BILL ANALYSIS
SB 1150
Page 1
Date of Hearing: June 22, 2010
ASSEMBLY COMMITTEE ON BUSINESS, PROFESSIONS AND CONSUMER
PROTECTION
Mary Hayashi, Chair
SB 1150 (Negrete McLeod) - As Introduced: February 18, 2010
SENATE VOTE : 31-1
SUBJECT : Healing arts.
SUMMARY : Requires license designations on health care provider
advertising, 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, requires MBC to post a factsheet
on cosmetic surgery, requires MBC to adopt standards for
settings that offer in vitro fertilization, and makes changes to
MBC oversight of accreditation agencies. Specifically, this
bill :
1)Requires advertising by the following licensees to include the
following specified designations:
a) A chiropractor shall include the designation "DC" or the
word "chiropractor" immediately following the
chiropractor's name;
b) A dentist shall include the designation "DDS" or "DMD"
immediately following the dentist's name;
c) A physician and surgeon shall include the designation
"MD" immediately following the physician and surgeon's
name;
d) An osteopathic physician and surgeon shall include the
designation "DO" immediately following the osteopathic
physician and surgeon's name;
e) A podiatrist shall include the designation "DPM"
immediately following the podiatrist's name;
f) A registered nurse (RN) shall include the designation
"RN" immediately following the RN's name;
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g) A licensed vocational nurse shall include the
designation "LVN" immediately following the licensed
vocational nurse's name;
h) A psychologist shall include the designation "Ph.D."
immediately following the psychologist's name;
i) An optometrist shall include the applicable designation
or word, as specified, immediately following the
optometrist's name;
j) A physician assistant (PA) shall include the designation
"PA" immediately following the PA's name; and,
aa) A naturopathic doctor (ND) shall include the designation
"ND" immediately following the ND's name. However, if the
ND uses the term or designation "Dr." in an advertisement,
he or she shall further identify himself, as specified.
2)Defines "advertisement" as a communication by means of mail,
television, radio, motion picture, newspaper, book, directory,
Internet, or other electronic communication. Advertisements
do not include:
a) A medical directory released by a health care service
plan or a health insurer;
b) A billing statement from a health care practitioner to a
patient; or,
c) An appointment reminder from a health care practitioner
to a patient.
3)Applies the advertising requirements starting January 1, 2012
to any advertisement that is published annually and prior to
July 1, 2011.
4)States that this bill does not apply to any advertisement or
business card disseminated by a health care service plan, as
specified.
5)Requires 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 by January 1, 2012. However,
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these regulations shall not apply 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.
6)Requires MBC to post on its Internet Web site an
easy-to-understand factsheet to educate the public about
cosmetic surgery and procedures, including their risks.
Included with the factsheet shall be a comprehensive list of
questions for patients to ask their physician and surgeon
regarding cosmetic surgery.
7)Includes in vitro fertilization facilities in the definition
of "outpatient setting," (setting), authorizing MBC oversight.
8)Requires settings to, at the time of accreditation, submit for
approval by an accreditation agency of a detailed plan,
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 and
to govern emergency and urgent care situations.
9)Requires MBC to adopt standards that it deems necessary for
settings that offer in vitro fertilization.
10)Requires, rather than permits, MBC to notify the public
whether a setting is accredited, certified, or licensed, or if
the setting's accreditation, certification, or license has
been revoked, suspended, or placed on probation, or if the
setting has received a reprimand by the accreditation agency.
11)Requires every accredited setting to be inspected by the
accreditation agency and permits MBC inspection.
12)Requires MBC to ensure that accreditation agencies inspect
outpatient settings based on the following:
a) The frequency of inspection shall depend upon the type
and complexity of the outpatient setting to be inspected;
and,
b) Inspections shall be conducted no less often than once
every three years by the accreditation agency and as often
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as necessary by MBC to ensure the quality of care provided.
13)Deletes the requirement that MBC or the accreditation agency
give reasonable prior notice and present proper identification
to enter and inspect any setting that is accredited by an
accreditation agency.
14)Requires the setting to agree with the accreditation agency
on a plan of correction that gives the setting reasonable time
to supply information demonstrating compliance with the
standards of the accreditation agency, as well as the
opportunity for a hearing on the matter upon the request of
the setting. During that allotted time, a list of
deficiencies and the plan of correction shall be conspicuously
posted in a setting accessible to public view.
15)Requires reports on the results of any inspection be kept on
file with MBC or the accreditation agency along with the plan
of correction and the setting comments. The inspection report
may include a recommendation for reinspection. All inspection
reports, lists of deficiencies, and plans of correction shall
be public records open to public inspection.
16)Requires the accreditation agency to immediately report to
MBC if the setting has been issued a reprimand, if the
setting's certification of accreditation has been suspended or
revoked, or if the setting has been placed on probation.
17)Permits MBC to issue a citation to the accreditation agency
if it is not meeting MBC's criteria.
18)Permits MBC to establish, by regulation, a system to issue a
citation to an accreditation agency that is not meeting MBC's
criteria. This system shall meet the requirements of existing
law, as applicable, except that both of the following shall
apply:
a) Failure of an agency to pay an administrative fine
assessed pursuant to a citation within 30 days of the date
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
renewal fee, as specified. Approval of an agency shall not
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be renewed without payment of the renewal fee and fine;
and,
b) Administrative fines collected pursuant to the system
shall be deposited in the Outpatient Setting Fund of the
MBC.
19)States legislative intent.
20)Makes technical amendments.
EXISTING LAW :
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 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 or her license or other disciplinary
action including an administrative fine not to exceed $10,000.
2)Authorizes advertising by health care licensees to include certain
general information regarding the practitioner and requires
certain disclosures to be made regarding dentists, physicians
and surgeons, podiatrists and optometrists regarding the
advertising of their education, accreditation, certification
or specialty.
3)Requires a health care practitioner to disclose, while working, his
or her name and license status on a specified name tag in at
least 18-point type but provides if a health care practitioner
is in a practice or office where their license is prominently
displayed, they may opt to not wear a name tag.
4)Requires the MBC and the Board of Registered Nurses to promulgate
regulations to implement necessary changes on the use of laser
or intense pulse light devices for elective cosmetic
procedures by physicians and surgeons, nurses, and PAs.
5)Requires the MBC to adopt standards for accreditation of settings,
as defined, and in approving accreditation agencies to perform
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accreditation of settings, ensure that the certification
program shall, at a minimum, include standards for specified
aspects of settings' operations.
6)Requires accreditation of a setting to be denied by the
accreditation agency if the setting does not meet specified
standards and allows the setting to reapply for accreditation
at any time after receiving notification of denial.
7)Provides that before suspending or revoking a certificate of
accreditation, the accrediting agency shall provide the
setting with notice of deficiencies and reasonable time to
supply information demonstrating compliance with the standards
of the accrediting agency as well as the opportunity for a
hearing on the matter upon request of the setting.
8)Defines treatment for infertility as procedures consistent with
established medical practices in the treatment of infertility
by licensed physicians and surgeons including, but not limited
to, diagnosis, diagnostic tests, medication, surgery, and
gamete intrafallopian transfer. Defines in vitro
fertilization as the laboratory medical procedures involving
the actual in vitro fertilization process.
9)Requires the Department of Public Health (DPH) to license and
inspect health facilities, including acute care hospitals.
Requires DPH to conduct periodic inspections of acute care
hospitals no less than once every three years.
FISCAL EFFECT : Unknown
COMMENTS :
Purpose of this bill . According to the author's office, "SB
1150 guarantees the public's safety by strengthening the
regulation and oversight of fertility clinics and surgical
centers performing cosmetic procedures, and ensures that quality
of care standards are in place at these clinics and checked by
the appropriate credentialing agency."
Background . Cosmetic surgery is gaining in popularity. The
American Society of Plastic Surgeons' Web site states that
approximately 12.1 million cosmetic procedures were performed in
2008, representing a $10.3 billion industry.
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Most cosmetic procedures occur in physician-owned clinics.
These clinics are accredited by one of four accreditation
agencies approved by the MBC and are commonly referred to as
settings. A setting is defined as a facility where anesthesia
is used in doses that, when administered, does not have the
probability of placing the patient at risk for loss of life.
These accrediting agencies ensure that certification programs
include standards for the operation of settings, such as safety
and emergency training requirements, licensure or certification
of allied health staff, provision of onsite equipment, and
medication and trained personnel in a medical emergency.
Settings permit surgery only by a licensee who has admitting
privileges at a local accredited or licensed acute care hospital
and require a system for patient care and monitoring procedures.
Currently there are two organizations to which physicians who
practice reproductive medicine generally belong. Both
organizations provide practice guidelines and minimum standards
for assisted reproductive technologies, including in vitro
procedures. However, those guidelines are not mandatory.
Arguments in support . MBC writes, "This bill aims to improve
the regulation and oversight of outpatient settings including
surgery centers and fertility clinics, by ensuring that quality
of care standards are in place and evaluated regularly. MBC
feels that with the number of cosmetic procedures being
performed in the United States quickly increasing, there is
great need for state oversight of clinic operations."
Arguments in opposition . The California Hospital Association
(CHA) is concerned with the language in this bill that states,
"The department, pursuant to its existing regulations, inspect
the peer review process utilized by acute care hospitals as part
of its periodic inspection of these hospitals."
CHA states, "Peer review plays an essential role in assuring the
quality and safety of care provided in California hospitals.
CHA strongly supports peer review and the protections
surrounding peer review which are so important in assuring
candid, robust participation by physicians and other
practitioners. CHA believes that the intent language ? is
unnecessary because the department already has authority to
inspect hospitals for compliance with California hospital
licensing requirements, including requirements related to
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hospital medical staffs."
Previous legislation . SB 674 (Negrete McLeod) of 2009
required a health care practitioner, as specified, include
specific professional designation following the health care
practitioner's name in advertisements; required the 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; required 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; and,
authorized 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.
This bill was vetoed by the Governor, who stated, "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."
Related legislation : AB 583 (Hayashi) of 2009 requires health
care practitioners to display their educational degree, license
type and status, and board certification on either their nametag
or in their offices, as specified. Requires supervising
physicians and surgeons to post their hours in each office. AB
583 is on the Senate Inactive File.
Double-referred . This bill is double-referred to Assembly
Health Committee.
REGISTERED SUPPORT / OPPOSITION :
Support
Consumer Attorneys of California
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Medical Board of California
Proctor & Gamble Company
Opposition
California Hospital Association
Analysis Prepared by : Sarah Weaver / B.,P. & C.P. / (916)
319-3301