BILL NUMBER: SB 1410	INTRODUCED
	BILL TEXT


INTRODUCED BY   Senator Cedillo

                        FEBRUARY 19, 2010

   An act to amend Section 2177 of, and to add Sections 2177.5 and
2177.7 to, the Business and Professions Code, relating to medicine,
and declaring the urgency thereof, to take effect immediately.


	LEGISLATIVE COUNSEL'S DIGEST


   SB 1410, as introduced, Cedillo. Medicine: licensure examinations.

   Existing law, the Medical Practice Act, requires the Medical Board
of California to issue a physician's and surgeon's certificate to a
qualified applicant. Under the act, an applicant for a physician's
and surgeon's certificate is required to include specified
information with his or her application and to obtain a passing score
on an entire examination or on each part of an examination. Existing
law authorizes applicants to take the written examinations conducted
or accepted by the board in separate parts. Existing law requires an
applicant to obtain a passing score on Part III of the United States
Medical Licensing Examination within not more than 4 attempts of
taking that part of the examination.
   This bill would delete the prohibition on taking Part III of the
United States Medical Licensing Examination more than 4 times, and
would make that change retroactive to January 1, 2007. The bill would
also require the board to accept as a passing score from an
applicant the passing score that was adopted by the board and in
effect on the date the applicant registered for that examination or
part of the examination, and would make that requirement retroactive
to January 1, 2007. The bill would further require the board to adopt
a formal process for determining whether to adopt recommended
passing scores from the Federation of State Medical Boards.
   This bill would declare that it is to take effect immediately as
an urgency statute.
   Vote: 2/3. Appropriation: no. Fiscal committee: yes.
State-mandated local program: no.


THE PEOPLE OF THE STATE OF CALIFORNIA DO ENACT AS FOLLOWS:

  SECTION 1.  The Legislature finds and declares all of the
following:
   (a) Under Section 2177 of the Business and Professions Code, an
applicant who is seeking a physician's and surgeon's certificate in
California must obtain a passing score on Part III of the United
States Medical Licensing Examination (USMLE) within not more than
four attempts in order to be eligible for a certificate. The
examination has three parts. However, only Part III has a limit on
the number of times that an applicant may attempt to pass the part.
   (b) The USMLE is administered by the Federation of State Medical
Boards (FSMB), a national nonprofit entity. Periodically, the FSMB
recommends passing scores to the various state medical boards. It is
left to the discretion of each state board to determine whether to
adopt the recommended score. Historically, the Medical Board of
California (MBC) has not had a formal procedure regarding adoption of
the FSMB recommended passing score.
   (c) When an applicant registers for the USMLE, he or she has an
eligibility period of three months in which to take the examination.
Multiple examination dates are available within the three-month
period. The lack of a formal adoption process within the MBC combined
with a three-month window to take the examination after registration
has created some confusion as the MBC may increase the accepted
passing score at any time without public record, input, or
notification to applicants that have already registered for the
examination. In fact, there is an instance where an applicant
registered for the USMLE under one passing score and found out after
her examination date that the accepted passing score had been
increased without her knowledge. This applicant would have passed the
examination under the criteria in place when she registered for the
examination but because the passing score was increased between the
time she registered and sat for the examination, she did not pass.
   (d) Furthermore, prior to the enactment of Chapter 843 of the
Statutes of 2006 (AB 1796), California did not limit the number of
times an applicant may take any part of the USMLE. Under the new law,
which places an arbitrary limit of attempts on Part III of the
examination, highly qualified and much needed physicians and surgeons
are being denied a license to practice medicine in California. Their
only option is to move to another state, become licensed and
practice there, and return four years later.
   (e) Failing to pass the USMLE under an arbitrary cap on the number
of attempts does not translate into a lack of competency in
providing high-quality medical care. Furthermore, existing law does
not take into consideration learning disabilities, a history of poor
performance on standardized tests, hardships, or other variables that
may impede the ability of an individual to pass the examination,
essentially discriminating against certain applicants.
   (f) Twenty-eight states in the United States and one territory
have more lenient policies regarding the USMLE, which may include
having no cap or allowing for more attempts than California. Those
states and the one territory include AL, AZ, CO, CT, DE, FL, GU, HI,
IA, IL, KS, MA, MI, MN, MS, MT, NM, NV, NJ, NY, NC, ND, OH, OK, PA,
TN, VA, VI, and WY. In fact, AZ, CO, CT, DE, GU, HI, IA, KS, MA, MI,
MN, MS, MT, NJ, NY, NC, ND, OH, PA, TN, VI, VA, and WY have no limit
on the number of times an applicant may take the examination.
   (g) Lastly, even though AB 1796 was signed by the Governor, he
expressed concerns with the measure. The Governor issued a signing
message stating that AB 1796 failed to provide the appropriate
exceptions to the requirement that physicians and surgeons applying
for licensure pass Part III of the USMLE within four attempts, and
that AB 1796 may have unintended consequences. The Governor requested
that the MBC address his concerns. Subsequently, the MBC requested
that language be added to Section 2177 of the Business and
Professions Code that would cross-reference Section 2135.5 of the
Business and Professions Code to exempt from the four-attempt
limitation an applicant who holds an unlimited and restricted license
as a physician and surgeon in another state and who has held that
license continuously for a minimum of four years prior to the date of
application. This amendment was added by Chapter 588 of the Statutes
of 2007 (SB 1048), which was an omnibus bill for the Senate
Committee on Business and Professions.
   (h) The inclusion of those changes by SB 1048 has proven to be an
inadequate approach to addressing the need for flexibility and
consideration of other factors that may contribute to an individual
failing to pass Part III of the USMLE within four attempts. It is now
viewed by the Legislature as unreasonable to require an individual
to leave the state, go through all the steps necessary to obtain
licensure in another state, and then return to California after four
years to obtain a license to practice medicine.
   (i) It is further unreasonable for the MBC to change the passing
score for an examination once an applicant has registered for that
examination without any formal procedure or notification to the
applicant.
  SEC. 2.  Section 2177 of the Business and Professions Code is
amended to read:
   2177.  (a) A passing score is required for an entire examination
or for each part of an examination, as established by resolution of
the  Division of Licensing   board  .
   (b) Applicants may elect to take the written examinations
conducted or accepted by the  division   board
 in separate parts.
   (c)  (1)    An applicant shall
have obtained a passing score on Part III of the United States
Medical Licensing Examination within not more than four
attempts  in order to be eligible for a physician's and
surgeon's certificate. 
   (2)  Notwithstanding paragraph (1), an applicant who obtains a
passing score on Part III of the United States Medical Licensing
Examination in more than four attempts and who meets the requirements
of Section 2135.5 shall be eligible to be considered for issuance of
a physician's and surgeon's certificate.  
   (d) The changes made to subdivision (c) by the act adding this
subdivision shall apply retroactively to January 1, 2007. 
  SEC. 3.  Section 2177.5 is added to the Business and Professions
Code, to read:
   2177.5.  (a) Notwithstanding subdivision (a) of Section 2177, the
board shall accept as a passing score on an examination or part of an
examination from an applicant the passing score that was adopted by
the board and in effect on the date the applicant registered for that
examination or part of the examination.
   (b) This section shall apply retroactively to January 1, 2007.
  SEC. 4.  Section 2177.7 is added to the Business and Professions
Code, to read:
   2177.7.  The board shall adopt a formal process for determining
whether to adopt recommended passing scores from the Federation of
State Medical Boards.
  SEC. 5.  This act is an urgency statute necessary for the immediate
preservation of the public peace, health, or safety within the
meaning of Article IV of the Constitution and shall go into immediate
effect. The facts constituting the necessity are:
   In order to allow for the licensure of competent physicians and
surgeons at the earliest possible time, it is necessary that this act
take effect immediately.