Bill Text: CA AB646 | 2009-2010 | Regular Session | Amended


Bill Title: Physicians and surgeons: employment.

Spectrum: Partisan Bill (Democrat 26-1)

Status: (Engrossed - Dead) 2010-06-21 - In committee: Hearing postponed by committee. [AB646 Detail]

Download: California-2009-AB646-Amended.html
BILL NUMBER: AB 646	AMENDED
	BILL TEXT

	AMENDED IN SENATE  APRIL 13, 2010
	AMENDED IN ASSEMBLY  MAY 5, 2009
	AMENDED IN ASSEMBLY  APRIL 13, 2009

INTRODUCED BY   Assembly Member Swanson
   (Coauthors: Assembly Members Beall, Buchanan, Chesbro, Coto, De
Leon, Evans, Fong, Fuentes, Furutani, Hall, Jeffries, Lieu, Bonnie
Lowenthal, Ma, Mendoza, Nava, Portantino,  Price, 
Salas, Skinner, and Torres)
   (Coauthors: Senators  DeSaulnier  
  and Wiggins   DeSaulnier,  
Price,   Romero,   Wiggins,   and Yee
 )

                        FEBRUARY 25, 2009

   An act to amend  , repeal, and add  Section 2401 of, and
to repeal Section 2401.1 of, the Business and Professions Code,
relating to healing arts.



	LEGISLATIVE COUNSEL'S DIGEST


   AB 646, as amended, Swanson. Physicians and surgeons: employment.
   Existing law, the Medical Practice Act, restricts the employment
of licensed physicians and surgeons and podiatrists by a corporation
or other artificial legal entity, subject to specified exemptions,
and makes it a crime to practice medicine without a license. Existing
law establishes, until January 1, 2011, a pilot project to allow
qualified district hospitals that, among other things, provide more
than  50 percent   50%  of patient days to
the care of Medicare, Medi-Cal, and uninsured patients, to employ a
physician and surgeon, if the hospital does not interfere with,
control, or otherwise direct the professional judgment of the
physician and surgeon. The pilot project authorizes the direct
employment of a total of 20 physicians and surgeons by those
hospitals to provide medically necessary services in rural and
medically underserved communities, and specifies that each qualified
district hospital may employ up to 2 physicians and surgeons, subject
to specified requirements.
   This bill would delete that pilot project and would instead  ,
until January 1, 2021,  authorize a health care district, as
defined,  and a clinic owned or operated by a health care
district, as specified,  to employ physicians and surgeons if
the health care district's service area includes a Medically
Underserved Area (MUA) or a Medically Underserved Population (MUP),
or has been federally designated as a Health Professional Shortage
Area (HPSA);  the district board   conducts a public
hearing and adopts a specified resolution declaring the need for the
district to recruit and directly employ one or more physicians and
surgeons;  and the  chief  executive officer of
the district provides specified documentation to the Medical Board
of California. Upon receipt of that documentation, the bill would
require the board to approve the employment of up to 5 primary or
specialty care physicians and surgeons by the district, and, upon
receipt of additional documentation after that employment, to approve
an additional 5 primary or specialty care physicians and surgeons.
The bill would provide that a district may, until December 31, 2020,
enter into, renew, or extend any employment contract with a physician
and surgeon for up to 10 years. The bill would require the Office of
Statewide Health Planning and Development, in consultation with the
State Department of Public Health and the board, to report to the
Legislature by June 1, 2018, with regard to the efficacy of the
employment of physicians and surgeons by health care districts, as
specified.
   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.  Section 2401 of the Business and Professions Code is
amended to read:
   2401.  (a) Notwithstanding Section 2400, a clinic operated
primarily for the purpose of medical education by a public or private
nonprofit university medical school, which is approved by the
 Division of Licensing   board  or the
Osteopathic Medical Board of California, may charge for professional
services rendered to teaching patients by licensees who hold academic
appointments on the faculty of the university, if the charges are
approved by the physician and surgeon in whose name the charges are
made.
   (b) Notwithstanding Section 2400, a clinic operated under
subdivision (p) of Section 1206 of the Health and Safety Code may
employ licensees and charge for professional services rendered by
those licensees. However, the clinic shall not interfere with,
control, or otherwise direct the professional judgment of a physician
and surgeon in a manner prohibited by Section 2400 or any other
provision of law.
   (c) Notwithstanding Section 2400, a narcotic treatment program
operated under Section 11876 of the Health and Safety Code and
regulated by the State Department of Alcohol and Drug Programs, may
employ licensees and charge for professional services rendered by
those licensees. However, the narcotic treatment program shall not
interfere with, control, or otherwise direct the professional
judgment of a physician and surgeon in a manner prohibited by Section
2400 or any other provision of law.
   (d) (1) Notwithstanding Section 2400, a health care district
operated pursuant to Division 23 (commencing with Section 32000) of
the Health and Safety Code may employ physicians and surgeons, and
may charge for professional services rendered by a physician and
surgeon, if the physician and surgeon in whose name the charges are
made approves the charges, and if all of the following conditions are
met:
   (A) The service area of the health care district includes a
Medically Underserved Area (MUA) or a Medically Underserved
Population (MUP),  as defined in Section 127928 of the Health and
Safety Code,  or has been federally designated as a Health
Professional Shortage Area (HPSA). 
   (B) (i) The chief executive officer of the health care district
documents that the district has been actively attempting and unable
to recruit a primary or specialty care physician and surgeon for any
12 consecutive month period, beginning on or after July 1, 2008.
 
   (ii) The chief executive officer submits an application to the
 
   (B) The board conducts a public hearing and adopts a formal
resolution declaring that a need exists for the district to recruit
and directly employ one or more physicians and surgeons to serve
unmet community need.  
   (C) The resolution shall include all of the following findings and
declarations:  
   (i) Patients living within the community have been forced to seek
care outside of the community, or have faced extensive delays in
access to care, due to the lack of physicians and surgeons. 

   (ii) The communities served by the district lack sufficient
numbers of physicians and surgeons to meet community need or have
lost or are threatened with the impending loss of one or more
physicians and surgeons due to retirement, planned relocation, or
other reasons.  
   (iii) The district has been actively working to recruit one or
more physicians and surgeons to address unmet community need, or to
fill an impending vacancy, for a minimum of 12 consecutive months,
beginning July 1, 2008, without success.  
   (iv) The direct employment of one or more physicians and surgeons
by the district is necessary in order to augment or preserve access
to essential medical care in the communities served by the district.
 
   (D) The resolution shall also do the following:  
   (i) Direct the district's executive officer to begin actively
recruiting one or more physicians and surgeons, up to the limits
specified in this chapter, as district employees.  
   (ii) Prohibit the executive officer from actively recruiting or
employing a physician and surgeon who is currently employed by a
federally qualified health center, rural health center, or other
community clinic not affiliated with the district. 
    (E)     Upon adoption of the resolution by
the board, the executive officer shall submit an application to the
 board certifying the district's inability to recruit one or
more physicians and surgeons, including all relevant documentation,
certifying that the inability to recruit primary or specialty care
physicians and surgeons has negatively impacted patient care in the
community, and that the employment of physicians and surgeons by the
district would meet a critical, unmet need in the community based
upon a number of factors, including, but not limited to, the number
of patients referred for care outside of the community, the number of
patients who experienced delays in treatment, the length of
treatment delays, and negative patient outcomes.
   (2) Upon receipt and review of the  certification
  application, adopted resolution, and all relevant
documentation  of the district's inability to recruit a
physician and surgeon as specified in subparagraph  (B)
  (E)  of paragraph (1), the board shall approve
and authorize the employment of up to five primary or specialty care
physicians and surgeons by the district.
   (3) Upon receipt and review of subsequent  certification
  documentation  of the need for additional primary
or specialty care physicians and surgeons by the district, the board
shall approve and authorize the employment of up to five additional
primary or specialty care physicians and surgeons by the district.
   (4) Employment contracts with physicians and surgeons issued
pursuant to this subdivision shall be for a period of not more than
10 years, but may be renewed or extended. Districts may enter into,
renew, or extend employment contracts with physicians and surgeons
pursuant to this subdivision until December 31, 2020.
   (5) The Office of Statewide Health Planning and Development, in
consultation with the State Department of Public Health and the
board, shall conduct an efficacy study of the program under this
subdivision to evaluate improvement in physician and surgeon
recruitment and retention in the districts participating in the
program, impacts on physician and surgeon and health care access in
the communities served by these districts, impacts on patient
outcomes, degree of patient and participating physician and surgeon
satisfaction, and impacts on the independence and autonomy of medical
decisionmaking by employed physicians and surgeons. This study shall
be completed and its results reported to the Legislature no later
than June 1, 2018. 
   (6) This subdivision applies to health care districts and to any
clinic owned or operated by a health care district, provided the
health care district meets the criteria of, and ensures compliance
with, the requirements of this subdivision. 
   (e) A health care district authorized to employ physicians and
surgeons pursuant to subdivision (d) shall not interfere with,
control, or otherwise direct a physician and surgeon's professional
judgment in a manner prohibited by Section 2400 or any other
provision of law. Violation of this prohibition is punishable as a
violation of Section 2052, by a fine not exceeding ten thousand
dollars ($10,000), by imprisonment in the state prison, by
imprisonment in a county jail not exceeding one year, or by both the
fine and either imprisonment. This subdivision is declaratory of
existing law, and, as such, does not create a new crime or expand the
scope of any existing crime. 
   (f) Nothing in subdivision (d) shall be construed to affect a
primary care clinic licensed pursuant to subdivision (a) of Section
1204 of the Health and Safety Code.  
   (g) This section shall remain in effect only until January 1,
2021, and as of that date is repealed, unless a later enacted
statute, that is enacted before January 1, 2021, deletes or extends
that date. 
   SEC. 2.    Section 2401 is added to the  
Business and Professions Code   , to read:  
   2401.  (a) Notwithstanding Section 2400, a clinic operated
primarily for the purpose of medical education by a public or private
nonprofit university medical school, which is approved by the board
or the Osteopathic Medical Board of California, may charge for
professional services rendered to teaching patients by licensees who
hold academic appointments on the faculty of the university, if the
charges are approved by the physician and surgeon in whose name the
charges are made.
   (b) Notwithstanding Section 2400, a clinic operated under
subdivision (p) of Section 1206 of the Health and Safety Code may
employ licensees and charge for professional services rendered by
those licensees. However, the clinic shall not interfere with,
control, or otherwise direct the professional judgment of a physician
and surgeon in a manner prohibited by Section 2400 or any other
provision of law.
   (c) Notwithstanding Section 2400, a narcotic treatment program
operated under Section 11876 of the Health and Safety Code and
regulated by the State Department of Alcohol and Drug Programs, may
employ licensees and charge for professional services rendered by
those licensees. However, the narcotic treatment program shall not
interfere with, control, or otherwise direct the professional
judgment of a physician and surgeon in a manner prohibited by Section
2400 or any other provision of law.
   (d) This section shall become operative on January 1, 2021. 
   SEC. 2.   SEC. 3.   Section 2401.1 of
the Business and Professions Code is repealed.
                
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