BILL ANALYSIS
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|SENATE RULES COMMITTEE | SB 674|
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VETO
Bill No: SB 674
Author: Negrete McLeod (D)
Amended: 8/17/09
Vote: 21
SENATE BUS., PROF. & ECON. DEVEL. COMMITTEE : 8-0, 4/20/09
AYES: Negrete McLeod, Corbett, Correa, Florez, Oropeza,
Romero, Walters, Yee
NO VOTE RECORDED: Wyland, Aanestad
SENATE APPROPRIATIONS COMMITTEE : 12-0, 5/28/09
AYES: Kehoe, Cox, Corbett, Denham, DeSaulnier, Hancock,
Leno, Oropeza, Runner, Walters, Wyland, Yee
NO VOTE RECORDED: Wolk
SENATE FLOOR : 31-2, 6/3/09
AYES: Alquist, Cedillo, Corbett, Correa, Cox, Denham,
DeSaulnier, Ducheny, Dutton, Florez, Hancock,
Hollingsworth, Huff, Kehoe, Leno, Lowenthal, Maldonado,
Negrete McLeod, Oropeza, Padilla, Pavley, Romero,
Simitian, Steinberg, Strickland, Walters, Wiggins, Wolk,
Wright, Wyland, Yee
NOES: Aanestad, Ashburn
NO VOTE RECORDED: Benoit, Calderon, Cogdill, Harman, Liu,
Runner, Vacancy
SENATE FLOOR : 38-1, 9/8/09
AYES: Alquist, Ashburn, Benoit, Calderon, Cedillo,
Cogdill, Corbett, Correa, Cox, Denham, DeSaulnier,
Ducheny, Dutton, Florez, Hancock, Harman, Huff, Kehoe,
Leno, Liu, Lowenthal, Maldonado, Negrete McLeod, Oropeza,
Padilla, Pavley, Price, Romero, Runner, Simitian,
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Steinberg, Strickland, Walters, Wiggins, Wolk, Wright,
Wyland, Yee
NOES: Aanestad
NO VOTE RECORDED: Hollingsworth
ASSEMBLY FLOOR : 78-0, 9/2/09 - See last page for vote
SUBJECT : Healing arts
SOURCE : Author
DIGEST : This bill requires for purposes of
advertising that a health care practitioner, as
specified, include specific professional designation
following the health care practitioner's name.
Requires the Medical Board of California (MBC) to
adopt regulations on the appropriate level of
physician availability necessary within clinics or
other settings using laser or intense pulse light
devices for elective cosmetic surgery.
Assembly Amendments require certain healing arts
licensees to include in advertisements certain words
or designations following their names indicating the
particular educational degree they hold or healing art
they practice, as specified, authorize the MBC to
issue an accreditation agency a citation, including an
administrative fine, in accordance with a specified
system established by the MBC if the agency is not
meeting the criteria set by the MBC.
ANALYSIS :
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 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
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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/her license or other disciplinary
action including an administrative fine not to exceed
$10,000.
2.Specifies that the review conducted by the MBC, the Board
of Registered Nursing (BRN) and the Physician Assistant
Committee (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.
3.Requires the MBC to post on its Internet website
specified information in its possession, custody or
control regarding physicians and surgeons.
Existing law, the Health and Safety Code, Section 1248 et
seq.:
1.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.
2.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.
This bill:
1.Requires the following licensees to include the
appropriate professional initials or other designation
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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".
K. 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
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"advertisement":
A. A medical director released by a health care
service 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.
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 the 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 include in vitro fertilization
in the definition of "outpatient setting".
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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 high risk for
injury or harm.
11.Requires the 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.
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 bill.
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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.
17.Permits the MBC to terminate approval of the agency or
issue a citation to the agency if the agency is not
meeting the criteria set by the MBC.
18.Permits the 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
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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 agency with the standards approved
by the MBC.
22.States the intent of the Legislature that the Department
of Public Health inspect the peer review process
utilized by acute care hospitals during periodic state
inspections of those hospitals.
Comments
The author's office 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 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's office also points out that the statistics on
these procedures belie the potential risks associated with
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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 five and one-half 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.
FISCAL EFFECT : Appropriation: No Fiscal Com.: Yes
Local: Yes
According to the Senate Appropriations Committee:
Fiscal Impact (in thousands)
Major Provisions 2009-10 2010-11
2011-12 Fund
Outpatient facility $170 $464 $350
Special*
inspection
*Medical Board of California Contingent Fund
SUPPORT : (Verified 9/3/09)
American Society for Dermatologic Surgery Association
California Medical Association
California Society of Dermatology and Dermatologic Surgery
California Society of Plastic Surgeons
Medical Board of California
Proctor and Gamble
OPPOSITION : (Verified 9/3/09)
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American Nurses Association of California
GOVERNOR'S VETO MESSAGE:
"I am returning Senate Bill 674 without my signature.
While some provisions may provide marginal
improvements to consumer protection, I cannot support
this bill when it fails to address the need for
stronger licensing and oversight of outpatient
surgical centers. The continued reliance by the
medical community on external accreditation agencies
without enforcement capability is an insufficient
solution for protecting patients. As outpatient
surgeries continue to increase in number and
complexity, surgical centers cannot continue to
perform procedures in an unregulated and unenforced
environment.
I would ask the medical community to work with my
Administration next year to bring consistent and
effective oversight to this growing industry in the
shared interest of protecting patient safety.
For these reasons, I am unable to sign this bill."
ASSEMBLY FLOOR :
AYES: Adams, Ammiano, Anderson, Arambula, Beall, Bill
Berryhill, Tom Berryhill, Blakeslee, Block, Blumenfield,
Brownley, Caballero, Charles Calderon, Carter, Chesbro,
Conway, Cook, Coto, Davis, De La Torre, De Leon, DeVore,
Duvall, Emmerson, Eng, Evans, Feuer, Fletcher, Fong,
Fuentes, Fuller, Furutani, Gaines, Galgiani, Garrick,
Gilmore, Hagman, Hall, Harkey, Hayashi, Hernandez, Hill,
Huber, Huffman, Jeffries, Jones, Knight, Krekorian, Lieu,
Logue, Bonnie Lowenthal, Ma, Mendoza, Miller, Monning,
Nava, Nestande, Niello, Nielsen, John A. Perez, V. Manuel
Perez, Portantino, Ruskin, Salas, Saldana, Silva,
Skinner, Smyth, Solorio, Audra Strickland, Swanson,
Torlakson, Torres, Torrico, Tran, Villines, Yamada, Bass
NO VOTE RECORDED: Buchanan, Vacancy
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JJA:do 1/6/10 Senate Floor Analyses
SUPPORT/OPPOSITION: SEE ABOVE
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