BILL NUMBER: SB 1483 AMENDED
BILL TEXT
AMENDED IN ASSEMBLY JULY 2, 2012
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 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
licensure 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 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.
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 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 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.
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 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
830.10.
(f) "Physician Health Program" or "program" means the program
defined in Section 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.
830.4. The Physician Health Program shall do all of the
following:
(a) Subject to the requirements of Section 830.10, be available to
all physicians and surgeons, as defined in subdivision (g) of
Section 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 who are not on probation
with the board.
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 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 a
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.
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 program vendor 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)
(d) The program vendor shall monitor the monitoring
entities that participating physicians and surgeons have retained for
monitoring a participant's treatment and shall provide ongoing
services to physicians and surgeons that resume practice.
(f)
(e) 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
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)
(f) 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 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)
(g) In addition to the requirements of Section 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)
(h) Copies of the audits referenced in paragraph (2) of
subdivision (g) (f) 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.
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 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) (e) of Section 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 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) (e)
of Section 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) (d), and (e)
of Section 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.
830.14. (a) The committee shall report to the department
statistics received from the program pursuant to Section 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 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 830.10.
(b) This section shall become inoperative on October 1, 2018,
pursuant to Section 10231.5 of the Government Code.
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 completed by ____ and shall
ascertain if the program is operating in conformance with the rules
and regulations established by the committee.