BILL ANALYSIS �
Senate Appropriations Committee Fiscal Summary
Senator Christine Kehoe, Chair
SB 1483 (Steinberg) - Physicians and surgeons.
Amended: April 30, 2012 Policy Vote: B&P 7-0
Urgency: No Mandate: No
Hearing Date: May 14, 2012 Consultant: Bob Franzoia
This bill meets the criteria for referral to the Suspense File.
Bill Summary: SB 1483 would establish the Physician Health
Program administered by the Physician Health, Awareness and
Monitoring Quality Oversight Committee. 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.
Fiscal Impact: Unknown, major program costs, likely in the range
of $1.2 million to $1.4 million, from an unknown fund annually,
ongoing.
Unknown, likely significant administrative costs from an
unknown fund annually, ongoing.
Background: A similar physician health program was established
in 1980 with the intent "that the Medical Board of California
(MBC) seek ways and means to identify and rehabilitate
physicians and surgeons with impairment due to abuse of
dangerous drugs or alcohol, or due to mental illness or physical
illness, affecting competency so that physicians and surgeons so
afflicted may be treated and returned to the practice of
medicine in a manner which will not endanger the public health
and safety."
Although the enabling language made reference to physicians with
mental or physical
illness, the diversion program was structured to monitor
substance-abusing physicians. Participants in the diversion
program included physicians who voluntarily
sought help (self-referrals), physicians who were referred by
the MBC's enforcement
program during investigation of a complaint (board-referred),
and physicians who were
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ordered to participate by MBC's Division of Medical Quality
(DMQ) as a term of probation in a formal disciplinary order
(board-ordered). Each participant was required to enter into a
contract with the program and agree to abstain from the use of
drugs and alcohol, submit to random bodily fluids testing,
attend support group meetings with similarly impaired
physicians, undergo psychotherapy and/or substance abuse
treatment, retain a "worksite monitor," and cease practicing
medicine if so instructed by the program due to relapse or other
noncompliance with the terms of the contract.
Twelve MBC staff administered the program. Although several of
the program's components (including bodily fluids collection,
laboratory testing, and facilitation of support group meetings)
were contracted, the case management function of the program and
program administration were performed by the MBC at $1,200,000
to $1,400,000 annually and paid through licensing fees paid by
all California physicians. As of June 30, 2005, 232 physicians
were participating in the program though participation was near
300 at one time.
Each of five audits found the program was not adequately
monitoring participants though the MBC implemented
recommendations of the auditor each time. After the June 2007
Bureau of State Audits report, the MBC voted not to support
continuation of the program. This program sunset on July 1,
2008 and was repealed on January 1, 2009.
Proposed Law: This bill enacts the Physician Health, Awareness,
and Monitoring Quality Act of 2012, which would facilitate a
public-private program, independent of the MBC, to:
- Promote awareness about physician health issues that could
interfere with safe practice; including alcohol or substance
abuse, mental illness, or other health conditions that may be
addressed through private treatment and monitoring programs.
- Coordinate and oversee private treatment and monitoring
programs, educate the medical community about early intervention
options and provide resources to ensure physicians and surgeons
are better able to choose interventions that meet their needs.
- Protect patients by, as a condition of receiving confidential
access to such resources and referrals, requiring that
participating physicians and surgeons agree to specific terms
and conditions, the violation of which would result in immediate
reporting to the MBC for purposes of potential enforcement
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action.
California is one of only 5 states in the U.S. that does not
have a physician health program to coordinate and provide care
and referral services for physicians suffering from these
maladies.
No state regulatory agency is provided an oversight role and the
bill does not specify how the program would be funded.
Related Legislation: AB 526 (Fuentes) 2009 would have
established the Public Protection and Physician Health Program
Act of 2009 to create within the State and Consumer Services
Agency the Public Protection and Physician Health Committee,
which would, until January 1, 2021, assist physicians and
surgeons who may be impaired by alcohol or substance abuse or
dependence or by a mental disorder. AB 526 was held on the
Suspense File.
AB 214 (Fuentes) 2008 would have created the Public Protection
and Physician Health Program Act of 2008 under the Department of
Public Health. The Governor vetoed this bill and in his veto
message stated that it is inappropriate to separate the program
from the MBC because it is critical that the licensing agency be
directly involved in monitoring participation in the diversion
program to protect patients and enable timely enforcement
actions.
Recommended Amendments: In order to administer and fund this
program, staff recommends:
(1) Place the oversight of the committee within the Department
of Public Health or the Department of Consumer Affairs. Placing
oversight within the MBC may cause conflicts with its regulatory
role.
(2) Increase the biennial renewal fee of a physician's
certificate by $22 or an amount equal to 2.5 percent of this
same fee as set in Business and Professions Code 2435, whichever
is greater. (The fee in statute is $790; 2.5 percent would be
$19.75.) All costs of the committee and the program would be
paid out of the revenue collected by this fee.
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