BILL NUMBER: SB 1483 AMENDED
BILL TEXT
AMENDED IN SENATE APRIL 17, 2012
INTRODUCED BY Senator Steinberg
FEBRUARY 24, 2012
An act to amend Section 2842 add Article
14 (commencing with Section 2340) to Chapter 5 of Division 2 of
the Business and Professions Code, relating to healing arts.
LEGISLATIVE COUNSEL'S DIGEST
SB 1483, as amended, Steinberg. Vocational nursing.
Physicians and surgeons.
Existing law provides for the licensing and regulation of
physicians and surgeons by the Medical Board of California.
This bill would create the Physician Health Program, administered
by the Physician Health, Recovery, and Monitoring Oversight
Committee, with 14 members to be appointed as specified. The purpose
of the program would be to promote awareness and education relative
to physician and surgeon health issues, including impairment due to
alcohol or substance abuse, mental disorders, or other health
conditions that could affect the safe practice of medicine. The bill
would provide for referral by the program of physicians and surgeons,
as defined, to certified monitoring programs on a voluntary basis,
governed by a written agreement between the participant and the
program. The bill would require the Department of Consumer Affairs to
select a contractor to implement the program, with the committee
serving as the evaluation body for submitted proposals. The bill
would require the committee to report to the department on the
outcome of the program and would require regular audits of the
program. The bill would enact other related provisions.
Existing law, the Vocational Nursing Practice Act, provides for
the licensure and regulation of the practice of vocational nursing by
the Board of Vocational Nursing and Psychiatric Technicians of the
State of California. The board is comprised of 11 members, including
one member who is a licensed vocational nurse or registered nurse
with specified experience as a teacher or administrator in an
accredited school of vocational nursing.
This bill would instead require that experience to have been
obtained in a board-approved school of vocational nursing. The bill
would make other technical, nonsubstantive changes.
Vote: majority. Appropriation: no. Fiscal committee: no
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) (1) It is in every patient's interest to have physicians and
surgeons that are healthy and well.
(2) Physicians and surgeons may have health conditions that
interfere with their ability to practice medicine safely.
(3) In such cases, the most effective long-term protection for
patients is early intervention to address health issues that have the
potential to interfere with the safe practice of physicians and
surgeons.
(b) While the Legislature recognizes that physicians and surgeons
have a number of options for obtaining treatment, it is the intent of
the Legislature in enacting this act to promote awareness among
members of the medical community about health issues that could
interfere with safe practice, to promote awareness that private early
intervention options are available, to provide resources and
referrals to ensure physicians and surgeons are better able to choose
high quality private interventions that meet their specific needs,
and to provide a separate mechanism for monitoring treatment.
SEC. 2. Article 14 (commencing with Section 2340)
is added to Chapter 5 of Division 2 of the Business and
Professions Code , to read:
Article 14. Physician Health, Awareness, and Monitoring
Quality
2340. This article shall be known and may be cited as the
Physician Health, Awareness, and Monitoring Quality Act of 2012.
2341. For purposes of this article, the following terms have the
following meanings:
(a) "Board" means the Medical Board of California.
(b) "Committee" means the Physician Health, Awareness, and
Monitoring Quality Oversight Committee established pursuant to
Section 2343.
(c) "Department" means the Department of Consumer Affairs.
(d) "Impairment" means the inability to practice medicine with
reasonable skill and safety to patients by reason of alcohol or
substance abuse, a mental disorder, or another health condition as
determined by a clinical evaluation in individual circumstances.
(e) "Participant" means a physician and surgeon enrolled in the
program pursuant to an agreement entered into as provided in Section
2346.
(f) "Physician Health Program" or "program" means the program
defined in Section 2342 and includes vendors, providers, or entities
that contract with the committee pursuant to this article. The
program itself shall not offer or provide treatment services to
physicians and surgeons.
(g) "Physician and surgeon" means a holder of a valid physician
and surgeon's certificate. For the purposes of participating in the
program under this article, "physician and surgeon" shall also mean a
student enrolled in a medical school approved or recognized by the
board, a graduate of a medical school enrolled in a medical specialty
residency training program approved or recognized by the board, or a
physician and surgeon seeking reinstatement of a license from the
board.
(h) "Qualifying illness" means alcohol or substance abuse, a
mental disorder, or another health condition that a clinical
evaluation determines can be monitored and treated with private
clinical and monitoring programs.
2342. The Physician Health Program shall do all of the following:
(a) Be available to all physicians and surgeons, as defined in
subdivision (g) of Section 2341.
(b) Promote awareness among members of the medical community on
the recognition of health issues that could interfere with safe
practice.
(c) Educate the medical community on the benefits of and options
available for early intervention to address those health issues.
(d) Refer physicians and surgeons to monitoring programs certified
by the program by executing a written agreement with the participant
and monitoring the compliance of the participant with that
agreement.
(e) Provide for the confidential participation by physicians and
surgeons who have a qualifying illness and that are not on probation
with the board.
2343. (a) (1) There is hereby established the Physician Health,
Awareness, and Monitoring Quality Oversight Committee that shall have
the duties and responsibilities set forth in this article. The
committee may take any reasonable administrative actions to carry out
the responsibilities and duties set forth in this article,
including, but not limited to, hiring staff and entering into
contracts.
(2) The committee shall be formed no later than ____.
(3) The committee composition shall be as follows:
(A) All of the members under this subparagraph shall be appointed
by the Governor and licensed in this state as physicians and surgeons
with education, training, and experience in the identification and
treatment of substance use or mental disorders, or both.
(i) Two members recommended by a statewide association
representing psychiatrists with at least 3,000 members.
(ii) Two members recommended by a statewide association
representing addiction medicine specialists with at least 300
members.
(iii) Three members recommended by a statewide association
representing physician and surgeons from all specialties, modes of
practice, and practice settings with at least 25,000 members.
(iv) One member recommended by a statewide hospital association
representing at least 400 hospitals.
(v) For the purpose of the initial composition of the committee,
one member appointed under clause (i) shall be appointed for a
two-year term and the other member for a three-year term; one member
appointed under clause (ii) shall be appointed for a two-year term
and the other member for a three-year term; one member appointed
under clause (iii) shall be appointed for a two-year term, one member
for a shall be appointed for three-year term, and one member shall
be appointed for a four-year term; and the member appointed under
clause (iv) shall be appointed for a four-year term.
(B) All members appointed under this subparagraph shall have
experience in a field related to mental illness, or alcohol or
substance abuse, or both.
(i) Four members of the public appointed by the Governor. For the
initial appointment to the committee, two members shall be appointed
to serve for two-year terms and two members shall be appointed to
serve for four-year terms.
(ii) One member of the public appointed by the Speaker of the
Assembly. The initial appointment shall be for a three-year term.
(iii) One member of the public appointed by the Senate Committee
on Rules. The initial appointment shall be for a three-year term.
(4) For the purposes of this section, a public member may not be
any of the following:
(A) A current or former physician and surgeon or an immediate
family member of a physician and surgeon.
(B) A current or former employee of a physician and surgeon, or a
business providing or arranging for physician and surgeon services,
or having any financial interest in the business of a physician and
surgeon.
(C) An employee or agent or representative of any organization
representing physicians and surgeons.
(D) An individual or an affiliate of an organization who has
conducted business with or regularly appeared before the board.
(5) A public member shall meet all of the requirements for public
members on a board as set forth in Chapter 6 (commencing with Section
450) of Division 1.
(b) Members of the committee shall serve without compensation.
(c) Except as provided for in subdivision (a), committee members
shall serve terms of four years and may be reappointed.
(d) The committee shall be subject to the Bagley-Keene Open
Meeting Act (Article 9 (commencing with Section 11120) of Chapter 1
of Part 1 of Division 3 of Title 2 of the Government Code) and the
California Public Records Act (Chapter 3.5 (commencing with Section
6250) of Division 7 of Title 1 of the Government Code).
(e) The rules adopted by the committee shall be consistent with
Section 315, the guidelines of the Federation of State Physician
Health Programs, Inc., as well as community standards of practice,
including, but not limited to, criteria for acceptance of
participants into the program and the refusal to accept a person as a
participant into the program and the assigning of costs of
participation and associated financial responsibilities of
participants. In the event of any conflicts between standards
established pursuant to Section 315 and the guidelines of the
Federation of State Physician Health Programs, Inc., and community
standards of practice, Section 315 shall prevail.
2344. (a) The department shall select a contractor for the
Physician Health Program pursuant to a request for proposals, and the
committee shall contract for a five-year term with that entity. The
process for procuring the services for the program shall be
administered by the department pursuant to Article 4 (commencing with
Section 10335) of Chapter 2 of Part 2 of Division 2 of the Public
Contract Code. However, the committee shall serve as the evaluation
body for the procurement.
(b) The chief executive officer of the program vendor shall have
expertise in the areas of substance or alcohol abuse, and mental
disorders in health care professionals.
(c) The program vendor shall have a medical director to oversee
clinical aspects of the program's operations. The medical director
shall have expertise in the diagnosis and treatment of alcohol and
substance abuse and mental disorders in health care professionals.
(d) The program vendor shall have established relationships with
local medical societies and hospital well-being committees for
conducting education, outreach, and referrals for physician and
surgeon health.
(e) The program vendor shall monitor the monitoring entities that
participating physicians and surgeons have retained for monitoring
the participant's treatment and shall provide ongoing services to
physicians and surgeons that resume practice.
(f) The program vendor shall have a system for promptly reporting
physicians and surgeons unable to practice safely to the board when,
contrary to agreements with the Physician Health Program, they
continue to practice unsafely. This system shall ensure absolute
confidentiality in the communication to the enforcement division of
the board, and shall not provide this information to any other
individual or entity unless authorized by the enrolled physician and
surgeon.
(g) The contract entered into pursuant to this article shall also
require the program vendor to do both of the following:
(1) Report annually to the committee statistics related to the
program, including, but not limited to, the number of participants
currently in the program, the number of participants referred by the
board as a condition of probation, the number of participants who
have successfully completed their agreement period, the number of
participants terminated from the program, and the number of
participants reported by the program pursuant to subdivision (c) of
Section 2346. However, in making that report, the program shall not
disclose any personally identifiable information relating to any
participant.
(2) Submit to periodic audits and inspections of all operations,
records, and management related to the program to ensure compliance
with the requirements of this article and its implementing rules and
regulations, if any.
(h) In addition to the requirements of Section 2349, the committee
shall monitor compliance of the program with the requirements of
this article. The committee or its designee may make periodic
inspections and onsite visits with the vendor contracted to provide
Physician Health Program services.
(i) Copies of the audits referenced in paragraph (2) of
subdivision (g) shall be published and provided to the appropriate
policy committees of the Legislature within 10 business days of
publication. A copy shall also be made available to the public by
posting a link on the committee's Internet Web site homepage no more
than 10 business days after publication.
2346. (a) A physician and surgeon shall, as a condition of
participation in the Physician Health Program, enter into an
individual agreement with the program.
(b) The agreement between the physician and surgeon and the
program shall include all of the following:
(1) A jointly agreed-upon plan and mandatory conditions and
procedures to monitor compliance with the program, including, but not
limited to, an agreement to cease practice.
(2) Compliance with terms and conditions of treatment and
monitoring.
(3) Limitations on practice.
(4) Conditions and terms for return to practice.
(5) Criteria for program completion.
(6) Criteria for termination of the participant from the program.
(c) In addition, if the physician and surgeon retains the services
of a private monitoring entity, he or she shall agree to authorize
the program vendor to receive reports from the private monitoring
entity and to request information from the private monitoring entity
regarding his or her treatment status. Except as provided in
subdivisions (b), (c), (d), and (e), and subdivision (f) of Section
2344, a physician and surgeon's participation in the program pursuant
to an agreement shall be confidential unless waived by the physician
and surgeon.
(d) Any agreement entered into pursuant to this section shall not
be considered a disciplinary action or order by the board, and shall
not be disclosed to the committee or the board if both of the
following apply:
(1) The physician and surgeon did not enroll in the program as a
condition of probation or as a result of an action of the board.
(2) The physician and surgeon is in compliance with the conditions
and procedures in the agreement.
(e) (1) The program shall immediately report the name of a
participant to the committee when it learns of the participant's
failure to meet the requirements of the program including failure to
cease practice when required or failure to submit to evaluation,
treatment, or biological testing when required. The program shall
also immediately report the name of a participant to the committee
when it learns that the participant's impairment is not substantially
alleviated through treatment, or if the participant withdraws or is
terminated from the program prior to completion, or if, in the
opinion of the program after a risk assessment is conducted, the
participant is unable to practice medicine with reasonable skill and
safety.
(2) Within two business days of receiving a report pursuant to
paragraph (1), the committee shall refer the matter to the board.
(f) Except as provided in subdivisions (b), (c), and (e) and
subdivision (f) of Section 2344, and this subdivision, any oral or
written information reported to the board pursuant to this section,
including, but not limited to, any physician and surgeon's
participation in the program and any agreement entered into pursuant
to this article, shall remain confidential as provided in subdivision
(c) of Section 800, and shall not constitute a waiver of any
existing evidentiary privileges under any other provision or rule of
law. However, confidentiality regarding the physician and surgeon's
participation in the program and of all information and records
created by the program related to that participation shall not apply
if the board has referred a participant as a condition of probation.
(g) Nothing in this section prohibits, requires, or otherwise
affects the discovery or admissibility of evidence in an action by
the board against a physician and surgeon based on acts or omissions
within the course and scope of his or her practice.
(h) Any information received, developed, or maintained by the
committee regarding a physician and surgeon in the program shall not
be used for any other purposes.
2347. The committee shall report to the department statistics
received from the program pursuant to Section 2344, and the
department shall, thereafter, report to the appropriate policy
committees of the Legislature on or before ____, and annually
thereafter, the outcomes of the program, including, but not limited
to, the number of individuals served, the number of participants
currently in the program, the number of participants referred by the
board as a condition of probation, the number of individuals who have
successfully completed their agreement period, the number of
participants terminated from the program, and the number of
individuals reported to the board for noncompliance pursuant to
subdivision (c) of Section 2346. However, in making those reports,
the committee and the department shall not disclose any personally
identifiable information relating to any physician and surgeon
participating in the program pursuant to an agreement entered into
pursuant to Section 2346.
2349. (a) The committee shall biennially contract to perform an
audit of the Physician Health Program and its vendors. This section
is not intended to reduce the number of audits the committee may
otherwise conduct. The initial audit shall commence two years after
the award of an initial five-year contract. Under no circumstances
shall General Fund revenue be used for this purpose.
(b) Any person or entity conducting the audit required by this
section shall maintain the confidentiality of all records reviewed
and information obtained in the course of conducting the audit and
shall not disclose any information identifying any program
participant.
(c) The biennial audit shall be done by ____ and shall ascertain
if the program is operating in conformance with the rules and
regulations established by the committee.
SECTION 1. Section 2842 of the Business and
Professions Code is amended to read:
2842. (a) Each member of the board shall be a citizen of the
United States and a resident of the State of California. The board
shall have the following composition:
(1) Two members shall be duly licensed vocational nurses who have
been licensed for a period of not less than three years prior to
appointment.
(2) Two members shall be licensed psychiatric technicians, each of
whom shall have had not less than five years' experience in a
psychiatric hospital, or in a psychiatric unit of a hospital licensed
by the State Department of Health Care Services, or a private
institution licensed by the State Department of Health Care Services.
(3) One member shall be a licensed vocational nurse or registered
nurse who shall have had not less than five years' experience as a
teacher or administrator in a board-approved school of vocational
nursing.
(4) Six members shall be public members who are not licentiates of
the board or any other board under this division or of any board
referred to in Sections 1000 and 3600.
(b) No person may serve as a member of the board for more than two
consecutive terms.
(c) Per diem and expenses of members of the board who are licensed
psychiatric technicians shall be paid solely from revenues received
pursuant to Chapter 10 (commencing with Section 4500) of Division 2.