BILL ANALYSIS �
SB 1483
Page 1
SENATE THIRD READING
SB 1483 (Steinberg)
As Amended August 20, 2012
Majority vote
SENATE VOTE :36-2
BUSINESS & PROFESSIONS 9-0
APPROPRIATIONS 16-0
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|Ayes:|Hayashi, Bill Berryhill, |Ayes:|Gatto, Harkey, |
| |Allen, Butler, Eng, | |Blumenfield, Bradford, |
| |Hagman, Hill, Ma, Smyth | |Charles Calderon, Campos, |
| | | |Davis, Fuentes, Hall, |
| | | |Hill, Cedillo, Mitchell, |
| | | |Nielsen, Norby, Solorio, |
| | | |Wagner |
|-----+--------------------------+-----+--------------------------|
| | | | |
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SUMMARY : Creates the Physician Health, Awareness, and
Monitoring Quality (PHAMQ) Act and establishes the Physician
Health Program (PHP), which is a referral and monitoring program
for physicians, medical students, and medical residents seeking
treatment for alcohol or substance abuse, a mental disorder, or
other health conditions. Specifically, this bill :
1)Requires the PHP to be available to all physicians and
surgeons, promote awareness among members of the medical
community on the recognition of health issues that could
interfere with safe practice, educate the medical community on
the benefits of and options available for early intervention
to address those health issues, refer physicians and surgeons
to monitoring programs certified by the PHP by executing a
written agreement with the participant and monitoring the
compliance of the participant with that agreement, and provide
for the confidential participation by physicians and surgeons
who have a qualifying illness and who are not on probation
with the Medical Board of California (MBC).
2)Establishes within the Department of Consumer Affairs (DCA)
the Physician Health, Awareness, and Monitoring Quality
Oversight Committee (Oversight Committee) and vests it with
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the duties and responsibilities set forth in this bill, as
specified.
3)Requires the Oversight Committee to be formed no later than
April 1, 2013, and to have the following members:
a) Eight licensed physicians and surgeons appointed by the
Governor who have education, training, and experience in
the identification and treatment of substance use or mental
disorders, or both, including: two members recommended by
a statewide association representing psychiatrists with at
least 3,000 members; two members recommended by a statewide
association representing addiction medicine specialists
with at least 300 members; 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; and, one member
recommended by a statewide hospital association
representing at least 400 hospitals. Initial appointments
have staggered terms of two, three or four years, as
specified;
b) Six public members who have experience in a field
related to mental illness, or alcohol or substance abuse,
or both, and meet current law requirements for public
members of DCA boards. Four members are to be appointed by
the Governor, one is to be appointed by the Speaker of the
Assembly, and one is to be appointed by the Senate
Committee on Rules, with initial appointments of staggered
terms, as specified. Public members may not be:
i) A current or former physician and surgeon or an
immediate family member of a physician and surgeon;
ii) 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;
iii) An employee or agent or representative of any
organization representing physicians and surgeons; or,
iv) An individual or an affiliate of an organization who
has conducted business with or regularly appeared before
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the MBC.
4)Provides that the Oversight Committee members serve without
compensation, serve four-year terms except as specified, and
may be reappointed, and that the Oversight Committee shall be
subject to the Bagley-Keene Open Meeting Act, the
Administrative Procedure Act, and the California Public
Records Act.
5)Requires the rules adopted by the Oversight Committee to be
consistent with the Uniform Standards Regarding
Substance-Abusing Healing Arts Licensees (Uniform Standards)
as adopted by the Substance Abuse Coordination Committee
(SACC) of DCA, the guidelines of the Federation of State
Physician Health Programs, Inc., (FSPHPs) as well as community
standards of practice, as specified.
6)Requires DCA to select a contractor for the PHP pursuant to a
request for proposals, and requires the Oversight Committee to
contract for a five-year term with that entity. The process
for procuring the services for the PHP shall be administered
by DCA pursuant to law governing state agency contracting for
services within the Public Contract Code. However, the
Oversight Committee shall serve as the evaluation body for the
procurement.
7)Requires the PHP vendor to have expertise in the areas of
substance or alcohol abuse, and mental disorders in health
care professionals.
8)Requires the PHP vendor to oversee clinical aspects of the
PHP's operations, and requires the vendor to have expertise in
the diagnosis and treatment of alcohol and substance abuse and
mental disorders in health care professionals.
9)Requires the PHP vendor to monitor the monitoring entities
that participating physicians and surgeons have retained for
monitoring a participant's treatment and to provide ongoing
services to physicians and surgeons that resume practice.
10)Requires the PHP vendor to have a system for immediately
reporting physicians and surgeons who fail to meet the
requirements of the PHP, as specified, and prohibits the PHP
vendor from providing this information to any other individual
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or entity unless authorized by the enrolled physician and
surgeon.
11)Requires the contract entered into pursuant to this bill to
also require the PHP vendor to report annually to the
Oversight Committee statistics related to the PHP, as
specified, without disclosing any personally identifiable
information relating to any participant, and submit to
periodic audits and inspections of all operations, records,
and management related to the PHP to ensure compliance with
the requirements of this bill and its implementing rules and
regulations.
12)Requires, in addition to specified auditing requirements, the
Oversight Committee to monitor compliance of the PHP with the
requirements of this bill. The Oversight Committee or its
designee may make periodic inspections and onsite visits with
the vendor contracted to provide PHP services.
13)Requires copies of the audits referenced above to 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 on
Internet, as specified.
14)Requires a physician and surgeon, as a condition of
participation in the PHP, to enter into an individual
agreement with the PHP and agree to pay expenses related to
treatment, monitoring, laboratory tests, and other activities
specified in the participant's written agreement with the PHP.
15)Requires the written agreement between the physician and
surgeon and the PHP to be consistent with standards adopted by
the Oversight Committee and to include specified components.
16)Requires a physician and surgeon who retains the services of
a private monitoring entity to agree to authorize the PHP
vendor to receive reports from the private monitoring entity
and to request information from the private monitoring entity
regarding the physician and surgeon's treatment status. A
physician and surgeon's participation in the PHP pursuant to
an agreement shall be confidential unless waived by the
physician and surgeon, with specified exceptions.
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17)Specifies that any agreement entered into pursuant to this
bill shall not be considered a disciplinary action or order by
the MBC, and shall not be disclosed to the Oversight Committee
or the MBC if the physician and surgeon did not enroll in the
PHP as a condition of probation or as a result of an action of
the MBC, and the physician and surgeon is in compliance with
the conditions and procedures in the agreement.
18)Requires the PHP to immediately report the name of a
participant to the MBC and the Oversight Committee when it
learns of the participant's failure to meet the requirements
of the PHP, as specified. The PHP shall also immediately
report the name of a participant to the Oversight 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 PHP prior to
completion, or if, in the opinion of the PHP after a risk
assessment is conducted, the participant is unable to practice
medicine with reasonable skill and safety. Notwithstanding
other provisions of this bill, the report shall provide
sufficient information to permit the MBC to assess whether
discipline or other action is required to protect the public.
19)Provides, with specified exceptions, that any oral or written
information reported to the MBC pursuant to this bill,
including, but not limited to, any physician and surgeon's
participation in the PHP and any agreement entered into
pursuant to this bill, shall remain confidential, as
specified, 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 PHP and of all information and
records created by the PHP related to that participation shall
not apply if the MBC has referred a participant as a condition
of probation.
20)Provides that nothing in this bill prohibits, requires, or
otherwise affects the discovery or admissibility of evidence
in an action by the MBC against a physician and surgeon based
on acts or omissions within the course and scope of his or her
practice.
21)Prohibits any information received, developed, or maintained
by the Oversight Committee regarding a physician and surgeon
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in the PHP from being used for any other purposes.
22)Increases, beginning July 1, 2013, the existing biennial
license renewal fee for physicians and surgeons by $39.50 for
the purposes of this bill, except as specified, and requires
the MBC to transfer every month the revenue generated from
this increase to the trust fund described below.
23)Establishes in the State Treasury the PHAMQ Trust Fund (Trust
Fund), requires all revenue generated by this bill's increase
in license renewal fees to be deposited into the Trust Fund
and to be the sole source of funding for the program, and
requires the funds to be used, upon appropriation by the
Legislature, exclusively for the purposes of this bill, except
as specified.
24)Provides that nothing in this bill shall be construed to
prohibit additional funding from private contributions to the
Trust Fund from being used to support operations of the PHP or
to support the establishment of the Oversight Committee and
the PHP.
25)Requires the Oversight Committee to manage the program so as
not to exceed the amount of funding and resources provided.
26)Provides that an applicant for a physician's and surgeon's
certificate pursuant to current law requirements for licensure
shall be required to list on the application form whether he
or she has participated or is participating in the program or
in a program for alcohol or substance abuse in another state
or jurisdiction.
27)Requires the Oversight Committee to report to DCA statistics
received from the PHP and requires DCA to report to the
appropriate policy committees of the Legislature on or before
October 1, 2014, and annually thereafter until October 1,
2018, the outcomes of the program, as specified. However, in
making those reports, the Oversight Committee and DCA shall
not disclose any personally identifiable information relating
to any physician and surgeon participating in the PHP, as
specified.
28)Requires the Oversight Committee to biennially contract to
perform an audit of the PHP and its vendors, beginning two
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years after the award of an initial five-year contract, as
specified, prohibits General Fund revenue from being used for
this purpose, and requires any person or entity conducting the
audit to maintain the confidentiality of all records reviewed
and information obtained in the course of conducting the audit
and to not disclose any information identifying any PHP
participant.
29)Requires the biennial audit described above to be completed
by a date uncertain and to ascertain if the PHP is operating
in conformance with the rules and regulations established by
the Oversight Committee.
30)Provides terms and definitions.
FISCAL EFFECT : According to the Assembly Appropriations
Committee:
1)Costs related to this bill are expected to be covered 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. The bill requires the Oversight Committee to manage the
program within the available funding.
2)One-time costs to DCA to establish contract specifications and
procure a suitable vendor of $100,000 (Trust Fund).
3)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.
b) Administrative costs to DCA to provide fiscal
management, administrative staff, and information
technology (IT) support to the Committee in the range of
$100,000 (Trust Fund).
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1)Biennial vendor audit costs in the range of $300,000 (Trust
Fund).
COMMENTS : According to the author, "The MBC operated the
Diversion Program for 27 years, which utilized statutory
authority granted to 'divert' a physician into the Diversion
Program for treatment and rehabilitation in lieu of facing
disciplinary action. In 2007, the Diversion Program was
terminated following the release of audit upon audit exposing
the egregious shortcomings of the program, which in many cases
put patients at tremendous risk.
"Since the end of the diversion program, physicians dealing with
alcohol or substance abuse issues, mental illness, or other
health conditions that may interfere with their ability to
practice medicine safely can seek private treatment and
monitoring services. However, California is one of only five
states in the United States that does not have a physician
health program to coordinate and provide care and referral
services for physicians suffering from these maladies.
"This is a serious public health risk for the state, as these
troubled practitioners present a very real and immediate threat
to patients. Without a statewide system for increasing
awareness among the medical community about health issues that
could interfere with safe practice, coordination and oversight
of private treatment and monitoring programs, education about
such private early intervention options, and provision of
resources and referrals to ensure physicians and surgeons are
better able to choose high quality private interventions that
meet their specific needs, California's already overburdened and
aging physician workforce often has no other option than keeping
their struggle to themselves and trying to work through it.
This is both unsafe and unacceptable."
Analysis Prepared by : Angela Mapp / B.,P. & C.P. / (916)
319-3301
FN: 0005066
SB 1483
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