BILL ANALYSIS
SB 700
Page 1
Date of Hearing: March 23, 2010
ASSEMBLY COMMITTEE ON BUSINESS AND PROFESSIONS
Mary Hayashi, Chair
SB 700 (Negrete-McLeod) - As Amended: January 26, 2010
SENATE VOTE : 35-0
SUBJECT : Healing arts: peer review.
SUMMARY : Makes various changes to the physician peer review
process. Specifically, this bill :
1)Requires specified health-related boards' licensee central
files to include disciplinary information reported pursuant to
Section 805.01 and 805, including any exculpatory or
explanatory statements submitted by the licentiate.
2)Requires the central file to include a statement from a court,
if in its final judgment the court determined that the peer
review resulting in the 805 report was conducted in bad faith.
3)Requires the Medical Board of California (MBC), the
Osteopathic Medical Board of California (OMB), and the
California Board of Podiatric Medicine (CBPM) to disclose
information regarding enforcement actions taken against a
former licensee by their respective board or by another state
or jurisdiction. Such enforcement actions, for both current
and former licensees, shall include 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, unless a court finds, in a final
judgment, that the peer review resulting in the disciplinary
action was conducted in bad faith and the licensee notifies
the board of that finding. In addition, any exculpatory or
explanatory statements submitted by the licentiate
electronically shall be disclosed.
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4)Revises the definition of peer review to mean both of the
following:
a) A process in which a peer review body reviews the basic
qualifications, staff privileges, employment, medical
outcomes, or professional conduct of licentiates to make
recommendations for quality improvement and education, if
necessary, in order to do either or both of the following:
i) Determine whether a licentiate may practice or
continue to practice in a health care facility, clinic,
or other setting providing medical services, and, if so,
to determine the parameters of that practice; and,
ii) Assess and improve the quality of care rendered in a
health care facility, clinic, or other setting providing
medical services.
b) Other activities of a peer review body, as specified.
5)Requires the specified authority of a medical or professional
staff, peer review body, or licensed health care facility or
clinic where the licentiate is employed or has staff
privileges or membership or where the licentiate applied for
staff privileges or membership, or sought the renewal thereof
(Chief), to file an 805 report with the relevant agency within
15 days after the licentiate takes the following actions after
receiving notice of a pending investigation initiated for a
medical disciplinary cause or reason or after receiving notice
that his or her application for membership or staff privileges
is denied or will be denied for a medical disciplinary cause
or reason:
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a) Resigns or takes a leave of absence from membership,
staff privileges, or employment;
b) Withdraws or abandons his or her application for staff
privileges or membership; or,
c) Withdraws or abandons his or her request for renewal of
staff privileges or membership.
6)Requires notice sent to a licensee indicating that information
submitted electronically will be publicly disclosed to those
who request the information.
7)Requires the Chief to file a report (805.01 report)with the
relevant agency within 15 days after a peer review body makes
a final decision or recommendation regarding a disciplinary
action, as specified, resulting in a final proposed action to
be taken against a licentiate based on the peer review body's
determination that any of the following acts may have
occurred, regardless of whether a hearing is held pursuant to
Section 809.2:
a) Incompetence, or gross or repeated deviation from the
standard of care involving death or serious bodily injury
to one or more patients, such that the physician and
surgeon poses a risk to patient safety;
b) Drug or alcohol abuse by a physician and surgeon
involving death or serious bodily injury to a patient;
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c) Repeated acts of clearly excessive prescribing,
furnishing, or administering of controlled substances or
repeated acts of prescribing, dispensing, or furnishing of
controlled substances without a good faith effort prior
examination of the patient and a medical reason. However,
in no event shall a physician and surgeon prescribing,
furnishing, or administering controlled substances for
intractable pain, consistent with lawful prescribing, be
reported for excessive prescribing and prompt review of the
applicability of these provisions shall be made in any
complaint that may implicate these provisions; or,
d) Sexual misconduct with one or more patients during a
course of treatment or an examination.
8)Authorizes the relevant agency, including MBC, OMBC, and DBC
to inspect and copy the following documents in the record of
any formal investigation required to be reported pursuant to
805 or 805.01:
a) Any statement of charges;
b) Any document, medical chart, or exhibit;
c) Any opinions, findings, or conclusions; and,
d) Any certified copy of medical records, as permitted by
applicable law.
9)Requires the 805.01 report and related information to be kept
confidential and not be subject to discovery, except that the
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information may be reviewed in certain limited circumstances
and may be disclosed in any subsequent disciplinary hearing
conducted pursuant to the Administrative Procedure Act.
10)Does not require a peer review body to make a 805.01 report
if it does not make a final decision or recommendation
regarding the disciplinary action to be taken against a
licentiate based on their determination that any of the above
mentioned acts may have occurred.
11)Requires MBC to furnish a copy of an 805 report and any
additional exculpatory or explanatory information submitted
electronically to the board by the licensee upon request made
by a health facility, as specified. Prohibits MBC from
sending a copy if a court finds, in a final judgment, that the
peer review resulting in the report was conducted in bad faith
and the licensee who is the subject of the report notifies the
board of that finding.
12)Requires a peer review body, within 15 days of initiating a
formal investigation of a physician and surgeon's ability to
practice medicine safely based upon information indicating
that the physician and surgeon may be suffering from a
disabling mental or physical condition that poses a threat to
patient care, report to the MBC executive director (ED) name
of the physician and surgeon under investigation and the
general nature of the investigation. Requires a peer review
body that has made this report to also notify the MBC ED when
it has completed or closed an investigation.
13)Requires the MBC ED, upon receipt of the above report, to
contact the peer review body that made the report within 60
days in order to determine the status of the peer review
body's investigation. Requires the MBC ED contact the peer
review body periodically thereafter to monitor the progress of
the investigation. At any time, if the MBC ED determines that
the progress of the investigation is not adequate to protect
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the public, the MBC ED shall notify the MBC chief of
enforcement (CE), who shall promptly conduct an investigation
of the matter. Concurrently with notifying the CE, the MBC ED
shall notify the reporting peer review body and the chief
executive officer or an equivalent officer of the hospital of
its decision to refer the case for investigation by the CE.
Information received pursuant to this report is deemed
confidential, and if the peer review body closes the
investigation and determines there is no need for further
action to protect the public, the MBC ED shall purge and
destroy all records, unless the MBC ED has referred the matter
to the CE.
14)Defines "formal investigation" for the purpose of the above
report only, as an investigation ordered by the peer review
body's medical executive committee or its equivalent, based
upon information indicating that the physician and surgeon may
be suffering from a disabling mental or physical condition
that poses a threat to patient care. "Formal investigation"
does not include the usual activities of the well-being or
assistance committee or the usual quality assessment and
improvement activities undertaken by the medical staff of a
health facility in compliance with the licensing and
certification requirements for health facilities, or
preliminary deliberations or inquiries of the executive
committee to determine whether to order a formal
investigation.
15)Requires MBC to post on its Internet Web site any hospital
disciplinary actions that resulted in the termination or
revocation of a licensee's hospital staff privileges for a
medical disciplinary cause or reason, and a link to any
additional explanatory or exculpatory information submitted
electronically by the licensee. This information and any
felony convictions reported to MBC after January 3, 1991 shall
not be removed from the Web site after 10 years.
16)Requires that if a court finds that peer review resulting in
a hospital disciplinary action was conducted in bad faith and
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the licensee notifies the board of that finding, the
information concerning that hospital disciplinary action is to
be immediately removed from MBC's Internet Web site.
17)Requires MBC to post on the Internet a factsheet that
explains and provides information on the 805 reporting
requirements.
18)Defines "usual activities" of the well-being or assistance
committee as activities to assist medical staff members who
may be impaired by chemical dependency or mental illness to
obtain necessary evaluation and rehabilitation services that
do not result in referral to the medical executive committee.
19)Defines "formal investigation" as an investigation performed
by a peer review body based on an allegation that specified
acts occurred.
20)Makes technical changes.
EXISTING LAW provides for the professional review of specified
healing arts licentiates through a peer review process.
FISCAL EFFECT : Unknown
COMMENTS :
Purpose of this bill . 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.
Given the indispensable nature of health care, high quality
patient care is vital. Patients expect their treating
physicians or other medical professionals to be competent and
qualified, and physicians who fail to meet established
professional standards must be discovered, reviewed and
disciplined if necessary in a timely manner. Physician peer
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review is one of the regimes used to ensure that quality of care
is delivered while minimizing medical errors and managing
patient risks."
Background . 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, some suspect that 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
under review.
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's
highest priority is 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 surgeons and adopts final decisions in
disciplinary matters.
REGISTERED SUPPORT / OPPOSITION :
Support
None on file.
Opposition
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California Hospital Association
Analysis Prepared by : Sarah Huchel / B. & P. / (916) 319-3301