BILL ANALYSIS
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|SENATE RULES COMMITTEE | SB 700|
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THIRD READING
Bill No: SB 700
Author: Negrete McLeod (D)
Amended: 5/20/09
Vote: 21
SENATE BUS., PROF. & ECON. DEVEL. COMMITTEE : 7-2, 4/20/09
AYES: Negrete McLeod, Corbett, Correa, Florez, Oropeza,
Romero, Yee
NOES: Aanestad, Walters
NO VOTE RECORDED: Wyland
SENATE APPROPRIATIONS COMMITTEE : Senate Rule 28.8
SENATE FLOOR : 19-15, 5/14/09 (Failed)
SUBJECT : Healing arts: peer review
SOURCE : Author
DIGEST : This bill makes various changes relating to the
peer review process in which a final proposed action may be
imposed on a licentiate, if certain conditions are met, for
which a report (commonly referred to as 805 report pursuant
to Section 805 of the Business and Professions Code) is
required to be filed to the appropriate health care
regulatory body. In addition this bill requires the
Medical Board of California to include in a licensee's
central file a finding by a court that a peer review
resulting in an 805 report was conducted in bad faith, and
prohibits disclosure by certain health care regulatory
CONTINUED
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bodies of any summaries of hospital disciplinary actions
that result in the termination or revocation of a
licensee's staff privileges for medical disciplinary cause
or reason if a court finds that the peer review resulting
in the disciplinary action was conducted in bad faith and
the licensee notifies the board of such finding.
Senate Floor Amendments of 5/20/09 delete the requirement
that an 805 report must be submitted regardless of whether
a hearing on a final proposed action has occurred. Clarify
the documents which a health board may obtain during an
investigation of report, and clarify report
confidentiality.
Senate Floor Amendments of 5/11/09 clarify when a report
pursuant to a determination by a peer review body shall be
made to the relevant agency.
ANALYSIS :
Existing Law:
1.Provides for the professional review of specified
healing arts licentiates through a peer review process.
Existing law defines the term "peer review body" as
including a medical or professional staff of any health
care facility or clinic licensed by the State Department
of Public Health.
2.Requires specified persons are to file a report,
designates as an "805 report," with a licensing board
within 15 days after a specified action is taken against
a person licensed by that board. Existing law provides
various due process rights for licentiates who are the
subject of a final proposed disciplinary action of a
peer review body, including authorizing a licentiate to
request a hearing concerning that action.
3.Requires the Medical Board of California to maintain an
805 report for a period of three years after receipt.
4.Authorizes the Medical Board of California, the
Osteopathic Medical Board of California, and the Dental
Board of California to inspect and copy certain
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documents in the record of any disciplinary proceeding
resulting in action that is required to be reported in
an 805 report.
5.Requires specified healing arts boards to maintain a
central file of their licensees containing, among other
things, disciplinary information reported through 805
reports.
6.Requires the Medical Board of California, the
Osteopathic Medical Board of California, and the
California Board of Podiatric Medicine to disclose an
805 report to specified health care entities and to
disclose certain hospital disciplinary actions to
inquiring members of the public. Existing law also
requires the Medical Board of California to post
hospital disciplinary actions regarding its licensees on
the Internet.
This bill:
1.Requires the Medical Board of California to include in a
licensee's central file a finding by a court that a peer
review resulting in an 805 report was conducted in bad
faith, and the licensee who is the subject of the report
notifies the Medical Board of California of such
finding.
2.Prohibits the Medical Board of California, the
Osteopathic Medical Board of California, and the
California Board of Podiatric Medicine from disclosing
to an inquiring member of the public any summaries of
hospital disciplinary actions that result in the
termination or revocation of a licensee's staff
privileges for medical disciplinary cause or reason if a
court finds that the peer review resulting in the
disciplinary action was conducted in bad faith and the
licensee notifies the board of the finding.
3.Defines peer review as a process in which a peer review
body reviews the basic qualifications, staff privileges,
employment, medical outcomes, and professional conduct
of licentiates to determine whether the licentiate may
practice or continue to practice in a health care
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facility, clinic, or other setting providing medical
services and, if so, to determine the parameters of that
practice.
4.Clarifies that the definition of peer review body
includes any clinic specified in the Health and Safety
Code, and deletes reference to licensed clinics.
5.Clarifies that if any of the following are imposed on a
licentiate as a result of an action by a peer review
body an 805 report must be filed by the chief of staff
or a medical or professional staff or other chief
executive officer, medical director or administrator of
any peer review body and the chief executive officer or
administrator of any licensed health care facility or
clinic with the relevant agency within 15 days after the
effective date on any of the actions specified:
A. A licentiate's application for staff privileges or
membership is denied or rejected for a medical
disciplinary cause or reason.
B. A licentiate's membership, staff privileges, or
employment is terminated or revoked for a medical
disciplinary cause or reason.
C. Restrictions are imposed, or voluntarily accepted,
on staff privileges, membership or employment for a
cumulative total of 30 days or more for any 12-month
period, for a medical disciplinary cause or reason.
6.Clarifies that if a licentiate undertakes any of the
following the chief of staff or whoever is authorized
under existing law must file an 805 report within 15
days after the licentiate takes the action:
A. Resigns or takes a leave of absence from
membership, staff privileges, or employment.
B. Withdraws or abandons his or her application for
membership, staff privileges, or employment.
C. Withdraws or abandons his or her request for
renewal of membership, staff privileges or employment
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after receiving notice of a pending investigation
initiated for a medical disciplinary cause or reason
after receiving notice that his/her application for
membership, staff privileges, or employment is denied
or will be denied for a medical disciplinary cause or
reason.
7.Clarifies existing law by requiring an 805 report to be
filed within 15 days following the imposition of summary
suspension of staff privileges, membership, or
employment, if the summary suspension remains in effect
for a period in excess of 14 days, regardless of whether
a hearing has occurred, as specified.
8.Requires an 805 report to be maintained electronically
for dissemination purposes for a period of three years
after receipt.
9.Requires the chief of staff of a medical or professional
staff or other chief executive officer, medical
director, or administrator of any peer review body and
the chief executive officer or administrator of any
licensed health care facility or clinic to file a report
with the relevant agency within 15 days after a peer
review body makes a decision or recommendation regarding
the disciplinary action to be taken against a licentiate
based on the peer review body's determination, following
formal investigation of the licentiate, which any of the
following occurred:
A. The licentiate departed from the standard of
care and there was patient harm.
B. The licentiate committed or was responsible for
the occurrence of an adverse event described in
existing law.
C. The licentiate suffered from mental illness or
substance abuse.
D. The licentiate engaged in sexual misconduct.
10.Specifies that a peer review body shall not await a
final proposed action, as defined in existing law, for
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purposes of filing this report.
11.Entitles the relevant agency, without subpoena, to
inspect and copy the following unredacted documents in
the record of any formal investigation required to be
reported pursuant to item # 9) above:
A. Any statement of charges.
B. Any document, medical chart, or exhibit.
C. Any opinions, findings, or conclusions.
12.States that the information reported pursuant to item #
9) above shall be kept confidential and not subject to
discovery, but the information may be reviewed, as
specified, and may be disclosed in any subsequent
disciplinary hearing, as specified.
13.Specifies that the report required by item # 9) above is
in addition to any other report currently required to be
reported under Section 805.
14.Defines formal investigation for purposes of item # 9)
above as an investigation performed by a peer review
body based on an allegation that any of the acts listed
in #9) above occurred..
15.Requires that a licensee's central file of individual
historical record that is maintained by specified
agencies include information reported pursuant to item #
9) above.
16.Entitles the Medical Board of California, the
Osteopathic Medical Board of California, and the Dental
Board of California to inspect and copy specified
documents relating to any disciplinary proceeding
resulting in an action that is required to be reported
pursuant to Section 805 without subpoena and that the
specified documents be unredacted. Includes in the list
of documents that may be copied and inspected any peer
review minutes or reports.
17.Prohibits the disclosure of an 805 report to specified
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health care entities if a court finds that the peer
review resulting in the 805 report was conducted in bad
faith and the licensee who is the subject of the report
notifies the board of the court's finding.
18.Requires the Medical Board of California to remove from
its Internet website any information concerning a
hospital disciplinary action that is posted on the
Internet website if a court finds that peer review
resulting in a hospital disciplinary action was
conducted in bad faith and the licensee notifies the
Medical Board of California of the court finding.
19.Requires the Medical Board of California to post on the
Internet a factsheet that explains and provides
information on the reporting requirements under Section
805.
Background
What is Peer Review ? In peer review, physicians evaluate
their colleagues' work to determine compliance with the
standard of care. Peer reviews are intended to detect
incompetent or unprofessional physicians early and
terminate, suspend, or limit their practice if necessary.
Peer review is triggered by a wide variety of events
including patient injury, disruptive conduct, substance
abuse, or other medical staff complaints. A peer review
committee investigates the allegation, comes to a decision
regarding the physician's conduct, and takes appropriate
remedial actions. However, there is reluctance among
physicians to serve on peer review committees due to the
risk of involvement in related future litigation, including
medical malpractice lawsuits against a physician under
review. In addition, there has been rising concern
relating to "sham peer review." Sham peer review is the
use of the peer review system to discredit, harass,
discipline, or otherwise negatively affect a physician's
ability to practice medicine or exercise professional
judgment for a non-medical or patient safety related
reason. Other criticisms of peer review include over
legalization of the process, lack of transparency in the
system, and burdensome human and financial toll peer review
brings not only to the hospital but also to a physician
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under review.
Medical Board of California and 805 Peer Review Reporting
Requirements. The MBC is responsible for regulating and
licensing physicians in California. The MBC revokes,
suspends, or limits the practice of any physicians and
surgeons. In exercising regulatory authority over
physicians and surgeons the MBC has as its highest priority
the protection of the public. Currently, the MBC regulates
125,612 physicians and surgeons, of which 97,878 reside in
California. The MBC investigates complaints against
physicians and adopts final decisions in disciplinary
matters against physicians and surgeons.
According to the Medical Board of California, it received
one hundred thirty-eight 805 reports in 2007-2008 from
hospitals/clinics (74), health care service plans (17), and
medical group/employers (47). Out of all of these reports,
one accusation was filed, 92 cases are pending disposition
and 45 cases were closed. The number of 805 reports varies
from year to year but it appears that when adjusted to the
number of physicians and surgeons licensed and living in
California, or the number of people living in California,
the trend shows a downward direction.
FISCAL EFFECT : Appropriation: No Fiscal Com.: Yes
Local: No
SUPPORT : (Verified 5/27/09)
Medical Board of California
OPPOSITION : (Verified 5/27/09) (Previous version)
California Hospital Association
California Medical Association
ARGUMENTS IN SUPPORT : According to the author's office,
this bill is necessary to ensure that the current peer
review process continues to protect the public from
incompetent physicians. The author's office points out
that given the indispensable nature of health care, high
quality patient care are vital. Patients expect their
treating physicians or other medical professionals to be
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competent and qualified, and physicians who fail to meet
established professional standards must be discovered,
reviewed and disciplined if necessary in a timely manner.
The author's office indicates that physician peer review is
one of the regimes used to ensure that quality of care is
delivered while minimizing medical errors and managing
patient risks.
The author's office further points out that the Medical
Board of California is the agency ultimately responsible
for the oversight of physicians and surgeons and it is
necessary that the Medical Board of California must be
notified when its licensees are practicing below the
standard of care, have substance abuse or mental illness
problems, or have committed sexual misconduct.
Furthermore, the author's office states that it is not the
bill's intent to cast physicians and surgeons in a false
light but to improve the delivery of quality health care to
consumers.
ARGUMENTS IN OPPOSITION : The California Hospital
Association states in opposition, "SB 700 seeks to add a
new Section 805.01 to the Business and Professions Code,
which would, in part, require reporting of investigations
by peer review bodies that find a departure in the standard
of care, mental illness, substance abuse, and sexual
misconduct. The bill was amended on April 22 to further
qualify the reporting for a departure of the standard of
care, "the licentiate departed from the standard of care
and there was patient harm, including, but not limited to,
any of the adverse events described in paragraph (1) of
subdivision (b) of Section 1279.1 of the Health and Safety
Code." This reporting will be in addition to any report
required under Section 805. We are very concerned that
reporting at this early juncture will have a number of
deleterious effects, including: (1) a chilling effect on
peer review in that it is likely to make reviewers more
reluctant than they already are to reach adverse standard
of care decisions; and (2) not providing meaningful
information for the medical board since the reporting
threshold is so low. This could distract attention from
meaningful medical board oversight."
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JJA:do 5/27/09 Senate Floor Analyses
SUPPORT/OPPOSITION: SEE ABOVE
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