BILL ANALYSIS
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|SENATE RULES COMMITTEE | SB 700|
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UNFINISHED BUSINESS
Bill No: SB 700
Author: Negrete McLeod (D)
Amended: 8/20/10
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 (FAIL)
AYES: Alquist, Calderon, Corbett, DeSaulnier, Florez,
Hancock, Kehoe, Leno, Lowenthal, Negrete McLeod, Oropeza,
Padilla, Pavley, Romero, Simitian, Steinberg, Wiggins,
Wolk, Yee
NOES: Aanestad, Ashburn, Benoit, Cogdill, Cox, Denham,
Ducheny, Dutton, Harman, Hollingsworth, Huff, Maldonado,
Strickland, Walters, Wyland
NO VOTE RECORDED: Cedillo, Correa, Liu, Runner, Wright,
Vacancy
SENATE FLOOR : 17-16, 6/3/09 (FAIL)
AYES: Alquist, Calderon, Cedillo, Corbett, DeSaulnier,
Kehoe, Leno, Negrete McLeod, Oropeza, Padilla, Pavley,
Romero, Simitian, Steinberg, Wiggins, Wolk, Yee
NOES: Aanestad, Ashburn, Benoit, Cogdill, Correa, Cox,
Denham, Dutton, Harman, Hollingsworth, Huff, Maldonado,
Runner, Strickland, Walters, Wyland
NO VOTE RECORDED: Ducheny, Florez, Hancock, Liu,
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Lowenthal, Wright, Vacancy
SENATE FLOOR : 35-0, 1/28/10
AYES: Aanestad, Ashburn, Calderon, Cedillo, Cogdill,
Corbett, Correa, Cox, Denham, DeSaulnier, Ducheny,
Dutton, Florez, Hancock, Harman, Hollingsworth, Kehoe,
Leno, Liu, Lowenthal, Maldonado, Negrete McLeod, Oropeza,
Padilla, Pavley, Price, Romero, Simitian, Steinberg,
Strickland, Wiggins, Wolk, Wright, Wyland, Yee
NO VOTE RECORDED: Alquist, Huff, Runner, Walters, Vacancy
ASSEMBLY FLOOR : 76-0, 8/23/10 - See last page for vote
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 specified
licensing agencies include in a licensee's central file a
final judgment by a court that a peer review resulting in
an 805 report was conducted in bad faith and any
explanatory or exculpatory information submitted by a
licensee.
Assembly Amendments clarify the causes for which a
licentiate may be subject to an 805.01 report, delete
requirements related to peer review investigations of a
physician and surgeon who may be suffering from a disabling
mental or physical condition that pose a threat to patient
care, and make technical and conforming changes.
ANALYSIS :
Existing Law:
1.Provides for the professional review of specified
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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 (MBC) to
maintain an 805 report for a period of three years after
receipt.
4.Authorizes the MBC, the Osteopathic Medical Board of
California, and the Dental Board of California to
inspect and copy certain 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 MBC, 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 MBC to post hospital
disciplinary actions regarding its licensees on the
Internet.
This bill:
1.Requires specified licensing agencies include in a
licensee's central file the following:
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A. Any additional exculpatory or explanatory
statements submitted by the licentiate.
B. A finding by a court, in final judgment, that a
peer review resulting in an 805 report was
conducted in bad faith, provided the licensee
notifies the agency.
2.Prohibits the MBC, 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, in final judgment,
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, or professional conduct of
licentiates to make recommendations for quality
improvement and education in order to do either or both
of the following:
A. 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.
B. Assess and improve the quality of care rendered
in a health care facility, clinic, or other setting
providing medical services.
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 a licentiate undertakes any of the
following actions after receiving a notice or a pending
investigation initiated for a medical disciplinary cause
or reason or after receiving notice that his/her
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application for membership or staff privileges is denied
or will be denied for a medical disciplinary cause or
reason, 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/her application for
membership or staff privileges.
C. Withdraws or abandons his or her request for
renewal of membership or staff privileges.
6.Specifies that the notice advising a licentiate that
they may submit additional statements or other
information shall notify the licentiate that information
submitted electronically will be publicly disclosed to
those who request the information pursuant to current
law.
7.Requires an 805 report to be maintained electronically
for dissemination purposes for a period of three years
after receipt.
8.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 final decision or recommendation
regarding the disciplinary action resulting in a final
proposed 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 may have occurred, regardless of whether a
hearing is held regarding the final proposed action
pursuant to current B&P Code 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, to the
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extent or in such a manner as to be dangerous or
injurious to any person or the public.
B. The use of, or prescribing for, or administering
to, himself/ herself, any controlled substance; or
the use of any dangerous drug, or of alcoholic
beverages, to the extent or in such a manner as to
be dangerous or injurious to the licentiate, any
other person, or the public, or to the extent that
such use impairs the ability of the licentiate to
practice safely.
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 medical reason therefore. 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.
D. Sexual misconduct with one or more patients
during a course of treatment or an examination.
9.Requires the notice the licentiate receives regarding
the proposed final action include a notice advising the
licentiate of the right to submit additional explanatory
or exculpatory statements electronically or otherwise.
10.Entitles the relevant agency to inspect and copy the
following documents in the record of any formal
investigation required to be reported pursuant to item
#8) above:
A. Any statement of charges.
B. Any document, medical chart, or exhibit.
C. Any opinions, findings, or conclusions.
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D. Any certified copy of medical records, as
permitted by other applicable law.
11.States a peer review body is not required to make a
report if that body does not make a final decision or
recommendation regarding the disciplinary action to be
taken against a licentiate based on the body's
determination that any of the acts listed in #8) above
may have occurred.
12.States that the information reported pursuant to item
#8) 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 #8) above is
in addition to any other report currently required to be
reported under Section 805.
14.Defines formal investigation for purposes of item #8)
above as an investigation performed by a peer review
body based on an allegation that any of the acts listed
in #8) 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
#8) above.
16.Entitles the MBC, the Osteopathic Medical Board of
California, and the Dental Board of California to
inspect and copy any certified copy of medical records,
as permitted by other applicable law relating to any
disciplinary proceeding resulting in an action that is
required to be reported pursuant to Section 805.
17.Prohibits the disclosure of an 805 report to specified
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.
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18.Requires the MBC to remove from its Internet Web site
any information concerning a hospital disciplinary
action that is posted on the Internet Web site if a
court in final judgment finds that peer review resulting
in a hospital disciplinary action was conducted in bad
faith and the licensee notifies the MBC of the court
finding.
19.Requires the MBC to post on the Internet a fact sheet
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
under review.
MBC 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
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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 MBC, it received 138 805 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.
This bill is substantially similar to SB 820 (Negrete
McLeod), 2009-10 Session, which was vetoed by the Governor.
FISCAL EFFECT : Appropriation: No Fiscal Com.: Yes
Local: No
SUPPORT : (Verified 8/23/10)
California Medical Association
Center for Public Interest Law
Medical Board of California
ASSEMBLY FLOOR
AYES: Adams, Ammiano, Anderson, Arambula, Bass, Beall, Bill
Berryhill, Tom Berryhill, Block, Blumenfield, Bradford,
Brownley, Buchanan, Caballero, Charles Calderon, Carter,
Chesbro, Conway, Cook, Coto, Davis, De La Torre, De Leon,
DeVore, Eng, Evans, Feuer, Fletcher, Fong, Fuentes,
Fuller, Gaines, Galgiani, Garrick, Gatto, Gilmore,
Hagman, Hall, Harkey, Hayashi, Hernandez, Hill, Huber,
Huffman, Jeffries, Jones, Knight, Lieu, Logue, Bonnie
Lowenthal, Ma, Mendoza, Miller, Monning, Nava, Nestande,
Niello, Nielsen, V. Manuel Perez, Portantino, Ruskin,
Salas, Saldana, Silva, Skinner, Smyth, Solorio, Audra
Strickland, Swanson, Torlakson, Torres, Torrico, Tran,
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Villines, Yamada, John A. Perez
NO VOTE RECORDED: Furutani, Norby, Vacancy, Vacancy
JJA:do 8/24/10 Senate Floor Analyses
SUPPORT/OPPOSITION: SEE ABOVE
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