BILL ANALYSIS �
SB 1483
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Date of Hearing: August 8, 2012
ASSEMBLY COMMITTEE ON APPROPRIATIONS
Felipe Fuentes, Chair
SB 1483 (Steinberg) - As Amended: July 2, 2012
Policy Committee: Business and
Professions Vote: 9-0
Urgency: No State Mandated Local Program:
No Reimbursable: No
SUMMARY
This bill establishes the Physician Health Program (program) to
promote awareness and provide oversight and referral services
for physicians suffering mental health, addition, or other
health conditions that impair a physician's ability to practice
safely. Specifically, this bill:
1)Establishes, delineates the composition of, and specifies
duties of the Physician Health, Awareness, and Monitoring
Quality Oversight Committee (Committee) within the Department
of Consumer Affairs (DCA).
2)Requires DCA to contract with a vendor to administer the
program.
3)Establishes minimum qualifications for, and duties of, a
vendor administering the program.
4)Requires physicians participating in the program to enter into
an agreement with the program, including agreeing to pay all
treatment, monitoring, and other related expenses.
5)Establishes the Physician Health, Awareness, and Monitoring
Quality Trust Fund (Trust Fund), increases the biennial
physician's licensure fee by $39.50, and requires deposits of
this fee increase to the Trust Fund for purposes of funding
the program.
FISCAL EFFECT
1)Costs related to this bill are expected to be covered, at
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least initially, by an increase in license renewal fee
revenue. This bill raises renewal fees by $39.50 per biennial
renewal cycle, which will raise approximately $2.3 million in
revenue for the Trust Fund.
2)One-time costs to DCA to establish contract specifications and
procure a suitable vendor of $100,000 (Trust Fund).
3)One-time IT and administrative costs of $20,000 (Contingent
Fund of the Medical Board of California) would be incurred by
the Medical Board of California in order to implement the
licensure fee change effective January 1, 2013.
4)Annual costs as follows:
a) Contract costs, likely in the range of $1 to $2 million
(Trust Fund). A prior physician health program, which was
administered by the MBC and functioned as a diversion from
enforcement, cost approximately $1.3 million annually.
Given that the program envisioned by this bill is expected
to be largely voluntary and is not intended to function as
a diversion from enforcement, the potential take-up rate
may be higher than in the previous program. If enrollment
in the program over time is higher than projected here,
costs could exceed $2 million annually.
b) Administrative costs to DCA to provide fiscal
management, administrative staff, and IT support to the
Committee in the range of $100,000 (Trust Fund).
1)Biennial vendor audit costs in the range of $300,000 (Trust
Fund).
COMMENTS
1)Rationale . The author argues the 2007 dissolution of a
problem-plagued physician diversion program previously
operated by the MBC left a gap in the state's ability to
address serious physician health conditions. He indicates
that since the program ended, physicians dealing with alcohol
or substance abuse issues, mental illness, or other health
conditions that may interfere with their ability to practice
medicine safely have not had a centralized resource to assist
them in seeking private treatment and monitoring services. He
contends this is a serious public health risk for the state,
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as troubled practitioners present a threat to patients.
2)Background . At least 42 states offer centralized physician
health programs that offer assistance to physicians struggling
with health conditions that impair their ability to care for
patients.
The Medical Board of California voted to allow California's
previous physician health program to sunset in 2008 after
reports by the California State Auditor cited numerous
problems, including inconsistent monitoring of doctors and
poor medical board oversight. This program was run by the MBC
itself, and functioned as an option for diversion from
enforcement. Since the program was terminated and a
transition plan was established for participants, there has
not been a diversion from the discipline process for physician
with substance abuse or mental health problems.
It is unclear whether the MBC will interact with the Committee
or the program established by this bill. Language in this
bill appears to permit the MBC to require physician
participation in the program as a condition of probation, but
there is no requirement that MBC must make use of the program.
Some healing arts boards still operate diversion programs.
DCA currently manages a master contract for six healing arts
boards' and one committee's diversion programs. Similar to
the program envisioned by this bill, health practitioners with
mental illnesses or substance abuse issues may be referred or
self-refer into the programs and receive help with
rehabilitation. The individual boards oversee the programs,
but monitoring, case management, and evaluation services are
provided by the contractor.
3)Fiscal Sustainability of Program . Based on past projections
and experience of similar programs, the revenue generated by
the new fee established in this bill should equal operating
costs. However, if enrollment in the program is larger than
anticipated, or if program costs grow over time, revenue
raised by the fee may prove inadequate. The bill does not
establish a mechanism to increase revenues to match
expenditures. In addition, the bill authorizes expenditure
from the Trust Fund exclusively for purposes of this program,
but does not require the Trust Fund to be the sole state
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funding source for the program.
4)Previous Legislation . Since the dissolution of the prior
program, there have been two legislative attempts to
reestablish a program. AB 214 (Fuentes) in 2008 established a
voluntary program within the Department of Public Health, and
was vetoed due to concerns that physician oversight would be
fragmented without MBC involvement. AB 526 (Fuentes) in 2009
established a voluntary program within the State and Consumer
Services Agency, and was held on the Suspense File in Senate
Appropriations Committee.
SB 1441 (Ridley-Thomas), Chapter 548, Statutes of 2008 created
the Substance Abuse Coordination Committee (SACC) and required
the committee to formulate uniform and specific standards in
specified areas that each healing arts board shall use in
dealing with substance-abusing licensees, whether or not a
board chooses to have a formal diversion program.
Analysis Prepared by : Lisa Murawski / APPR. / (916) 319-2081