BILL NUMBER: SB 1483 AMENDED
BILL TEXT
AMENDED IN SENATE MAY 29, 2012
AMENDED IN SENATE APRIL 30, 2012
AMENDED IN SENATE APRIL 17, 2012
INTRODUCED BY Senator Steinberg
FEBRUARY 24, 2012
An act to add Article 14 (commencing with Section 2340)
to Chapter 5 12.7 (commencing with Section 830) to
Chapter 1 of Division 2 of the Business and Professions Code,
relating to healing arts.
LEGISLATIVE COUNSEL'S DIGEST
SB 1483, as amended, Steinberg. Physicians and surgeons.
Existing law provides for the licensing and regulation of
physicians and surgeons by the Medical Board of California
(board) within the Department of Consumer Affairs (department). Under
existing law, the biennial license renewal fee for physicians and
surgeons is required to be fixed by the board and may not exceed $790
.
This bill would create the Physician Health Program, administered
by the Physician Health, Recovery, and Monitoring Oversight Committee
within the department , with 14 members to be appointed
as specified. The purpose of the program would be ,
among other things, 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 , and
to make treatment available to all physicians and surgeons subject
to a written agreement with the program that includes agreement by
the physician and surgeon to pay for expenses associated with the
treatment . The bill would also 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
department to select a contractor to implement the program,
with the committee serving as the evaluation body for submitted
proposals. The bill would require the program to report the name of a
participant to the board and the committee when it learns of the
participant's failure to meet the requirements of the program. The
bill would require the committee to report to the department certain
statistics received from the program, would require the department to
report to the Legislature on the outcomes of the program, and would
require regular audits of the program. The bill would enact
other related provisions.
This bill would increase the biennial license renewal fee by
$39.50 for purposes of these provisions, except as specified. The
bill would direct the board to transfer this revenue on a monthly
basis to the Physician Health, Awareness, and Monitoring Quality
Trust Fund, which the bill would create, and would specify that the
use of these funds is subject to appropriation by the Legislature.
The bill would enact other related provisions and make other
conforming changes.
Vote: majority. 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) (1) It is in every patient's interest to have physicians and
surgeons that who 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.
SEC. 2. Article 12.7 (commencing with Section 830)
is added to Chapter 1 of Division 2 of the Business and
Professions Code , to read:
Article 12.7. Physician Health, Awareness, and
Monitoring Quality
830. This article shall be known and may be cited as
the Physician Health, Awareness, and Monitoring Quality Act of 2012.
2341. 830.2. For purposes of this
article, the following terms shall 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 830.6 .
(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 830.10 .
(f) "Physician Health Program" or "program" means the program
defined in Section 2342 830.4 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. 830.4. The Physician Health
Program shall do all of the following:
(a) Be Subject to the requirements of
Section 830.10, be available to all physicians and surgeons, as
defined in subdivision (g) of Section 2341
830.2 .
(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
who are not on probation with the board.
2343. 830.6. (a) (1) There is
hereby established within the Department of Consumer Affairs
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 ____
April 1, 2013 .
(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 physicians 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), the
Administrative Procedure Act (Chapter 3.5 (commencing with Section
11340) 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
the Uniform Standards Regarding Substance-Abusing Healing Arts
Licensees as adopted by the Substance Abuse Coordination Committee of
the Department of Consumer Affairs pursuant to 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 the Uniform Standards Regarding Substance-Abusing Healing
Arts Licensees as adopted by the Substance Abuse Coordination
Committee of the Department of Consumer Affairs pursuant to Section
315 and the guidelines of the Federation of State Physician Health
Programs, Inc., and community standards of practice, the Uniform
Standards Regarding Substance-Abusing Healing Arts Licensees as
adopted by the Substance Abuse Coordination Committee of the
Department of Consumer Affairs pursuant to Section 315 shall prevail.
2344. 830.8. (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 a participant's treatment and shall
provide ongoing services to physicians and surgeons that resume
practice.
(f) The program vendor shall have a system for immediately
reporting physicians and surgeons who fail to meet the requirements
of the program as provided in subdivision (e) of Section
2346 830.10 . 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 (e) of
Section 2346 830.10 . 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.
(h) In addition to the requirements of Section 2349
830.16 , 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. 830.10. (a) A physician and
surgeon shall, as a condition of participation in the Physician
Health Program, enter into an individual agreement with the program
and agree to pay expenses related to treatment, monitoring,
laboratory tests, and other activities specified in the participant's
written agreement with the program .
(b) The written agreement between the physician and
surgeon and the program shall be consistent with the standards
adopted by the committee pursuant to subdivision (e) of Section
2343 830.6 , and 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.
(7) A stipulation that expenses related to treatment, monitoring,
laboratory tests, and other activities specified in the participant's
written agreement with the program will be paid by the participant.
(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 830.8 , 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 board and the committee when it learns of the
participant's failure to meet the requirements of the program,
including failure to cease practice when required, failure to submit
to evaluation, treatment, or biological testing when required, or a
violation of the rules adopted by the committee pursuant to
subdivision (e) of Section 2343 830.6 .
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) Notwithstanding subdivision (f) of Section 2344
830.8 , the report shall provide sufficient
information to permit the board to assess whether discipline or other
action is required to protect the public.
(f) Except as otherwise provided in subdivisions (b), (c), (e),
and (f) of Section 2344 830.8 ,
subdivision (e) of this section, 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.
830.12. (a) The biennial license renewal fee established in
subdivision (d) of Section 2435 shall increase by thirty-nine dollars
and fifty cents ($39.50) for purposes of this article, except those
purposes specified in Section 830.10. The board shall, on a monthly
basis, transfer the revenue generated from this increase to the trust
fund described in subdivision (b).
(b) There is hereby established in the State Treasury the
Physician Health, Awareness, and Monitoring Quality Trust Fund into
which all revenue generated pursuant to subdivision (a) shall be
deposited. These funds shall be used, upon appropriation by the
Legislature, exclusively for the purposes of this article, except
those purposes specified in Section 830.10.
(c) Nothing in this section shall be construed to prohibit
additional funding from private sources from being used to support
operations of the program or to support the establishment of the
committee and the program.
2347. 830.14. (a)
The committee shall report to the department statistics
received from the program pursuant to Section 2344
830.8 , and the department shall, thereafter, report to
the appropriate policy committees of the Legislature on or before
____ October 1, 2014 , 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 (e) of Section 2346 830.10
. 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
830.10 .
(b) This section shall become inoperative on October 1, 2018,
pursuant to Section 10231.5 of the Government Code.
2349. 830.16. (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
completed by ____ and shall ascertain if the program is
operating in conformance with the rules and regulations established
by the committee.