plans, standardized procedures, and
protocols to be followed in the event of serious complications
or side effects from surgery that would place a patient at
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high risk for injury or harm.
11)Requires MBC to adopt standards that it deems necessary for
outpatient settings that offer in vitro fertilization.
12)Requires the MBC to automatically notify the public about an
outpatient setting's accreditation, certification, or
licensure, and if a setting's accreditation, certification, or
license has been revoked, suspended, or placed on probation,
or the setting has received a reprimand by the agency.
13)Requires an agency to immediately report to the MBC if an
outpatient setting's certificate for accreditation has been
denied.
14)Requires every accredited outpatient setting to be inspected
by an agency and be subject to inspection by the MBC.
15) Requires the MBC to ensure that accreditation agencies
inspect outpatient settings according to the following
parameters:
a) The frequency of inspection shall depend upon the type
and complexity of the outpatient setting to be inspected;
b) Inspections shall be conducted no less often than once
every three years by the agency and as often as necessary
by the MBC to ensure the quality of care provided; and,
c) Permits the MBC or the agency to enter and inspect any
outpatient setting that is accredited by an agency at any
reasonable time to ensure compliance with, or investigate
an alleged violation of, any standard of the agency or any
provision of this chapter.
16)Requires an agency to provide the outpatient setting with
notice of any deficiencies before suspending or revoking a
certificate of accreditation and requires the outpatient
setting to agree with the agency on a plan of correction that
gives the outpatient setting reasonable time to supply
information demonstrating compliance. Requires the outpatient
setting to publicly post a list of deficiencies and the plan
of correction during the time it is working towards
compliance.
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17)Permits MBC to terminate approval of the agency or issue a
citation to the agency if the agency is not meeting the
criteria set by MBC.
18)Permits MBC to establish, by regulation, a system for the
issuance of a citation to an agency that is not meeting the
criteria set by the board. This system shall include the
following terms:
a) Failure of an agency to pay an administrative fine
within 30 days of the assessment, unless the citation is
being appealed, may result in MBC's termination of approval
of the agency. Where a citation is not contested and a fine
is not paid, the full amount of the assessed fine shall be
added to the agency's renewal fee. Approval of an agency
shall not be renewed without payment of the renewal fee and
fine.
b) Administrative fines collected pursuant to the system
shall be deposited in the MBC's Outpatient Setting Fund.
19)Requires reports on the results of any inspection to be kept
on file with the MBC or the agency along with the plan of
correction and the outpatient setting comments. Permits the
inspection report to include a recommendation for reinspection
and requires all inspection reports, lists of deficiencies,
and plans of correction to be public records open to
inspection.
20)Requires the agency to immediately report to the MBC if:
a) The outpatient setting has been issued a reprimand;
b) The outpatient setting's certification of accreditation
has been suspended or revoked; or,
c) If the outpatient setting has been placed on probation.
21)Requires, rather than permits, the MBC to evaluate the
performance of an approved agency no less than once every
three years, or in response to complaints against an agency,
or complaints against one or more outpatient settings
accreditation by an agency that indicates noncompliance by the
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agency with the standards approved by the MBC.
22)States the intent of the Legislature that the Department of
Public Health (DPH) inspect the peer review process utilized
by acute care hospitals during periodic state inspections of
those hospitals.
FISCAL EFFECT : According to the Assembly Appropriations
Committee, absorbable workload to the MBC to comply with the
authorizations and requirements established in this bill and to
continue oversight of medical professionals working in cosmetic
and in vitro clinics.
COMMENTS : According to a 2007 study by the American Society of
Plastic Surgeons, almost 12 million cosmetic plastic surgery
procedures were performed in 2007, a 7% increase from 2006 and a
59% increase from 2000. The study concludes that, as with all
surgical procedures, cosmetic surgery carries with it certain
risks-if performed poorly, it can be disfiguring or
life-threatening. In California, cosmetic surgery can be
performed by any licensed physician; from a plastic surgeon to a
pediatrician.
Medical spas or facilities offering botox injections, laser hair
removal, and microdermabrasion are emerging in malls, city
office buildings, and store fronts across the country. Although
the federal Food and Drug Administration oversees the safety of
the 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
treatment.
The Health and Safety Code makes a distinction between clinics
licensed by the 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 those not part of a hospital which provide ambulatory
surgical care for patients who remain fewer 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.
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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 are
defined as a facility where anesthesia is used in doses that do
not have the probability of placing the patient at risk for loss
of life. These clinics are accredited by one of four
accreditation bodies 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.
Analysis Prepared by : Sarah Huchel / B. & P. / (916) 319-3301
FN: 0002272