Quarterly Board Meeting Webcast 7/20/2012


okay I would good morning and I’d like to
call this meeting to order but prior to that I’d also like to remind everyone to please
turn off their cell phones or at least put them to silent and BlackBerry’s do make static
on the feedback so I please appreciate for them to be off the table or off and as you
may notice there are board members that will be using laptops they’re doing that to access
the materials of the board electronically and the board I want to ask mr. Reiner to
come forward please and take the role dr. Bishop dr. carrion here mr. Cheng dr. Diego
here dr. Guha so here dr. gana dev here dr. Levine dr. LOH here dr. Sahlman Singh here
miss Shipp ski ski here thank you so we have a quorum thank you very much mr. Murphy also
remind you that this is mr. Einar if anyone wants to have the opportunity to speak we
welcome public comment please make sure you saw some of these slips one of these slips
please fewer is fine and make sure he has them prior to starting Iowa the item number
to which is public comment I want to recognize a board member who is serving today at her
last meeting Eddie Jane was appointed to this board in 2004 and reappointed in 2008 she
has served in many capacities in this organization stepping up to chair committees serving as
the chair of a panel and serving the Secretary to the board and now serves as a board member
on the Federation of state medical boards representing the interests of California I
would like to call Hetty up to presenter with an award as a token of our appreciation of
her time served on this board and say thank you for your engagement and participation
and your passion good and giving voice to many issues that we’ve addressed recently
I do want to thank all of you and a staff member especially for a fine eight years it
has been very rewarding and I really enjoyed it and as I’m going away I will still stay
on the Federation of the state medical board for two more years my term expires them one
thing I wanted to because everywhere I go with the Federation California has always
impressed me and it impressed the rest of the country that we are a very high standard
well-run I can group I can always say California is ruling it this way and they will listen
so I want to encourage all of you to keep up with the good high standards that we had
before in English you know I guess I have to say this way in the process of getting
the reform and it was great to be able to have insurance for everyone but I think the
process is how to maintain the quality of the physicians to the best vendors that we
have it will take some effort and I am hoping we do not dilute now this is my saying because
there will be some shortage of physicians and shortage of health worker in general but
I my thought is please do not dilute the quality of our doctors and then keep our quality up
thank you all moving back to the agenda item number two I have the following speaker slips
for items not on the agenda as I indicated in my open opening remarks please try and
keep your comments to three minutes and less would be better so starting off let’s have
mr. Kuna come forward Frank my name is Frank Cooney I’m the executive
director of the California citizens for health freedom and I’ve been going to board meetings
for about twenty years now longer than any board member I think on to it I welcome you
to Northern California and I want to urge the board to consider looking at a bill that
we will be introducing next year and possibly sponsoring or supporting a bill that will
make integrative treatment of cancer legal in California we have over 2,000 people I
know go to Mexico each year for treatment that is not available in California under
the current law it is a criminal offense Forge for a physician nature Pathak doctor to do
treatment of cancer can become a become a felling event that law prevents many hospitals
and other groups coming into California and offering integrative treatment more advanced
treatment and Senator Vasconcelos years back passed a bill that required the Medical Board
to have a committee on alternative medicine and that committee looked at alternative treatments
and the board sponsored the bill that made non conventional treatments legal in California
but we’re now trying to deal with a law that exists in the other code and changed that
law and would appreciate whatever the board would do to it and to help work on the process
of changing its center of a senator vasconcelos tried to introduce a bill on that and he did
the non credential medicine and that board did not have the opportunity to follow through
on it because the budget cuts that existed at that time I’m borrowing the board’s money
into it the last chair of the Senate business and professional practice committee trying
to remember her name that brought the revisions in the board through the process also sponsored
a bill to do it but unfortunately it got killed in the Health Committee on the assembly side
went through the Senate and when the board had puts a bill in heavily their experience
with the non-conventional medicine there were only two votes total opposition through the
both the Senate Assemblyman thank you very much for your time and welcome to Northern
California oh by the way you’re invited to have some free peaches over there thank you
very much next on my agenda Rahan sheet please come forward [Music] thank you madam president
for the opportunity and I’ll put aboard we could complete without my remarks so first
of all I wanna pologize dr. Anwar who we are distributing some flyers at the Cedars Medical
Association and I could not give you one I thought I will bring same for dr. bishop at
the same time so this is how the Flyers that I was distributing I got one copy for each
of you our spare copy if anyone wants secondly I am here to introduce all of you to University
of California Davis it has higher educational standards and the graduates of the University
of California they are considered competent to practice in the state of California and
here is a certificate issued by the University of California to my wife dr. farzana here
she is here so today we are bringing a pilot program that she can practice medicine in
the state of California because she is graduated from University of California Davis you have
a copy so since you know state of California has already recognized the board has a burden
of proof if you want to oppose this thing so anyone has any objections to this proposition
you remember mr. sheep my admonition is that this is not a conversation this is your opportunity
to speak to us so please usual time appropriately okay since you don’t have any objection I
consider that motion is adopted thank you madam chairman and president if I may if I
may be heard the purpose of public comment is the board cannot take any action during
this action except for the determination whether it put it on on the agenda for the next meeting
so there was no action taken by the Boron’s correct thank you next chena Minassian good
morning madam president and board members tina Minassian i am here on behalf of the
consumers union safe patient project a nationwide campaign that is organizing patient safety
advocates from across the state of California as the California State patient network since
California is such a large state medical board public meetings are routinely inaccessible
for consumers who cannot afford the funds and time to travel the length of California
to attend in person many of the consumer activist is that we work with with excuse me many of
the consumer activists as we work with our survivors of medical harm and some are disabled
as a result for these well-informed and passionate activist travel to medical board meetings
is even more difficult and in some cases not possible one very important request the consumers
union safe patient project California network has the making to the Medical Board is that
you begin providing teleconferencing of your public meetings to allow members of the public
to participate in your public meetings remotely by teleconferencing we mean opportunities
for the public to listen to medical board publicly news by telephone and to allow public
testimony by telephone we are not urging the medical board to establish remote locations
from which the public can participate we want the public to be able to use their own cell
or landlines to call in to the meetings from wherever they are the California Health Care
acquired infections committee and the new California Health Benefit Exchange are bagley-keene
govern entities that provide such interactive teleconference e successfully the consumers
union safe patient project believes the bagley-keene ACT supports public participation by teleconferencing
and that the Medical Board is misinterpreting and thus failing to abide by the Act when
they fail to keep up with the new with the new technologies that can facilitate public
participation in government we de Bourgh – instructed staff to develop plans for providing teleconferencing
for the public for future quarterly board meetings and committee meetings thank you
for your time and consideration thank you very much next I have an Robinson madam president
and board members I’m Ann Robinson and I’m also with consumer Union safe patient project
and I’ve come from Chico we have some issues to put before you I’d like to raise one thing
now consumers unions safe patient project is concerned about the unbalanced nature of
the medical boards membership the Medical Board has a total of 15 seats the law requires
that seven of these be filled by public members the remaining eight our physician seats at
the moment unfortunately there are seven physicians on the medical board and only four public
members a relationship that should have been close to 50/50 is now askew with nearly twice
as many physicians as public members this creates a dramatic imbalance on the on the
Medical Board we are concerned about the implications this has for priority setting and policy and
process decisions being made by the Medical Board now certainly the legislature envisioned
a balanced a balanced viewpoint on the Medical Board when it assigned 7 of 15 seats to public
members to public seats that are gubernatorial appointments expired in June since the appointees
holding these expired seats have already served two terms as you know they must leave the
board after a 60-day grace period at the end of July this will leave the Medical Board
with seven physician seats filled and only two public seats filled at the end of this
month I’d like to share with you a letter we sent last week to Governor Brown raising
these concerns the letter is signed by the leadership of consumers union ARP California
pan-ethnic Health Network CALPIRG Center for public interest law University of San Diego
School of Law and the Latino Coalition for a healthy California we hope that Medical
Board will also work to call this important issue to the governor’s attention soon thank
you thank you Yvonne Chow good morning on the bond shown with the California Medical
Association we just wanted to bring the board’s attention to a brochure that has been produced
by the California Medical Association a California Medical Association foundation with support
of the California Endowment it’s intended to help patients understand their new benefits
highlight opportunities to obtain or change health coverage and provide timelines for
when these changes will take effect and there’s links to resources where patients can find
more information are also included in the brochure we’ve also produced the brochure
and other languages it’s available in Spanish Vietnamese and in Chinese and we have copies
available in the back of the room and we are more than happy to send copies for distribution
to your offices as well just let us know and we just want to let you know that this resource
is available thank you thank you so I have no other public comment slips so we’re gonna
move on the agenda and I’m going to ask dr. nuovo who I didn’t see oh I did right in front
of me I apologize please come from I’ve been looking good so please have a seat before
you speak I apologize we’re going to have the approval of the minutes from the last
meeting do I have a motion for the May 3rd and 4th meeting notes to be approved so second
okay do I have any public comments on the minutes from the May 3 & 4 meeting to have
any copy any Corrections or additions from the board members all those in favor of the
minutes being approved as written please say aye aye opposed so the minutes are approved
so now I would like dr. novo from the University of California Davis to provide us for the
annual report on the Medical Board UCD telemedicine pilot program and asked that given we have
new members since this has been brought before us in the past I would ask you to give a brief
historical overview as well as information as the scope and the view of this pilot project
if you wouldn’t mind thank you very much yes I’ll incorporate that into my presentation
I’ve worked hard to of being respectful of the a number of agenda items I’ll incorporate
that into my talk and I’ll try to keep this under 10 minutes thank you the purpose of
this project was the development of a diabetes self-management education program delivered
via telemedicine to patients in rural communities in California it started our effort started
in 2003 and we’re in the process of analyzing our data there’s a bit of a travelogue though
of slides incorporated into this of the places that our team has been throughout the many
counties through northern and central California this is just one from up in to a lake way
up north the genesis of this project came from maybe 329 nakanishi an Assembly Bill
required to conduct a pilot program to develop methods using telemedicine model of delivering
health care to those with chronic diseases and delivering other health information my
background on this is that I started about 14 years ago now a diabetes disease management
program through the UC Davis health system in which we are now looking and managing 30,000
patients with type 2 diabetes just within our health system a disease which is an epidemic
not just in California but across the world just another place that we’ve been in our
travels I do have to acknowledge all the people and all the groups that have participated
in this the Medical Board the disease chronic disease management program which was responsible
for the educational content of this intervention the Center for healthcare policy and research
which helped with all the analysis in the Center for Health and Technology which had
all the capacity for the telemedicine connections another place that we were a lot of people
were involved in this I won’t go through the list of everyone but there are even more than
just these names that helped with this particular project and then of course I have to acknowledge
all the efforts of the people the physicians the staff especially the patients in the nine
clinics willing to participate who came from Nevada County Sierra County Plumas County
Tehama County Siskiyou County Mariposa County Trinity Humboldt and Amador County so we tried
as hard as we could to get a representative sample it wasn’t perfect but we tried as hard
as we could to do that again the goal is to test a model for improving access to diabetes
self-management training and resources to these patients in these areas the rationale
is that the the informed activated patient in concert with a prepared proactive health
care team can improve outcomes this comes from something called the chronic care model
and I incorporated the website if any of you have interest in pursuing how this is a very
different approach in caring for patients not just with diabetes but with any chronic
condition what we did the thing to keep in mind is that this was a onetime to our class
on diabetes that was focusing on self-management support to patients who receive care at these
nine clinics a one-time two-hour class keep that in mind as you look at the results that
we have of our intervention this would give you a sense on the left is one of our health
educators Acela on the right is one of our health educators Mauricio this gives you a
sense of what it would have looked like from the patient point of view they they met if
you will patients on the telemedicine link and they gave it to our class in which they
gave the content of their talk which was presented at a previous board meeting and then would
have time for interactive questions we did extensive survey of all the participants in
these rural clinics extensive could be in caps patients who participated in this project
did Allah gave us a lot of information on demographics how they were managing their
diabetes their knowledge of diabetes their confidence in management of diabetes their
perception of care in their clinic and so forth great deal of information and we followed
up by assessing all of these elements six to eight weeks after the intervention and
we even did a chart audit at the site so this is these are some of the findings very briefly
we’ve had 239 participants to date if you had to just look at the averages the average
or typical patient was in their 60s a woman white with some high school education about
a little more than two-thirds had access to the Internet and most from Medicare Medical
one of the things that we’ll be presenting in our final report is why we didn’t get a
population demographic that we thought we would get and in particular more Latino involvement
in the project we were quite surprised about that we’re doing a lot of work to sort out
whether the clinics that self selected to participate whether the population we received
is the population that they’re caring for or there were some other barriers this is
an example of one of the barriers our health educators told us stories repeatedly that
patients would tell them that this is a two-hour class I’m going to have to leave early because
I have to move the irrigation pipes and so we did some interventions to try to accommodate
that but that was a real issue that jobs affected their ability to participate in an education
program the demographics ma the these next few slides just reflect that the demographics
and some of the features of this population is so typical of any practice not just a rural
practice most had diabetes for at least five years nine percent didn’t even know the type
of diabetes that they had they were on these particular kind of agents again this this
pattern reflects what goes on in most practices around the state at least from the data that
we look at most people with diabetes have other chronic home morbid conditions and so
did this population I didn’t put depression here but depression was a is a common comorbid
condition in diabetes that affects outcomes and it was one of the more relevant ones that
occurred in this population as well so these are the results that I want you to take a
look at one was that patients were asked a series of questions about essentially reflecting
how the practice at their add supports diabetes self-management and there were 20 questions
about this the questions like have you as your doctor or anyone on the clinic had a
discussion on how diet or exercise influences your condition or has anybody in the clinic
too had a discussion with you about setting goals and these were the findings one is not
just to go back one is none of the time and five is all the time the the average scores
across all clinics were two and a half to three point six this would be the equivalent
of about a c-minus on a report card it is not a reflection of the quality of care in
these clinics in fact when we’ve done this exact same questions in our own clinics this
is about the same kind of answer most clinics are not geared up to help with diabetes self-management
and self-management support the concept is called the tyranny of the urgent the urgent
issue gets in the way of dealing with the core issues of the chronic condition we’ve
also asked a lot of questions about are you taking care of yourself looking after yourself
are you exercising looking after your feet getting your eyes examined once a year how
confident are you confidence is something I could talk about for an hour it’s a big
deal many patients with type 2 diabetes with any chronic disease feel overwhelmed and when
they feel overwhelmed oftentimes they and their providers give up and this is what we
found after the intervention was that there was a statistically significant reduction
in feeling overwhelmed with their diabetes from the pretest time before they engaged
in the two-hour session to the follow-up period specifically just under 20% felt overwhelmed
a pretty typical number with their diabetes and 5.4% Scheldt overwhelmed at the six to
eight week post intervention period there was also a change in observed number of days
that patients did physical activity at least 30 minutes of physical activity and checked
their feet so the exercise pre intervention was about the typical person was exercising
and that could just be walking we we gave a broad definition for exercise about three
point four days whereas the mean went up to three point nine days after the intervention
patients also check their feet more often that’s a big deal when it comes to diabetes
and I’ll show you in just a few minutes why so we went from four point two to five point
six days knowledge of diabetes was assessed very carefully and there were a series of
questions and they just to give you a sense of what we were asking how much do you know
about the kinds of things that would be important the effect of carbohydrates reading food labels
and so forth and what we discovered was that there were significant changes and again I’m
using significant I’m using the help that we received in our with all our statistical
support we were able to demonstrate that at the six to eight week follow-up period so
what did we find and this as we’re still analyzing the data is still working on our final report
which will prevent in the fall which will present in the fall is that patient self confidence
improved their knowledge improved their self-care behavior in all elements including things
such as exercise and foot care and this all came from a two-hour class there are a lot
of other findings that we will be presenting down the road some of these are qualitative
now I’m not targeting the Thule Lake supermarket but we found a substantial number of barriers
traveling around and going to towns the concept is called the food desert it simply means
that it’s awful hard to find the things the fresh fruits and vegetables and good things
that you’re supposed to be eating when you have a chronic condition many of the facilities
were gas stations many of the grocery stores were gas stations in which there was very
little opportunity to purchase things that when we consider helpful in managing diabetes
we are respectful that one of the things that we are going to be looking at and presenting
in the final report is outcomes on costs and the cost of doing this type of intervention
the impact on the cost of diabetes which is substantial I just want to give you a brief
sense of what we’re looking at again what we discovered was that patients were looking
at their feet far more often why is that a big deal well patients with first of all patients
with diabetes on average incur costs 2.4 times more than their age matched cohort and foot
pathology is the most common complication of diabetes leading to hospitalization others
may challenge it but like I promised you foot pathology meaning ulcers osteomyelitis need
for amputation is the most common complication of diabetes down the road leading to hospitalization
and it counts for one-third of the cost of diabetes care these are roughly the range
again this is a rough range of many of the costs in this country currently of managing
and uncomplicated foot ulcer complicated foot ulcer and amputation so I guess I’ll leave
it at that nice picture at the end so Wow again we will be presenting far more detail
at the final report but what the findings that we have our findings that are consistent
with other studies on education interventions and it seems that the initial efforts of not
ganesha in the assembly bill can demonstrate that an education program has the possibility
of improving outcomes in a very common chronic condition thank you very much dr. novo for
that presentation are there any questions from board members dr. Levine have you this
is this is a powerful technology applied primarily for an educational purpose in self Caribee
have you thought about the likelihood of success of actually using the technology for care
delivering and interaction with clinicians we have and I did I could talk for a long
time about that unfortunately it what was interesting was the lack of interest I probably
need to find a better word than lack of interest a lack of capacity of clinics to get engaged
in this project it was a big barrier it’s the tyranny of the urgent all those things
of some of the things that got in the way for example we went to Visalia trying to go
again that we were trying to target a population we thought was important there was a manager
change physicians changing and so forth it was just not much of a priority for the providers
or the practices they were incredibly helpful at getting us enrolled patients in the project
but that is a big challenge and it is a barrier that is difficult to overcome dr. Dave oh
I’m sorry so like you said this isn’t a good representation of California do you think
with if you reach out and get that representation the lucky knows the less educators because
I think you said 76% had high school I think the results will be different then hard to
say I’ve worked with others I don’t know if you know America Braco from the Latino Health
Alliance in my discussions with her it is very likely that this type of education program
would be effective but I don’t think I think one of the findings that will have a recommendations
is that we target clinics for these interventions to be done I see no reason why the same intervention
couldn’t be done at a community center at a church I think we would have one of the
recommendations will be just targeting clinics may have been inadvertently a barrier to accessing
everybody or a larger population so if I was to redo a B 329 I would have also targeted
churches community centers other places where people gather even grocery stores for that
matter to be honest I would go right to where people are as a means for improving access
to their homes as well why not doctor Canada just looking at your results actually they’re
amazing but you think there is a selection bias the way just one to our class you can
show statistically significant difference in their exercise looking at their feet as
a vascular surgeon I take care of all the complications of the diabetes including losing
toes and feet so that’s why I’m just curious well if you picked up a community centers
rather than these clinics where could be motivated pre-selected patients who are who are there
so that’s what amazes me is the one to our class can give such a statistically significant
difference in a population which is not the population we’ll look where you were looking
at when you started excellent point the concept is called readiness to change your stages
of change 20% of population with a chronic condition are ready and motivated and activated
to make lifestyle changes we selected for them I’m sure how do you help the 80% of the
population who may feel overwhelmed who may be struggling with depression who may be struggling
with financial issues other things that are more important to them to help move them along
a lot of the efforts that I didn’t mention America Braco is an expert on that is using
community activists to help move people who aren’t ready to do health behavior change
so yes you’re right this was the selected self selected population they also had to
do an incredible amount of paperwork as part of this there was a lot of data collection
which is off-putting to most people and took a lot of personal time and commitment to do
that I’m very delighted and grateful that they were willing to do so but you’re right
this is the selected population any other question so thank you very much for the wonderful
presentation dr. Nora as you recall from the last presentation this is a board sponsored
project a $400,000 is that correct yes so I agree with dr. Levine that this is wonderful
technology looking for an application and to me the thing that would make me a believer
that telemedicine is ready for primetime is that if with this education you can tell me
that the hemoglobin a1c is eight point six before and six point zero after I mean we
need objective metrics to tell us that our investment is giving us a good return I agree
and we are collecting that data and that will be part of our final report including our
specific recommendations we did do that as part of our study we did help pre and post
chart audits as part of this to look at hemoglobin a1c as an example metric blood pressure control
lipid control we did look at those dr. Loe dr. carry on a thank you dr. Noah for your
presentation a reviewing they success all the Telekom’s around the world the main reason
why they fail is because they don’t do what they call in needs assessment analysis basically
what you are doing is go to the community and present your program instead together
the way around and see what are the needs of the community and who is going to pay for
that because a failure is the main reason why these programs are are a failing around
the world is financial who is paying for these services and I think they the partial success
that you’re hiring because you are going to have doctors and patients who they don’t know
what is this and I think she should be the other way around first go and see what I need
and who is going to pay second we are going to need to do what I call market analysis
and third you business analysis that is a process how the experts recommend today to
implement a successful political problem I agree with you completely one of the specific
ways that that was reflected is if I had a slide on the number of clinics that were unable
to participate I think he’d be impressed at the number of places that we contacted and
worked at to see if we can get them engaged in this project who aren’t able to most of
it came from again I call it the tyranny of the urgent but most of it was in the financial
piece we are just in so much chaos right now this is a low priority for our practice we
recognize that we have many patients with diabetes but this is not something that’s
a high agenda item and we didn’t have we did make queries that will be in our final report
of at least what prevented you from participating but you’re right it would have been wiser
from the beginning and reflecting back on ab3 29 to look at more of a needs assessment
what does the community-at-large really need and want as opposed to what was part of the
project was telemedicine is great it will do all these improved outcomes let’s roll
it out I agree with you thank you dr. Bishop I think I think your works great this obviously
is a worldwide statewide countrywide problem have you considered or have you already collaborated
with others in other parts of the country other parts of the state it seems that would
be very cost effective to collaborate pool resources the education should be the same
throughout perhaps different languages the focus may be slightly different but basically
medicines medicine diabetes diabetes just seems to be wonderful if we could collaborate
and pool resources and and brains exactly and those are my efforts from gathering all
this data is then going with other groups I’ll be presenting this information at the
November meeting of the California Rural Health Association we working I have colleagues across
the state who have similar interest in chronic diseases so yes there will be continued discussion
it doesn’t end here with my presentation or with the final report that comes with with
the board is this say is this kind of a groundbreaking thing you’ve done or has this been done elsewhere
previously there are similar types of interventions that have been done in other states and the
findings are pretty close and that you know we get people who are motivated and ready
to change make changes when they receive the appropriate information and oftentimes it
isn’t generated out of the physicians office to have any other questions or any other questions
dr. Damon thank you very much for your presentation is very interesting and I wish you the best
of luck as you go forward it’s a situation that what we are finding in society I think
we all know that given the opportunity for education information people do want the information
and with that information it gives them the power the tool to to make change and this
hopefully will start to advance that opportunity as we move forward with health reform in general
and again on behalf of my team thank you to the board for your support for this project
good luck look forward to your final report I guess so now we’re going to move on to the
adoption emergency contraception protocols and has Miss Harrell at the executive officer
of the Board of Pharmacy in the significally representing ACOG to please come forward and
present this item I would like to remind the board members that this issue has been before
us before we’ve had lots of discussion on it it has been very intense and I would hope
that we all realize that now what this means is they were all on the same page with these
revised protocols so please your presentation good morning and thank you very much this
is a collaboration between two key boards where pharmacists will be able to manage and
provide emergency contraception pursuant to the protocol that is done by the Medical Board
so you are adopting a copy of the protocol we are adopting a copy of the protocol or
you’re approving it we’re actually adopting it as a regulation and so we’ve made one small
technical adjustment earlier this week I believe Tim is passing it out it’s a formatting issue
okay it you can it’s on the last page and it’s in the it occurs in the chart and it’s
a clarity issue it went from one tablet twice a day to two tablets and the we’ve even highlighted
the change for you if I can find it myself I hear it thank you we have been very pleased
to be working with Shannon and her group we’ve used the farms the California pharmacists
Association in various phases we’ve brought in technical experts to assure that the protocol
that is developed is concurrent with appropriate methodologists out there and one of the problems
we had before is the drug companies keep developing new forms of these things so just enough to
out date our factories or our protocol soon as we do it the last time we did this was
in 2004 and seems to work well we’ve had no complaints from any patient regarding implementation
of this which has been now on the books for about eight years so I would respectfully
request the approval of the Medical Board and should you have questions we have someone
here to help are there any questions for any members yes yes dr. carrion Hey I am an OBGYN
I am accustomed to please let me tell you what is my personal feeling I think that we
are transfer responsibility from the doctor to the pharmacist and this is something that
we are going setting a precedent but in the future other problems in this medication today
is going to be funded by the pharmacists in the future is going to be another medication
I may be always going to be seller by the pharmacist if you read very careful the recommendation
of a mother Danish pharmacist she’s completely hundred-percent right many of the pharmacist
today they feel very uncomfortable doing this and now with this new medication by name era
that is in the market is going to bring more morbidity and maybe mortality this is something
that is going to lead to a study very very careful the steps that we’re going to take
I’m clearly ignorant as an anesthesiologist about this topic my only concern was is there
any protocol or any thing in place to prevent a individual who well intentioned but LLL
inform might ask for the same drug from multiple pharmacists and receive an overdose with any
toxic consequences well to degree most of this is already if you’re over 17 is already
over-the-counter medication already doctor carry-ons concern about what we call conscientious
objectors in terms of a pharmacist that prefers not to provide emergency contraception or
other kinds of contraception we have a law that provides that every pharmacist has the
ability to decline to dispense such medication the pharmacy itself has to have a written
policy and they worked out ahead of time so that the patient can still obtain any medication
that’s been legally prescribed for the individual but a particular pharmacist does not have
to go against his or her moral objections to dispense and you also have some technical
things so also not every pharmacist participates in this program pharmacist the do participate
have to could undergo I believe it’s a two hours of training so if you only one hour
to their existing usually one hour and he’s clear here and in one hour I think a pharmacist
waiting arise he’s going to be quote-unquote an expert giving this medication let’s go
realistic dr. kay I’m gonna have to no option we’ve had the discussion of what is appropriate
protocols and what is appropriate procedures and this is for the Pharmacy Board to regulate
their members with what we’re going to be doing now is just mmm just adopting the protocol
so that they can take care of their habits it’s we’re not going to not do this based
on unless and the board is going to decide not to adopt the protocols but the object
being is that the discussion has gone forward in previous meetings as to the emerged the
pharmacist who doesn’t want to do this the issue of what a pharmacist can or cannot dispense
is a pharmacist situation we’re not adopting a protocol for what a doctor has to dispense
here we’re adopting the protocol to be on the same page with the Florida pharmacy correct
okay so I just wanna make sure that we’re all clear on this that we’re not looking to
tell doctors what to do we’re just going along with the protocols that have been agreed upon
by the experts from what I understand okay and mr. gipsz key yeah I had a question on
the statement that’s in here where it has procedure number three and I gather this is
the direction of the pharmacist to communicate to the pay to the patient but the phrase down
at the bottom other options for emergency contraception include consultation with your
physician regarding insertion of an IUD the inference there is that an IUD is for emergency
contraception and that it is not I agree with you part of this though is that we believe
and this is it exists pretty much what’s been around for a period of time keep in mind this
is an update part of the concern is is that what could have led to the need for emergency
contraception was a lack of understanding about various forms of birth control and I
think that’s the intent there’s also a fact sheet that has to be developed that’s okay
so but it you just specifically says IUD there are obviously many other forms of contraception
and so my concern would be if there’s some the it just sounds like the inference here
is if this didn’t work you know you need to go see your physician about an IUD and that
might not be appropriate for the that patient and that’s not the only form of contraception
it’s a question of I think what mischiefs key is getting to his why as a pharmacist
making recommendations about a medical procedure more than to suggest in a patient see a doctor
we could we get that struck because I just think that that’s it’s instructive for a patient
that maybe not perhaps being appropriate you can approve it by striking that if you wish
because you could also bring up abstinence and things like that too but you know we’re
not looking to rewrite okay that’s what I mean you’re bringing a good point but let’s
get everything on the table and then work we’re going to take a recommendation of what
to strike what to leave and what to move forward with okay there dr. carry on I apologize I
don’t want to we’re not gonna start this all over again that’s my concern no no that’s
fine what but is I want to bring some points of concern right see this is my speciality
and I handle this every day okay I think I am entitled as an obituary know as a member
of the board express my concerts please that’s all but do it from the perspective of the
pharmacist delivering this procedure and from the perspective of the pharmacist delivering
the protocol not from the doctors perspective that’s what I’m looking for information on
do you have concerns about the pharmacist and what the pharmacist is going to do as
to the quality or the quantity of the meds or the giving out the meds to a specific request
or yeah please the pharmacy is not a place to treat patients the pharmacy is a place
to give the medications that that the doctor prescribed this is under emergency circumstances
a regular place to chill going for that idea I understand that is an emergency but being
an emergency also if this medication is not given properly he’s going to create some more
ability and the typical case here is this new medication by name Ella I’m sure you are
very familiar that basically basically what does it is abortion this world well the literature
is very that the dosage normal is 30 milligrams and the research studies show that one milligram
is enough for what for the present the core pollutant and that is how is going to have
to happen and abortion okay so that’s one second okay Madam President members kind of
stepping outside my sandbox here I don’t often interpret pharmacy law thankfully but it’s
my understanding miss Harrell that the authority for a pharmacy pharmacist to prescribe emergency
contraception already exists in law exactly okay and what this is is sort of one of the
I guess methodologies by which a pharmacist can provide EC is that they do it in accordance
with the standardized procedure apart of all sort of developed and blessed by the Medical
Board is that actually that’s one way there’s two ways this this is one of them okay so
this is one of the two ways but the authorities standing alone is already in law yes and it
has we’ve had the protocol this is really an update of the existing protocol to make
it more current okay so by the board’s action today obviously not to mistake the obvious
but we’re not gonna overturn an existing law or the legislature has spoken what we’re gonna
do is sort of put our stamp of approval on you will on the protocols that would allow
at that revised protocol sorry that would allow pharmacists to essentially dispense
EC correct is is the question I mean I guess my question now is what is the medical boards
role it seems the Board of Pharmacy would be autonomous in this regard and perhaps our
acting on the protocol seems a little irrelevant perhaps I’m not understand that procedure
who can explain that this is an area let me and perhaps the attorney can do this this
is this is an outgrowth of a major policy area going back probably about 2000 2002 are
you comfortable talking about this or I can talk about all right about 2000 because patients
not getting in to see appropriate practitioners timely so the accessibility of the pharmacist
in an area where it’s a pretty clear-cut process you can develop a protocol although under
protocol pharmacist can manage patients for doing drug therapy based on the parameters
of the protocol the intent of this was to have the Medical Board and its technical expertise
develop a statewide protocol that could be implemented statewide under which pharmacists
could provide emergency contraception and within that there has to be outreach activities
and certainly a back seat that’s available to the public so that they become better aware
of what’s being done in addition the pharmacist is required to consult and advise and part
of the comment that you indicated was really it should have been perhaps part of the consultation
not part of the protocol answer your concern dr. Simonson okay so let’s move on this way
doctor I just just what you said right now is so the Medical Board will establish the
protocols for the pharmacy then to dispense a medication in the event something happens
it who gets sued right if the protocols are under the guidance of the Medical Board it
would be them if anyone gets sue there I believe it would be the pharmacy that uses the protocol
if the protocol is there and it’s state policy and by doing it in this manner you’re basically
establishing this is appropriate in these circumstances and if something goes haywire
or inappropriate then it would be the pharmacists but again this is very safe the FDA has approved
it for F for anyone over seventeen in the last couple of years when this process started
that was not the case okay so in addition to striking the language of the type of recommendation
that a pharmacist would make that’s a medical recommendation we’ll strike that is there
any other additions to the revised protocols there any public comments on the revised protocols
doctor though so I too am uncomfortable I’m giving a stamp on this protocol since this
is an area not of my personal idea piece I mean shouldn’t we have people that are expert
in this area review the protocol before we give a stamp of approval could I hear from
my cock down actually getting on behalf of America Congress of Obstetricians and Gynaecologists
we easily spent 40 hours on making these simple changes and we in addition we have OBGYNs
that are in addition to being opt lands have an additional one year of family planning
fellowship and so those physicians are the ones with whom we’ve consulted and part of
the issue is there’s a lot of miss miss harold was saying the science changes a lot the information
that we have changes a lot so we need to continually update this but I know through our organization
we have thoroughly vetted this and feel very comfortable with making a recommendation that
this be approved by the Medical Board well I’m concerned with that point that the ship
she brought up I mean other options for ICI include consultation with your position regarding
insertion ie an IUD that’s what we’re going to strike that I know but exact that that
made it through this committee makes me uncomfortable that it wasn’t reviewed in adequate detail
I mean that thing has nothing to do with the time of day is totally out of place and just
the fact that that made it in there makes me feel very uncomfortable Miss Smith Crowley
actually it is the standard of care for if there’s somebody who’s had more than five
years five days since an unprotected intercourse may have an IUD inserted to help prevent a
pregnancy that’s for prevention but this is for emergency contraception here’s a thought
there’s a little bit difference there isn’t that it’s a fine line I think is that right
emergency contraception is used to prevent a pregnancy and there’s a big because I medication
they already happened right i am i understanding is this is not to this is not to create anything
more than the result of a pregnancy it’s not to stop a pregnancy that has already occurred
or started the process this is only if the option would be that you could not get pregnant
from but you might get pregnant from unprotected sex it’s not if you are pregnant this is not
at all to do with that so the issue is to adopt these revised regulations that ACOG
has agreed and worked with the Department of the Board of Pharmacy and I assume with
our executive director Linda Whitney that the three entities that have oversight to
make sure that the rules and regulations are as clear as possible as of today as we go
forward in the medical community there will always be advances and changes they’ll come
back and ask again for revised protocols that the request is that I would like to have a
motion to approve the revised protocols the motion so I do want to make sure that it is
a law where that emergency contraception can be done by the pharmacist we we know that
and this this what I’m looking at this is Pharmacy Board and the Medical Board working
together to come up with some standards that’s the only thing I’m looking at in this in this
policy anything nothing more than that and nothing less so that’s why I’m comfortable
in making a motion to approve and chair doing it the only thing that and I sense because
I’m hearing this from the physicians that is there any why though there could be reference
to the fact that if it says where the treatment is if more than 72 hours you know the Ella
may be more effective can is going to be indication at the end that you you should consult a physician
or a health care provider you know so it’s very clear that the pharmacist is directing
that person if in fact this doesn’t work you need to go see a healthcare provider that
is very clear on the fact sheet that was developed to go with the initial protocol I just don’t
have a copy of that with me today because the intent is to not to prevent a patient
from seeing a physician it’s to solve the immediate emergency and I think part of the
reason we’ve got this in here baby and in part pieces of this are coming back to me
I’m not an expert we had experts working on it we are just moving it to you know procedure
and it says when a patient requests emergency contraception the pharmacists will ask and
communicate the following well I think we should direct that the pharmacist has to also
communicate that if this doesn’t work you need to see a healthcare professional healthcare
provider so it’s very clear that the patient isn’t just left with well if this doesn’t
work my concern is if it’s new or added text versus if it’s already in the original protocol
does it assume that it wasn’t in the original protocol by inserting it now that it was not
in the original protocol so my concern with the clarification and mischief Skiz asked
is that it would reference that maybe it wasn’t done because if you read the modified text
on page 2 at the bottom page 2 it says new or added text is shown by double underlined
that thus added language so it’s not new text it’s not added text it’s already existing
text so the idea of adding it now is that going to predispose people’s opinion that
it was never there before and that’s my well man can all due respect though however if
the if this is deficient in any way everything asked to approve it I think we have to very
clearly support the fact that the pharmacist happens should be giving a emergency contraception
however if we’re giving that pharmacist any kind of direction the other part of the direction
is that the pharmacists shop okay okay that’s that time I and a good missus would do that
anyway but I thought we can’t assume that I understand that the the protocol needs to
be complete so you you have had you have had a chance to review this prior to the speeding
this is now a 15 day comment we’ve already had the major 45-day before we released it
we brought it to you and I had the pharmacists expert that we brought this a women’s health
expert in pharmacology and then the American College have gotta call obstetricians and
gynecologists we had Shannon here and I think we brought an expert with you so we’ve had
some of this discussion before but like anything else sometimes subsequent discussion leads
to additional points and so we can refine this a little bit the intent is not to prevent
the patient from getting to the physician if this isn’t effective and in fact as you
say that would be the normal part of the consultation you would expect because it’s a follow-up
activity how how can the patient self monitor him herself in this case right doctor gonna
dev I agree with Miriam and mission ships t it’s repeating it is not a problem important
point so even if it was there if you can add on I think it tax value that’s all it is okay
so we’ll with those additions do I now have any public comment or any more comment second
I have a I had a second I had dr. Bennett Devon dr. mannus ships game Madam President
if I may I’m gonna offer the legal comment I think the board needs to have a little bit
of specificity here about what it’s actually approving so I have on page 105 on I guess
that the latest and greatest which is what Tim handed out my [Music] understanding of
the motion would be that when you’re going to strike the words on the last new or last
paragraph on page three on page one item three procedures there’s other options for EC include
consultation with your physician Perry getting over the strike regarding insertion of an
IUD that’s what I had now I’m a little bit fuzzy about what we’re going to apparently
we’re going to add something something whatever that is to somewhere about informing having
directing if something doesn’t work presumably the emergency contraception doesn’t work we’re
going to refer that person or the patient or whoever is receiving it to a physician
is that kind of the understanding and I’d sure like to know what we’re going to put
that no I think if you end it with consultation with your physician that’s the only amendment
then so if you look at the the paragraph that’s underlined currently it says if more than
72 hours have elapsed since unprotected intercourse the use of Ella may be more effective than
whatever the other drug is other options for ACA include consultation with your physician
period we okay with that yes dr. Levine I have sorry but from a grammatical perspective
consultation with a physician isn’t emergency contraception so I think I think the language
needs to be amended to say for information about other options for emergency contraception
consult with your physician so other options so read your sentence ways for information
about other options for emergency contraception please consult with your physician period
or health care provider so is health care provider yes okay so does the maker of the
motion agree to the amenities I do in a second any questions need any public comment now
on the new revised revised revised dr. Simon says the question how is the consumer to know
whether it worked or not I mean a very toll-like there’s a missed period they should go for
a pregnancy test anyway they should buy a pregnancy test kit and do their own tests
I have a comment I think that the obvious would be not just other options consult with
your physician but if the person is going to get emergency contraception somewhere they
should say it should be said and consult with your physician you should follow up no matter
what right exactly exactly no matter what here’s your pills now you make an appointment
for your physician to see or help I’m sorry look your problem or a kiss right pill regardless
okay so dr. Levine you want to revise your motion okay so dr. Levine if I may if you
would leave under the 72 hours alone and just ask to add a second hour another paragraph
that would specify that because it what you’re talking about doesn’t really relate to 72
hours right so so are you saying take out the whole second sentence okay so leave for
other options for emergency contraception consult with your physician period or health
care provider we’re gonna have a penalty jar you know it’s kind of like any time you use
the committeemen it’s committee person or chair person same idea I’m being rear and
then a new sentence that says fault please follow up with your physician or healthcare
provider after the use of emergency contraception I
know we can’t I know I mean we’re talking about human beings here that are walking into
a pharmacy we’re not talking about micromanaging what they do or what they don’t do the object
is is to give them some tools to make the right decisions going and meeting with your
health providers a tool whether they do it or not there’s not a gun to their head I mean
we have had a horrible tragedy in this country today because that you that don’t know about
it and anything we can do to get away from the use of weapons I’m I’m right there right
now so let’s get this moving because it’s starting to I’m going to tell you the bedding
of the language we understand what you want on there we understand very clearly what is
to be there the physician and healthcare provider to be part of the mix so you’re going to put
a paragraph put a sentence in there making sure that happens now actually two sentences
put two sentences in put three sentences but that’s two sentences we’re going to agree
to two sentences okay got it but I’m going to tell you I can’t get through this meeting
if we’re going to spend two hours on who and how often and who’s going to open the door
on the which side of the store and I apologize but this is starting to it’s we need to move
this out but forward I’m sorry we really do we’re gonna have to do this again well we
can take this as a final motion we can bring it to our board our board is going to have
to notice it then it’ll have to be released for common again we’re running close to the
one-year date that we have to do for the regulations right and so there is a risk because our board
mean our next board means the end of October much like yours and so we met earlier than
people you wanted back to this you wanted to come back you can come back it’s the same
time here I thought we were supposed to do that I don’t think it would need to come back
and let our board changes it or we get additional okay so let’s have a we have a motion to adopt
we have a second to that motion we have clarification of the language we’ve asked for public comment
all those in favor of the motion with the additions in Contra and corrections and Romero
improvements and inclusion of healthcare provider we say aye any opposed I are paying any abstention
to abstentions wanna put opposition okay thank you so now we’re going to continue on the
agenda with Miss Smith Crowley no apologist miss Harold thank you and thank you for your
comments doing regulations is sometimes messy this has not been too messy yet so thank you
very much this is nothing too messy if they all go this difficult for you guys you ought
to come watch what it’s like for some of us sometimes no thank you very much this is this
part of the process and you want to develop the best regulation possible for the public
so this is part of the process I’ve been asked to provide a brief update on and I heard the
brief update on what the Board of Pharmacy is doing where we interact with the Medical
Board of California our board is very excited to have this opportunity miss Whitney came
to our board meeting earlier this week and provided an update on some of the activities
that the Medical Board is doing with us and now it’s my turn to reciprocate and provide
you with a brief update on what we’re doing there is a lot of overlap and where physicians
and pharmacists need to be working together more and so we’re very appreciable appreciating
of this opportunity so the biggest thing for us right now I suppose is the possible means
by which we deal with cures there is a bill in the legislature that I’m sure is on your
agenda mr. DeSaulnier has a bill in where they’re looking for funding it is coming near
the end of session and we’re not sure what’s going to happen with that particular bill
but the concern is with the cures program which is a very vital program certainly for
our board and I’m understand that you use it very similarly to the way we do maybe have
trouble with its funding in the next year or two so they’re looking for funding sources
as an alternative to shutting it down so the Board of Pharmacy voted to approve or provide
a support position on SB six one six the other day which basically commits us potentially
to having a fee increase for our pharmacists down the road there’s no fee amount out there
it’s a tent up $5 a year fee right now is what they’re proposing but there is bias from
other sectors that have to be involved but the Pharmacy which has relatively low fees
anyway is very interested in ensuring that program continues we use it to trigger investigations
and to amplify investigations so are there any questions about cures or our role there
we provided the initial funding about 15 years ago for the program to get it automated now
it’s near real-time and the last step is to make it more user friendly so that when you’re
seeing a patient or when you’re dispensing a drug you can quickly access and see where
that patient has been in the in the recent past or even as long ago as a year so we’re
very interested in that in that vein we’re also talking about a pain summit with the
Medical Board which have you discusses it all with your board your next agenda okay
so I’ll hold off on that one the other thing that I would like to mention that it’s coming
up for the Board of Pharmacy we are walking into pharmacy practices we are discovering
in skilled nursing facilities we’re discovering in hospitals we’re discovering in various
environments that there are various forms of automation equipment that are out there
they take a Pyxis machine and go way beyond what a Pyxis machine does in a hospital existing
California law with respect to automation is relatively restrictive and so it outlines
the specific components that you can have in a any kind of automated dispensing device
in any particular environment and what we’re finding is we will walk in during an inspection
find a machine has features or very broad features that are not covered in existing
law so we are going to hold a one-day summit where we’re going to invite various technology
vendors to come in and show us what they have we will in advance have a list that for example
in a skilled nursing facility it’s got to be pre labeled it’s got to be this it’s got
to be that and a pharmacist has to check it or whatever the requirements are there are
means by which you can do a video release of medication so you’ve got a pharmacist in
a pharmacy and in a clinic hundreds of miles away the pharmacist can review the patient’s
chart the medication and then released the door that the drug but there are machines
that go far beyond that now and so what we’re going to do is set it up based on the environment
in which the machine is set these are this is what law provides for this is where the
machine does not fit and then hopefully let them take legislation next year to advance
it so that technology can help us all provide better care to patients but it needs to be
done appropriately and so we want we don’t want these machines out there that are not
authorized for use and for us it becomes a very difficult thing to shut down somebody
that’s spent me a sizeable chunk of money to put this machine in only to find out that
they can’t use it so we’re trying to do this in the openness of sharing what’s going on
so they’ve got machines that do I be compounding all kinds of things so so that will happen
on October 24th in Sacramento in the Maine Department of Consumer Affairs building so
any questions in this Herald doctor do so on the cures back to cures as cures considered
pursuing an FQHC status where perhaps if would be granted it would have funding stream for
for the pharmacy piece of it I’m not quite sure what kind of funding that is I’m unfamiliar
with that acronym you used that’s the federal qualified healthcare so portable Care Act
money not that I’m aware of but this would this is a system we all use all practitioners
can access it for their patients we access it for our dispensers on this specific item
here were going to continue with number seven update on controlled substances form and this
Whitney is going to participate with this Harold please good morning miss Harold and
I discussed this item with the Board of Pharmacy to lead into it I would like to let you all
know that we have a retired annuitant Janey Corder who is the main staff person who has
been working on this to organize it for the two boards to make sure that we have the correct
content that we’ll be able to contact the correct individuals as a retired annuitant
there is a potential that her position will not be considered mission-critical by the
administration we certainly do consider it mission-critical because we find that the
controlled substance issue is very very important to discuss with the prescribers as well as
the dispensers so with that any update on how we’re doing with the form that you want
to talk about now I think I think at this point we’ve got we’ve got our board presidents
very interested we haven’t it’s only been staff discussions at this stage where we’re
discussing where we’re going with the forum and we intend to broaden it a little bit in
the future but at this stage we’re still trying to figure out dates we’re still trying to
figure out where we’re going but every day it seems that we’re finding increasing evidence
of the widespread problem with prescription drug abuse in this country particularly the
diversion of controlled drugs and becoming a real problem we did mention at one point
in time we thought late November unfortunately one of the speakers that we really wanted
to have at the meeting Dr Fischman will not be available so now we’re looking at the first
part of 2013 the goal is to really address some of the issues where we have common overlap
some are more specific to physicians and other prescribers some are a little more specific
to pharmacies but the overall goal is to ensure patients that have pain needs get pain treatment
and those that are abusing the system don’t sort of remind one second mischievously to
remind the board this board did participate and did conduct a pain summit several years
ago it was done by task force with a round table with all engaged parties including people
from oxycontin from whatever part of the country they were in doctors that dealt with intractable
pain and to set up protocols and that was exactly the same issue then I guess it hasn’t
gone away it patients that have seen need pain medications and doctors will not be punished
as a result of having a treatment plan a good faith exam and all the regular protocols what
a doctor does in their practice in order to ensure patient safety so I’m sorry that this
is continuing that this is an issue that hasn’t gone away but I’m glad you guys are in the
process of addressing that so we could explore is the county of Alameda just passed an ordinance
called the safe disposal act where they’re going to be requiring manufacturers of particularly
scription medication to have a program whereby they take back the medication the act the
unused medication and it’s not just an issue because people are getting access to it but
it also is an environmental issue because these medications are being dumped into the
water system so I think it might be helpful and perhaps maybe we could work with the Board
of Pharmacy to really try to promote that because as a local official we have difficulties
we’ve had the water tested and medications have shown up repeatedly in the water system
and this might be something might be interesting Los Angeles County also does some things with
pharmacies taking back meds and their immigrants – that’s even better hide some kind of process
by which the mad Stan use meds can be disposed to say so we’ll put it on an agenda item for
future come in yeah there are a couple items in there at the end of September any of you
that have unused samples it’s really in to the public but the DEA now has sponsored drug
take-back days to help take these drugs out of circulation because for patients if they
have unused controlled drugs they can’t give them to a pharmacy they can’t give them to
anyone else the only destruction method that the DEA and the FDA both recommend is to wrap
it up and duct tape with kitty litter and throw it away but and but it’s to make it
unpalatable so it doesn’t become a substance abusing risk but the real problem we’ve got
in Alameda is looking at product stewardship which is going to have the producer paying
for the cost of absolutely because you have to pay for the law enforcement that needs
to be present we these take-backs as well and so that’s the other aspect of it so it
might be very helpful is that when you come up with things like this through your board
and your information that you share with our board so we can put it on our webpage we can
put it out as an alert to our constituents our doctors and our consumers and that way
sharing of information is a good go forward basis to promote good public policy I will
say that in the future you can expect to see more in the area of appropriate drug disposal
for the public as well as for example residents care resident the residential care homes and
especially the skilled nursing facilities where there are just tons literally tons of
drugs that we don’t have a good way to dispose of they and they’re over dispensed the one
end but then you can become a destruction issue and we really even with the collection
boxes California hasn’t addressed the issue in the level it should yeah and that’s something
you’re looking at that we know we’re going to be involved in that sharing syringes because
as a requirement and they cannot be put in the trash and so we’ve got a problem we have
a consumer the only place to put them and there’s a real substantial health risk to
anybody downstream from that okay thank you very much dr. Karen a brief comment yeah I
think this is the second or third time that we’ll get an update I think that we should
take action and both boards we should try to to try to date this forum as soon as possible
experts we have around the country and around the world if dr. a is not available we’ll
bring dr. B but this is his delay and delay and delay please little take action in this
forum and later get some results okay Linda here we go you’ve got your marching orders
thank you thank you dr. carrion okay so thank you very much for being here thank you very
much report anything else so now we’re going to right now we’re going to move to item number
8 mm-hmm and dr. LOH thank you I’d like to call our chief of licensing mr. warden to
help with this presentation the agenda item is the special faculty permit review committee
update and just as an overview the special paksy permit is a section under 2168 added
business and Professions Code that allows an internationally trained physician who is
sponsored by the Dean of a California Medical School and has been academically has been
recognized academically eminent in his or her field of specialty by the Medical Board
of California so that allows them to have a permit that authorizes them to practice
with all the rights and privileges of a California medical license only in the sponsoring medical
school and it’s formally affiliated hospitals so with that background we had a committee
meeting on [Music] let’s see what date was it June 14 2012 we reviewed three applications
one from UCLA one from UC Irvine and one from UC San Francisco so our first candidate that
I’d like to present is dr. Piercy’s and mr. Wardin will present his background dr. your
C’s specialty of our expert area of expertise is liver transplantation more specifically
in situ splitting of the liver for transplantation and dr. you see attended and graduated from
the Istanbul University Faculty MS and Turkey he attained his postgraduate training at the
same University from 1982 and also at the so Lisa if the hospital of Istanbul and he
presented training from 1982 through 1991 and including the transport patience surgery
which was done at the last three years of four years of his training from 1987 to 1991
and hepatopancreas towed by a Lhari Surgery Unit he’s been a had visiting institutional
appointments at UCLA as a visiting research scholar in 1992 a visiting associate researcher
in 1995 1998 as assistant clinical professor of surgery 2003 as an assistant adjunct professor
of surgery 2004 associate adjunct professor of surgery 2007 adjunct professor surgery
in 2011 he’s been appointed as the health science clinical professor and professor of
clinical Surgery dr. C is known throughout the United States and internationally as a
leading expert and Institute splitting a delivery for transplantation he has trained 43 fellows
or the and who have completed two years of fellowships and currently training three more
fellows at this time dr. C has performed 18 lectures and presentations in the US and internationally
and also provides consultation services regarding liver transplantation for the one legacy liver
Advisory Committee since 1999 and as approximately 60 peer-reviewed publication has written chapters
for seven different liver transplantation books and has written a one guide book on
liver transplantation that concludes my presentation dr. years okay so the committee is comprised
of a member from each of the California medical schools myself who this chair and Hedy Chang
who is a member and the committee voted to recommend that the board approved dr. your
C’s for a special faculty permit and so I would like to make that motion do I have a
second second I do have any discussion on the motion do I have any public comment do
you have any comments from any of the members of the committee all those in favor of the
motion please say aye I any opposed okay thank you that one has done the second candidate
is dr. Gallo Sethi who is from UC Irvine okay dr. Gelson graduated from the University of
Rome was specifically of medicine Italy he also has a PhD in education as a molecular
physiology and biophysics from Vanderbilt University he did his postgraduate training
and wrong at the same medical facility that he graduated from from 1986 to 1993 he’s done
postdoctoral training and research pulmonary exercise science and pulmonary ology medical
molecular physiology and biophysics and also endocrinology but I forgot to mention a dr.
glossaries areas expertise of pediatric diabetes endocrinology metal metabolism and obesity
he has a institutional appointment at Vandenberg University since 2001 as a research assistant
professor and division of diabetes and then ecology 2002 his wish list and professor and
residency at Department pediatrics at the University of UCI in 2005 he was a professor
at the department pharmacology 2007 associate professor in residence and department pediatrics
and pharmacology 2011 associate professor as in residence and department feet pediatrics
on pharmacology dr. glass Eddie has been awarded research awards from the southern Society
of Clinical investigators and the outstanding young investigator award from his from Association
of patient oriented research in 2001 and he is in receipt of at the first ages NIH k24
mid-career award that recognizes both scientific innovation outstanding internship and clinical
translational research dr. glass sanity’s research has been published in scientific
journals and he has reserved as a peer reviewer for over 30 different scientific journals
himself dr. Lakey khalessi has 81 peer-reviewed publication articles and 18 articles for books
chapters this concludes my presentation dr. cuesta the committee recommends that the board
approved dr. Gallo Sethi for a special faculty permit so I make that motion drove a second
any public discussion any discussion for many of the members all those in favor please say
aye any opposed thank you that carries dr. mode continued final candidate is dr. Sileo
and he’s from UC San Francisco he is a pediatric neonatal neurologist very unique field okay
dr. Co as dr. Lowe said is the specialty as pediatric neurologist with a specialty in
neonatal seizures she graduated from the University of warrant Rome and I don’t know go out bosco
Cynthia in Italy she also has a PhD and she graduated with a PhD from the University of
Harvard and pediatric sciences and graduated from that in 2002 she retained her postgraduate
training from the same university in rome for Niraj neurology she did other postgraduate
training at the Catholic University of Louvain in pediatric neurology she did in Belgium
and also followed up on more P attrex in Belgium in that same hospital and did a final postgraduate
training at the Bambino issues Children’s Hospital in Rome on pediatric neurology she
also has done specialty training in neural physiology at that same hospital she has she’s
at the University of San Francisco University California San Francisco she has the visiting
a professor appointment since 2008 associate professor 2009 is associate adjunct professor
and 2011 as a visiting professor dr. Slavs been invited to make presentation in US and
internationally in 45 occasions she has 34 peer-reviewed publications she has 6 books
and chap and or chapters for books she was awarded the presidential chair from UC San
Francisco in 2011 which calls for her to develop and implement internal medicine airy program
for neonatal neurophysiology dr. C leo is the project leader and principal investigator
for the prestigious multiply Center research grants with the European Commission and the
Italian Ministry of Health for rare neonatal neonatal neurological disease disorders and
genetics for the basis of neonatal seizures this concludes my presentation so the board
also recommends that we grant her a special faculty permit so I make that motion second
public comment adapter this is the last candidate that’s why I just want to ask the committee
is there a limit the number of people who can do this in each medical school is there
a requirement of a BMS certification any of those or is there a limit how long these people
can be practice there is no limit the requirements are exactly what I’ve stated and that is that
the committee which is comprised of somebody from each of the medical schools that the
person be internationally trained sponsored by the Dean of the school and recognizes academically
eminent and so all that’s pretty general and so the committee is very specific and they
look it over very carefully and when everybody decide and agrees that they are then they
get a permit so in the entire history of the program there only there have been less than
25 total so there’s not a lot yeah my America that’s my concern there was that if the number
is high it’s an unfair advantage we are giving to one segment of physician employers not
to the others and also unfair advantage were giving to certain number of people compared
to anybody else who wants to come to California so these are individuals that are practicing
only in the hospital University Hospital situation so that this is only a hospital based practice
hospital based education this is not to any other General Hospital or any other general
community these are preeminent people that are only practicing in a hospital based and
teaching teaching in a hospital basic situation so understand that very clearly yeah madam
chair I got that very clearly well my my that’s where I was showing that it is referring somewhat
of an unfair advantage to those institutions compared to the others that’s all I was pointing
out that they have an unfair advantage because they are the teaching hospitals in the state
of California Legislature said so that’s why they are special I would take an exception
that it’s not an unfair advantage I don’t think that anything I mean I apologize I was
not meant that was meant tongue-in-cheek be I don’t think good any unfair advantage entities
would entertain the thought of going into private practice are working in another institution
I mean if they wanted to work at the Mayo Clinic I’m sure which is you know an academic
institution but well they have a medical school but let’s say like the Cleveland Clinic or
something a very eminent clinic they probably could get some kind of permit to work there
as well so I don’t think that these are people that would be interested in working in private
practice so it’s not really an unfair advantage I mean their focus is so unique and specialized
it’s a very unique situation so the final I thing that I’d like to do is the University
of California Irvine is quested that there remember me dr. Loe we haven’t voted under
motion oh I thought you did no we’ve done any other discussion from any board members
or in the public so all those in favor the motion has stated please say aye any opposed
okay now you may continue his discussion wasn’t related to that so I didn’t think I thought
we had any way the University of California Irvine has requested that they change their
committee member from dr. Hubble to dr. Wadi nijem who is the Dean of associate dean of
academic affairs so I’d like to make a motion that we approve that change do have any discussion
for any questions board members dr. Diego was a special faculty permit committee that
committee they just want to change their member from yes every University in California where
the medical school has a member on remember is a some kind of a Dean yeah okay thank you
all those in favor the motion oh excuse me did I have public comment any public comment
no thank you all those in favor of the motion please say aye any opposed thank you dr. lo
before you start on agenda item number nine is when I have to make a remark and I want
to thank you for I take a moment and thank you for your time and commitment to the physician
assistant committee I know that in January with inordinate strain on your time commitments
that you ask to be able to take leave of chairing this committee and I want you to know that
on behalf of this board we thank you for your dedication finally now that I understand the
process we’ve heard and I looked into any fit to any physician member sitting on this
board to participate as share this committee I’d like to let me or miss Whitney know about
that and we will figure out if we can get you confirmed by the governor so now moving
on to number nine I wanted to thank you seriously but now you’re going to be relieved after
this meeting thank you we leave today all right working with the people from the PA
committee is just that there’s so many demands of my time and with this new business in enforcement
that’s taking so much more time it was impossible for me to go to all their meetings and to
perform adequately anyway so the PA committee update for today is that the the meeting was
held in May and since the last Medical Board meeting about a hundred and seventy five licenses
have been issued by the PA C and they’re now over 8,500 piays licensed in California as
at our current they have 70 complaints pending 25 investigation cases are pending and there
are 45 probationers 24 cases are awaiting administrative adjudication at the office
of the Attorney General at that last board meeting they considered a regulatory change
dealing with personal presence of a supervising physician remember that the Medical Board
is responsible for regulation regarding scope of practice issues and we’re going to hear
about that on the next agenda item upon review of the draft language the board members requested
that the PX see review and revise the proposed language to address the Medical Board of California’s
concerns and resubmit the revised language at a future medical board meeting there was
further discussion and it was suggested an informational presentation be made to the
board regarding the PA scope of practice so we’re going to hear that next the PA regulatory
proposal dealing with preceptors in the PA training program was modified to address the
concerns raised by the CMA in the California Academy of physician assistants this proposal
currently is out for a 15 day public comment period next the PA C is working on to incorporate
the uniform standards of SB 1 for 41 for substance abuse abusing licensees into the PA C model
disciplinary guidelines the PA C held an interested parties workshop on May 15 to discuss incorporating
the uniform standards draft language is being developed in regards to the sunset review
the for the PA C this bill is currently moving through legislative process and in corpse
coorporate several changes to the PA C including the name change from the physician’s assistant
committee to the physician assistant board inclusion of section 800 reporting requirements
and changing the composition of the new board which the executive officer can discuss in
the next section if passed by the legislature and signed by the governor the new board would
be in existence till 2017 lastly the PA C is considering implementing an examination
for new applicants for licensure which would focus on the laws and regulations governing
the practice of PAS in California that concludes my report thank you very much dr. Lowe I’m
going to call up number number 10 to discuss the physicians scope of practice miss Portman
executive officer of the physician assistant committee and Miss grivet and the member of
our physician responsibilities committee and a physician assistants as well please thank
you for being here today good morning thank you I’m Alberto Portman
executive officer of the physician assistant committee I’m here to provide you with some
information about the PA committee and the profession first I’ll provide you with information
about the history and current status of the committee later Beth will discuss with you
the PA practice from a licensee perspective the PA C was established in 1975 after recognition
that there was an increasing shortage of healthcare services in California the goal was to enable
physicians to delegate healthcare tasks to qualified pas there have been changes to PA
laws and regulations throughout the years that have encouraged and allowed for greater
utilization of PAS in California for example increasing the number of PAS a supervising
physician can supervise from two to four and a revision to chart signatures 10% to 5% the
current the PSC currently has nine members were a healthcare related committee that’s
part of that Department of Consumer Affairs as you can see we have a physician member
from the Medical Board and we currently have three to four meetings a year as dr. lo mentioned
our Sun Rise bill is currently going through stated process that would change the makeup
of the committee to include five physician assistants four public members and retain
one Medical Board member who would be a non-voting member of the committee as with all other
boards and committees within the Department of Consumer Affairs our mandate its consumer
protection be a licensing discipline etc as dr. lo mentioned we currently have 8,500 licensees
and we issue about 55 licenses per month additionally we are also mandated by law to maintain a
drug and alcohol monitoring program currently we have about 24 participants in that program
as you can see from the screen our priority for the committee aspra tection of consumers
through licensing education and objective enforcement of the PA laws and regulations
the physician assistant committee and the Medical Board of California have a unique
relationship Shira where a PA may only practice under the supervision of a physician as part
of our ongoing relationship with the Medical Board we have agreements to maintain our information
technology system as well as having the Medical Board staff handle our complaint and investigate
illnesses the system works well since often time complaints involve both the supervising
physician and a physician assistants I would just like to take a moment to thank dr. LOH
for his participation on our committee since he was appointed to the committee in 2008
we have enjoyed his time and sharing of his knowledge while serving as a member this concludes
my presentation if I or any questions for you they’re there any questions directly and
I’ll continue please queue so we’re just having a technology realignment I’ll just introduce
myself I’m Beth grivet I’m a practicing physician assistant in family practice in Orange County
and I appreciate the opportunity to share a little bit about the origins of the profession
as well as the scope of practice of the physician assistant I think what I wanted to do is just
kind of give a real brief overview I know there’s there’s members of the committee that
use physician assistants and public members that are members of the audience that do but
I think it’s it’s worth going a little bit into depth about our profession and our relationship
with physicians so as mr. Portman said there we always work with physician supervision
we really promote the physician assistant physician team and we do provide a broad range
of diagnostic and therapeutic services we can basically be found in just about any medical
specialty and any practice setting so anywhere a physician practices we can practice in that
area as well our duties also could include education research and administrative activities
where our profession came about is kind of interesting we basically came the first class
graduated in 1967 out of Duke has really sort of a answer to what to do with corpsman coming
out of Vietnam who didn’t really couldn’t practice as a civilian so when they graduated
the first class was just three students but they were all military veterans and we’ve
grown now to I think even 156 is inaccurate there’s probably closer to I think they’re
over 160 education programs in the United States we currently have nine accredited programs
in this state and as was mentioned earlier about 8,500 licensees which is makes up about
10% of the nationally so our education is a little bit varied and the interesting thing
with our education is we’ve always been very competency-based there has been a move now
to introduce the master’s education as the entry-level education for pas but there are
many pas practicing that do not have a master’s degree myself included and I think it’s important
to realize that we have traditionally allowed education to move forward in various settings
to increase the diversity of our profession and we’re actually very proud of the fact
that we can maintain standards through our certification and our high level of education
through our accredited programs the programs last about 24 months on average there’s two
to three year programs out there but the first year generally is a didactic encore Sciences
and then the second year is generally rotations physician assistant students go through usually
four to six week rotations at various sites and we basically act like a like an intern
or resident and work on the team providing services in the hospitals and outpatient settings
the reason that a master’s degree is such a vital component of the structure of education
in this state is the first three programs listed here Stanford San Joaquin and Riverside
are actually on the chopping block because our national accreditation for PA programs
will not allow a physician assistant program to continue to exist if they cannot provide
a master’s degree by 2020 these colleges do not have a mechanism to provide a master’s
degree because they’re not masters level institutions and so these three programs although they
do they provide education less expensively and to a more diverse population may cease
to exist in the next eight years we also see currently we have three programs that are
seeking accreditation in this Dame and probably we will see a few more initial licensure is
granted through obtaining certification on a national basis and in order to obtain sort
of certification a PA must graduate from an accredited PA program and must also pass past
the national exam and ministered by the national commission in order to maintain your certification
which is the PA – C you must log a hundred hours of continuing education every two years
and you must sit for a recertification exam every six years although in two more years
we’ll be going to a tenure cycle for national certification however this state and a few
other states in the country do not mandate that you maintain national certification and
in response to that the PA Committee passed regulation a couple years ago that does require
50 hours of continuing education every two years so if you see a physician assistant
that just has PA after their name without the – C it means that they’re meeting that
requirement through the state but they’re not maintaining their certification for whatever
reason so PA duties vary we can we can certainly do history and physical exams we can order
in interpret labs we can develop and initiate treatment plans provide patient education
in this state we don’t write prescriptions we write drug orders but they look a lot like
prescriptions and they take them to the pharmacy and fill their medications with them and we
can provide perform minor outpatient surgical procedures and first assisted surgery I will
make a point since part of the presentation was regarding surgery is we we can never be
a primary surgeon and as long as the patient’s under sedation so when we talk about minor
outpatient surgical procedures pas can perform any kind of surgical procedures as long as
it’s in the scope of their practice as well as as long as the patient is not under under
sedation so but in the surgical suite we can first assist we do still see most about half
of our pas that are in primary care specialties and we are getting about 55 since each month
that are newly licensed in the state I just wanted to bring a couple points the physician
assistant used to have to have a supervising physician that was licensed as a supervising
physician that went away probably detain open and that’s gonna say ten years twelve years
ago where there’s no additional now application for physicians to become physician assistant
supervisees or supervisors and so now as long as you’re in good standing with the Medical
Board you can supervise a PA we do have a delegation of services and that does delineate
our practice and our scope is limited to the scope of practice of that position and I think
that that’s a really important concept even if I’m totally competent to do a procedure
if my physician that I work with does is not it that’s not part of their routine practice
I can’t perform that while I’m under their supervision and again we don’t use the word
independent we use the word delegated autonomy because we do work with a physician and we
work also in the eyes of the law we’re considered an agent of the physician so orders that are
treated that come from the PA would be treated as if they were given by the physician and
a supervising physician can supervise up to four pas at one time again the supervision
requirements just briefly and then this part many other due to a little bit there’s a 5%
chart co-signature and review all scheduled two medications must be the charts must be
countersigned within a week and we do work off of protocols and that has to be mutually
agreed upon with the VA and the physician reimbursement we the payment goes to the physician
basically Medicare allows for a deduction of service of 15 percent when a services provided
by OPA and I think the most exciting thing for me and the profession right now is some
of the challenges and and opportunities that are available with health care reform I really
see the physician assistant focusing on prevention a lot of the chronic care management performing
a annual wellness exams for Medicare and focusing on quality metrics in patients satisfied I
think part of our challenges may is making primary camera attractive to PA students and
if you can if you can precept a student as a physician and show them how exciting and
fun and family practice can be I think that that’s the big challenge though that we’re
all facing and trying to you know open up their eyes to to that ability are you know
again our compensation although the curve is not quite as deep but it follows a long
physician salaries so if you’re working as a plastic surgery PA you’re making more money
than I am dr. panda and then dr. Diego and Yama actually my group has been employing
physician assistants for about 30 years and and also we trained the students from both
from Long Island and Western you it really works out well and there we have a residency
program in surgery and art critics like dr. Bishop mentioned the specialty training is
getting more and more in in physician assistants and my group my physician assistants actually
do well in burn unit well in ICU and well in surgery so I think it works out it’s a
very good relationship actually my question is though is when the new board comes on in
2017 would it have any relationship with the medical board that is completely separate
and delicious as thinking well the new board will continue this Sun Rise bill will just
extend the board until 2017 when another review will be done so we will continue to operate
as the physician assistant committee although we may be called bored if the bill goes through
it’s just to extend their ability to to continue doing what they’re doing today dr. Diego yeah
between some physician assistants in my career and having only through them stay in primary
care just drives me crazy is there a mechanism for the other specialist to train these guys
because you know quite frankly I’ve said no more that I’ve that’s it you know I’m a primary
care provider I totally believe in that so are the other other specialists in the burn
unit and those helping with the training or is there a mechanism to make sure that that
happens not try minute helping in the training to get them to stay in primary care the training
was all set to be primary care based focus right so the plan they left right so the question
is is that have you stepped up to the plate to request for the specialty organizations
specialties to step up to the plate to help with the training of pas so that a plastics
want to have plastic piece they don’t go through primary care training to get more money madam
chair I can answer that actually now there are PA residences that’s what I was talking
about we have an additional layer of training in general surgery orthopedics ob/gyn so this
is after the PA school so so there is that sport de specialties – so the advantage of
that is when if I want to hire a physician assistant it’s so easy if okay to hire somebody
we trained so that they can work with us so I think that dr. day goes question was is
that the beginning of training starts off in the general practice Family Practice consideration
office for training no they automatically go into a a training program in plastic surgery
they have one year of clinical training and that will go through multiple rotations just
like a medical student does surgery family medicine internal medicine so that is that
the food that’s the part of the school one-year training then if they want additional training
that when they do thank you yeah the other mechanism to do that there are some core rotations
that are mandated by the accreditation you know to get the PA program accredited but
there’s some flexibility so if a student knows they want to go into a certain specialty they
can request additional Road during their original training this gym in the number of physicians
in California is 25,000 25,000 so are we looking at one to ten actually I actually physicians
are actually using is that one to ten on one to uh I’m trying to I was using the calculators
I know it’s a number so I’m doing some don’t I don’t know that there’s a correlation no
no I guess so so the law says one can supervise four is actually pretty reasonable mm-hmm
now there’s a deal this is a different question because it I know the deal uses easier a percentage
differences or anything like that there’s no difference from our standpoint as far as
who can supervise it’s difficult to track who’s supervising because they don’t have
to apply for licensure any longer so I I couldn’t tell you how many physicians are supervising
pas because no one no one knows I have a question to you for you on when you were speaking about
the schools that might have to close this and not as a result of not having a master’s
program available the educational system in California it has some creative mechanisms
by which if you’re admitted to school a you’re guaranteed admission to school UCLA is there
an opportunity that you’re looking at that might allow you to use the local colleges
and state universities there’s a pathway to and that’s really where the glitches is right
now it says because the lava Department of Riverside now will sort of bridge you to a
master’s program but the the current regulation or the current accreditation standards says
that it has to be the program that’s training the PA that the master’s degree you can’t
partner with another institution we yeah we’ve had discussions with CSU we’ve had discussions
with you know lots of options legislative approach we’re looking at many different mechanisms
reason I recommend it and requested that question is because to the Health Professions Educational
Foundation which is also part of this arena I have made a specific not for pas request
for information on a pathway in situation where we we could work together so I just
I know that people are thinking about creative opportunities so I’m hoping that you’re doing
as well that’s where my mind is where’s the money dr. Bishop is to follow my initial question
since this was a question asked me by the recent my recent Senate confirmation hearing
and they said what is the Medical Board doing to help with the the problem with underserved
areas so might I suggest and listen may already be happening doctor though is very aggressive
and is this already happening that the boards are working together to address this issue
of how do we encourage our practitioners what can we do as a state and I my response to
that was the legislature has to be involved since they have the purse strings and perhaps
we can have some way to under underwrite some of the educational expenses to have these
people staying in a underserved area so I’m just suggesting our boards work together on
this topic because I think it’s a real critical one for the legislature I think for our state
doctor let me just remind you that $25 of your licensing fee every doctor in state of
California is going to the Health Professions Educational Foundation which provides money
through the Thompson fund for a loan repayment so the Medical Board was the entity that started
that housed it birthed it and expelled it so yet it get it’s a drop in the bucket compared
what we really need I think so that’s varies I would agree with you but as you said the
first rings are where the situation 150 stations 78 okay so just to put things in perspective
can you talk a little bit about nurse practitioners how they are similar or different and how
some of the nurse practitioners do similar things as PA so that really changes the whole
ratio yeah I think our our scope of practice is very similar and I know Misha speaking
chime in at any time but the the I’ve worked alongside nurse practitioners and family practice
and we’re doing the same things in the same patients the education and how we got there
is a little different and our backgrounds are a little different but and there’s there’s
minimal differences in the laws that govern our practice but I yeah it definitely increases
our numbers if you’re looking at respect oh sure some PA is a total thank you very much
any other further questions any public questions thank you dr. Lowe thank you thank you for
your presentation thank you support an appointment miss Gribben I said find my place I apologize
so now I’m going to ask for dr. Kaufman to come forward I’m gonna go on to number 11
we’re gonna have a presentation on the use of electronic health records yeah dr. Kaufman
is an associate professor at the Philip Arlie Institute for Health Policy Studies and the
Department of Family and Community Medicine at UCSF she has engaged in health workforce
policy and research for over 20 years and a more complete bio is located on page 145
so dr. Kaufman thank you for coming and please begin your presentation thank you very much
it’s a pleasure to be off with all of you today I’ve been asked to give you a whirlwind
tour and Linda was very clear that it needed to be a whirlwind tour of a report that our
team at UCSF released last month in June entitled on the road to meaningful use of electronic
health records a survey of California physicians and I do believe you’ve got the report prior
to the meeting and it’s got a lot more detail that I’m going to be able to share today we
did this survey in partnership with the Medical Board with funding and support from the California
Department of Health Care Services and the California Health Care Foundation first just
a little bit of background the high tech Act of 2009 authorizes Medicare and Medicaid what
we call medi-cal in California to make incentive payments to hospitals and clinics for meaningful
use of electronic health records and it’s estimated that the high tech act will generate
a total of 27 billion in payments to physician practices in hospitals over 10 years with
about 2 to 3 billion of that going to California hospitals and health professionals there’s
a large body of literature that suggests that broader adoption of electronic health records
has potential to improve prevention and early diagnosis and yield other benefits for medical
care however there are also a number of concerns about EHRs and their effects during initial
implementation and beyond and particularly concerns about whether the hrs are designed
with physicians and other health professionals needs in mind and whether they distract from
provider patient interactions disrupted workflow concern that they might actually increase
rather than decrease errors and reduce quality of care so it’s within this context that we
were asked to obtain baseline information about the availability of EHRs in California
physicians practices prior to the implementation of the medi-cal EHR and in payment the providers
and hospitals became eligible to start signing up for those payments in late 2011 so our
survey was a supplemental questionnaire that was sent out at the time of biennial physician
licensure renewal and we sent it to MDS whose renewal dates were from June 1 through July
31st 2011 so we sort of grabbed a snapshot of two months in the twenty more four month
cycle just as with licensure renewal generally physicians can choose to respond on paper
or online and I believe we had about 70 to 75 percent responding online and we combined
those results of the Supplemental survey with information from the medical boards mandatory
survey and material in the core license file database we asked physicians not only whether
they had an EHR but about the specific functions of that EHR and we asked specifically about
functions that are part of the meaningful use objectives that the Centers for Medicare
and Medicaid Services have set for the Medicare and Medicaid EHR Incentive payment programs
in other words it’s not enough for hospitals and eligible health professionals to show
that they have an EHR they’ve got to show that the EHR has specific functions and that
they’re using those functions in a meaningful way so here at the top you have a list of
some of the core objectives these are objectives that every health professional every hospital
has to meet and then at the bottom the menu objectives we measured and as the term menu
implies physicians other clinicians and hospitals can pick among the menu items to choose which
ones they want to implement and you’ll see this covers a range of things from patient
demographics to providing patients with access to their own records so it’s it’s quite a
comprehensive set now I’m going to turn to some of our results we distributed the survey
to approximately 10,000 physicians and really appreciate the medical boards help in sending
that out all those 10,000 physicians about seventy nine hundred had a practice ZIP code
in California and provide at least one hour of patient care per week per their response
to the mandatory survey and so that was really the population that we are looking at because
to even begin to be eligible for the medical incentives you’ve got a practice in California
and do some patient care and then on that seventy nine hundred or so five thousand three
hundred and eighty four completed the EHR supplemental survey so that’s about sixty
eight percent of those who are eligible and I know if any of you have been involved with
physician surveys that’s a very high response rate for physicians and we know that that’s
due to our ability to include the survey with the licensed report licensure annulment materials
you know you have a captive audience when you send out those license renewal materials
and so I think that really helps us and others to leverage that to get information that I
think will be useful to the board to policymakers and the public okay let’s get to the end so
this graph just shows you the proportion of physicians who had any electronic health record
and the dark blue bar well dark blue slice of the pie 71 percent of the physicians said
they had some sort of EHR in their practice and we’ve used several different terms for
EHR to try to make sure they understood what we meant so that’s I think the encouraging
news the less encouraging news is on this slide only about thirty percent of the respondents
had an EHR that met all of the meaningful use objectives we measured about forty one
percent had an EHR but didn’t meet all of these objectives so I think the message we’ve
got a lot of EHR adoption but we’re not quite there for meaningful use at least as CMS defines
it this is just a summary of the availability of specific EHR functions and the bottom line
here is that physicians were more likely to report that their EHRs had functions that
could help them in their encounters with individual patients such as a feature that let them take
clinical notes something that let them list patient’s medications and any medication allergies
that was more common that functions that would enable them to communicate electronically
with other providers other facilities say with the hospital or to communicate electronically
and share records with patients or to perform quality improvement quality management functions
some of them definitely had those capacities but it was less common than the functions
that would help them with the individual patient encounter this is just a graph comparing California
to the United States and here we compared our data with data from the National Ambulatory
Medical Care Survey this is a national survey that the National Center for self health statistics
fields every year so here we are looking at those physicians in office based practice
in California relative to office based practice in the US and here we see we’re a little ahead
of the curve about 68% of our respondents had had some sort actually I should back up
these our data are all from the NAM sees the National Ambulatory Medical Care Survey so
some of the percentages are a little lower than our survey basically having to do with
differences in our survey methodology and theirs but using the nom C’s data 68% of California
physicians 968 had some kind of electronic health record versus 57% in the u.s. forty-four
percent in California had what Nam C’s defines as a basic electronic health record versus
34% in the United States the nam C’s vote the folks who do the NAM C surveys ranked
the states by rapes of EHR availability and we’re 11th in the US so we’re not number one
but we’re definitely in the top 20 and I think as we’ll see later a lot of that has to do
I think with our medical marketplace and the decisions that some of our larger medical
groups like Kaiser Permanente have made around EHR adoption this slide just shows us the
factors associated with having an electronic health record in your practice we found higher
rates of EHR availability among physicians in large practices such as Kaiser Hospital
based physicians urban physicians and younger physicians practice size had the largest effect
as we’ll see on this graph and so this is EHR availability by the various practice types
that were response options in the survey and Kaiser Permanente at 99 percent had the highest
rate of EHR availability dr. Levine I sort of wonder about that one percent it Kaiser
that don’t think they have any HIV I agree with you I can’t imagine who they are maybe
it’s senior staff being patient well anybody who sees patients there are no paper charts
anymore so there may be some people who don’t actually realize they’re using the electronic
and the VA and other large practices have high rates of adoption the lowest rate of
adoption is in solo practices and then down toward the bottom community public health
clinics so dr. Diego that would be where Golden Valley and other community health centers
are a lower rate of adoption and then remember this is the rate statewide there are some
community health centers that do have pretty sophisticated electronic health records this
is just saying when you look across all of them the rate is only 54 percent versus 99
percent per Kaiser we did then also ask about physicians plans regarding the EHR Incentive
payments and keep in mind that this was done in these went out in the spring and summer
of last year so this is baseline data before the incentive programs went live so at that
point about 12% plan to apply for Medicare ones payments 10% to apply for Medicare incentive
payments 15% thought they’d apply for one or the other 39% said they don’t plan to apply
or need more information I think if we redid the survey now and and or in the future we
might that would probably drop I think there have been really concerted efforts to educate
physicians about the HR incentive payments and the board has been involved in working
with DHCS on that based on the responses to the survey we estimated that 17% of physicians
with active California licenses are eligible for the medical incentive payments and that’s
based largely on the proportion of their patients who are on medical you have to have it at
least 30% of patients on medical unless you’re a pediatrician for pediatricians the rate
is 20% and that’s simply because pediatricians are much more less likely much less likely
to qualify for the Medicare incentive payments because as a pediatrician you just don’t see
much Medicare if at all right you see some but it but it’s it’s less like you know less
likely that you would qualify for the Medicare if you’re a pediatrician and so CMS’s judgment
was for pediatricians will set the bar for the medi-cal incentive payments a little lower
we found that eligible physicians are more likely to practice in community in public
health clinics not surprising given the missions of those clinics also more likely to practice
in rural areas or to be primary care physicians some important limitations of our surveys
that data are self-reported we are taking what the physicians tell us on faith not everybody
completed the survey some responses were incomplete or implausible and we didn’t include other
health professionals who are eligible for the medical hita EHR incentive payments so
that includes physician assistants nurse practitioners dio’s and dentist so i think we’ve learned
a lot here about physicians but can’t save so much about other professions I will tell
you the there is a report in the works from a survey that was done of nurse practitioners
and there’s midwives that will be coming out later this year and can be made available
to you if you’re interested some implications I think there are opportunities for ongoing
education and outreach about the incentive programs and that that should involve DHCS
CMH at CMS the Regional Extension centers which are funded by the federal government
for the exclusive purpose of expanding use of EHRs and that there’s rules for the medical
board to be involved further as well probably important to emphasize use of certified electronic
health records these are electronic health records that are certified as meeting the
meaningful use standards important probably to place the highest priority for outreach
on community public clinics and small practices because they have the lowest rates of adoption
of baseline and lastly we think it would be helpful to do the survey again in 2013 to
assess the impact of the incentive payments and indeed i’ve had conversations with your
executive director and deputy director and folks at the Department of Health Care Services
and I think we’re all hopeful that we can do that I think this has been a good partnership
in terms of generating useful information and we’d like to continue working with one
another and then lastly thanks to Linda Whitney Kim Kirchner and others at the board who’ve
been incredibly helpful to us and to my other colleagues at UCSF Department of Health Care
Services California Health Care Foundation and the California Medicaid Research Institute
and hopefully we’ve got time for a question or two you have some questions doctor controversy
thank you actually you must have found a loophole for the physicians to fill out the survey
just send it from Medical Board they get so worried they fill out any survey which comes
from medical sounds like I’m surprised to see 39 percent were not even going to really
get something which way the physician leadership worked so hard to get that funding in in my
previous life in 2000 they’d actually the Pediatrics 20% came from California pediatric
doctors uh okay came to other CMA I was the same a president we took it to the congressman
Waxman was the chair of the sanity of the House DNC committee and he put that into the
bill so the it’s it’s when you start locally how far it can go but what puzzles me is how
many doctors are not really looking at to get that because if you don’t you get going
to be penalized next so that’s what surprised me right and you’re making an important point
that I didn’t mention that on the Medicare site you will be penalized and I’m not gonna
be I mean I’m gonna get the year-long but that in several years you will be penalized
if you’re not having you by the Medicare program if you’re participating if you don’t have
an electronic health record so I think I would say two things a lot of these Doc’s said they
needed more information and as I say I think if we did the survey again now hopefully some
of those physicians have been educated by the board CMA and others but I think you’re
right that there’s a need for ongoing information and a better understanding for those that
aren’t applying what what’s the rationale behind that dr. Diego – two comments or questions
one of them is you think maybe the 39% we’re plying on not having populations in their
patients in their practice that would cost a penalty and the other is is there a way
to provide a list for those providers that are trying to do this to choose the electronic
health records that will get them to meaningful use so I think I’m the first question we do
have a response option of whether you think you’re not eligible and so there’s 39 then
and that was nineteen percent so one would hope that that in that thirty nine percent
of people who don’t think that they’re also but I think that maybe part of it we certainly
do have a lot of practices that do not see medical patients and we have some that do
not see Medicare so that may be part of it it may in into your second question I think
the office the National Health today National Coordinator for health IT has tried to provide
a lot of guidance about certified EHRs and the regional exchange their change centers
in Regional Extension centers here in California and that’s Cal hips so in the north and then
LA County in Orange County have separate you know that’s what I think they’ve been trying
really hard is to push out the information not only about the benefits EHR but how to
get an EHR that’s gonna achieve meaningful use and maybe dr. Levine can speak to that
to you I think the number actually of ineligible physicians is fairly large in California because
if if you participate in Medicare through Medicare Advantage you’re not eligible for
the meaningful use incentive well that’s I mean I would refer to fer that to dr. Larry
Dicky who runs the program at DHS because I think the answer is yes or no depending
on the specifics of your Medicare Advantage plan but but dr. Dickies the expert on that
I know that maybe what needs your Doc’s are not not eligible so but maybe what needs to
happen is that the Medical Board needs to partner with such organizations to do outreach
in through our newsletter through other means along with a concerted effort from the specialty
boards as well as the health plan organizers to try and get this out there because the
idea that it’s available there’s incentive plans and that in the event you don’t want
to do this you’re going to get charged for that luxury of not doing it maybe something
that you know it’s like having broadband in your community there are certain communities
that just can’t put their arms around it there are people in their community that can’t put
their arms around you had an iPad but I’ll get there so the issue is is that technology
is coming and reform is coming and we can be very we can help get it out there and I
have to tell you I think that it’s an exciting opportunity you know III think that we’ve
all seen it work so other question definitely and I think miss Whitney you can cut wait
you did put an item in the newsletter I think at some point in the past and I know you’ve
talked to dr. Dickey about additional newsletter we can do more we can office tomorrow okay
so I think that those of us in the practice of medicine would agree that it’s electronic
health records have been very helpful in many many ways but it’s also very very costly and
I think it’s unlikely that any amount of incentive money is ever going to come close to paying
for the cost of true EHR so who I mean the reason solo practitioners can’t afford to
do it is because there’s just no money to do it secondly I think that this whole concept
is fantastic and while it’s very easy for a system like Kaiser or UC Davis who can afford
epic which is the rolls-royce of EMR that they should have had some ground rules for
all of the companies in this field who really are in the field to make money so that there
would be more compatibility in other words if you can’t afford an epic program and you
have an EMR in your office you can’t have an easy way to import x-rays into your EMR
like so that they can be easily seen like they are an epic nobody can afford it so they
should have had some guidelines and rules this is the DICOM format that’s going to be
sent by your radiologists to your office so that you can have access to the actual x-ray
or some kind of rules like that so I think that it’s nice that we have EMR but I think
that we need to backtrack and set some rules for these companies so that there can be more
compatibility and interchange well I think those are excellent points I think that those
who if there’s a way for the Medical Board and and those of you on the board and your
organization’s to make your voice heard to CMS and to office and National Coordinator
I you know I that’s what I would advise I think those are incredibly important points
no this is not something that Medical Board can do I mean we’re trying to protect our
people but we have limited resources we have no state money we have from my licensee this
has to be a national mandate from our president through his Secretary of Health I mean this
is not something we need to do it’s something that the government has to do from the top
just like they made a standard for x-rays they made the DICOM standard for x-rays about
12 years ago and it was done at a high level and when people said they weren’t in a play
the practitioner said we will not buy your x-ray equipment if you’re not part of the
dot-com standard so now it’s become a worldwide standard but it took somebody at the government
level to make that mandate we can’t do it at the medical board level you know and I
recognize that but I think what dr. Ghana deaf gave us is an example of the case where
pediatricians in California coming to the CMA may now in educating the CMA about why
this was a priority I think the CMA and others were able to educate government government
so I think you’re right it has to come from the top but sometimes the interest and then
the concern has to bubble up on the field in order for that but to happen anything are
you able to take the message back that you’ve heard from members of concern that there is
a platform that’s necessary for basic technology to be available so shared responsibility of
the technical skill set would be available I mean I can tell you I start with the former
Speaker of the legislature in Los Angeles the electronic medical records at a clinic
and and he he didn’t understand it nor did I when we walked into the hospital we understood
it very well when we walked out he’s no longer in the legislature but by the same token but
the same token is that that you have a united voice you you’re you’re doing the survey you’re
hearing from people what the weaknesses and the strengths are can we work together and
look to you for some you know guidance as far as what you’re doing in the future as
far as maybe we can chip you know tag along with it but but I think dr. LOH is exactly
right that this is this is bigger than all of us I’m sure but someone’s got to address
it well I think you know our goal is academics at the university is not necessarily as advocates
but I think certainly if we are able to go forward with a second round of the survey
it would be very helpful to have the board’s input on what questions to include understanding
of course that with surveys there’s always a trade-off between making it longer so you
can get more information and making it short enough that people will actually fill it out
so again I think those are great points okay dr. Simon so I’m gonna try and hear from people
well I can only echo dr. Loes points but as a solo practitioner in that minority I guess
it doesn’t have the EHR I can tell you that it’s gonna have to be shoved down my throat
because it is incompatible now and and not affordable because I have investigated it
and you know even fine hospitals have incompatible systems with each other so right now it looks
like an improved billing mechanism but the other shared information is not there and
basically yes I would like a more extended survey because I would like to be able to
express that because ultimately I do think it’s excellent but it’s so not very good and
I just would add the net the NAM see survey did have some extended questions and a lot
of the responses were very much like yours yeah I have a question and perhaps a comment
on the core objectives that relate to the patient demographics right maybe I missed
it but what did you find in that regard how at how aggressive are these folks that using
this system beginning to collect that particular data let me see that was not the most frequently
used but pretty pretty widely available and where we asked folks is it available in your
practice and do you use it and that was one in which there was a fairly high rate of use
some other things like let’s say quality indicators doctors a number of the doctors used them
but others would say well yeah we have it but I’m not using it myself I think what I’m
getting at here in terms of a comment know what the meaningful use we at the UC Davis
a design an instrument to drill down and collect the ethnic profile of patients so that in
the future we will be able to have a sense of who our patients are so that we can begin
to intervene in terms of reducing health disparities it’s particularly in light of the healthcare
reform that’s coming down the pike you know I think this is one really significant objective
that I think the providers at least should concentrate on that’s a great point we asked
a very general question about whether you were collecting patient demographic information
we gave race ethnicity as an example so this is a case where we’ve got some general information
but we’re not we were not able in a two-page survey to drill down as far as you’re drilling
down at Davis just a comment you know like many things the designers of the grand blueprint
honestly had no idea about the complexity of execution and much of the utilities that
you describe under advanced systems actually have to be bolted on they don’t come with
the electronic health record and to dr. Loes point a common platform is a start but you
can’t communicate between our epic systems and yours we can’t even communicate with Southern
California or Southern California region they come they owe the we completely underestimated
amount of ongoing adjustment development of tools to extract the quality data had to be
bolted on I don’t think the vendors understood what scale and scope was going to be so we
have a what I think is going to be really a 20-year journey to achieve what the incentives
are beginning to assume beginning in there’s a 2016 I think right the penalty kicks in
so yeah I think you’re right this is a pot you know this is not flipping the light switch
very much just to put it in perspective I mean kaisers invested initially over a billion
dollars it’s now four billion so they started with 1 billion they’re up to 4 billion dollars
now this is a huge cost and nobody’s paying helping to pay for it they wanted to come
out of the providers pocket well I mean I think the incentive payments are intended
to help pay for it whether there are not whether they’re really sufficient they may not be
for someone like tower Simonson in us in a private solo practice but there is some I
mean I think we need acknowledged CMS has put some money on the table so maybe we need
to have some kind of written policy within this opportunity of a return policy that doesn’t
work at the end of five years we when we turn it and get our money back what you can do
is about that state policy state policy I’m looking at it as someone specifically in the
audience state policy we need to break I mean in spite of the caution in spite of things
as you outline the hit on efficiency and the need to all up we would do every kind of work
process there isn’t a physician in our system who would go back to the old days just the
notion that you have the x-rays that you have the the notes that you need is an enormous
benefit in terms of provide actual in providing care implementation for this I’m hoping somebody
is putting more thought into help and to make it it’s a workable situation because the projection
is only the big people like UCLA like hi sir what would we’ll be able to to fashion well
even in the future but if you want to say it was wonderful for a patient Eddie you’re
paying every time you go in and observe I using the services trust me doctor Diego is
how you hand a minute oh yeah I just wanted to say I think that’s why it’s so important
to try to keep our you know our physicians informed in terms of which one’s of those
EHRs are the right choice to make I think that’s something that the Medical Board can
definitely do because some people may not be able to access those lists from Calif so
and all that you know as much as you distribute information obviously if it’s coming from
the Medical Board they’re reading it right so again that’s maybe an opportunity for the
board to partner with Cal hip so at the very least maybe to have them make a presentation
and then secondly is there information like these lists that could then be replicated
in medical board communications so that if they’re not paying attention to Cal hip so
if it’s coming from the Medical Board maybe they will read it in that helped them wrap
this up on that last one I just want to make a point it’s very difficult for the Medical
Board to make specific recommendations because these are proprietary private companies can’t
hip so can do that and that’s what their job or CMA can do that that’s what their job at
Medical Board is difficult because these are all private so none on open source companies
which are putting all this unity absolutely well thank you for calling it to our attention
so I want to thank you very much dr. Kaufman for your reports been very informative and
the best of luck thank you so much and we look forward to being able to work with the
board in the future on this area thank you so I’m going to move on to item number 12
okay so the the executive committee met on Wednesday and we heard testimony on SB 1483
and we will have a position to present recommend to the board and I would like to take are
we gonna do the legislation l won’t take legislation now okay so mr. mosz would you come forward
and make a presentation on this bill and [Music] we’ll do this one first and then we’ll do
the legislation as part of this after this okay okay we do all this station right now
what we’re gonna do the fortunately to do the portion of this one from the Executive
Board okay first thank you thanks good morning good morning okay so if you please refer to
your legislative packets we’re gonna discuss SB 1483 first SB 1483 Steinberg is sponsored
by the California Medical Association the California Hospital Association the California
Psychiatric Association and the California Society of addiction medicine first I would
like to thank the author’s office and the sponsors for addressing many concerns raised
by the board in its previous analysis the previous major issues of concern with this
bill that it was located and then boards Medical Practice Act that did not identify state agency
to have oversight of the committee and the position health program and that it did not
identify a funding source have been addressed to briefly review the bill this bill would
establish the position health program which would be administered by the physician health
recovering and monitoring Oversight Committee also created by this bill this bill now places
the committee and the Department of Consumer Affairs and would require DCA to select a
contractor to implement the physician health program and the committee would serve as the
evaluation body of the physician health program or the PHP the PHP would provide for confidential
participation by physicians who have a qualifying illness and are not on probation with the
Medical Board the PHP will refer physicians to monitoring programs through written agreements
and monitor the compliance of participants with that agreement it’s important to note
that the PHP would not actually provide any treatment monitoring services this bill would
require the committee to report to DCA on the outcome of the PHP and the bill would
require regular audits of the PHP this bill would increase the physician and surgeon license
renewal fee by thirty nine fifty to fund the cost of the PHP in the committee this bill
the defying physician surgeon as a holder of a valid Physicians and Surgeons certificate
it also includes students enrolled in medical schools approved or recognized by the board
graduates of medical schools and residency training programs or Physicians and Surgeons
seeking reinstatement of license although the board believes that applicants would still
be required to report this information on their licensing application it is a possible
amendment to require and to specify this in the bill this bill would also required the
PHP to have a system in place for immediately reporting physicians who fail to meet program
requirements to the board the system would be required to ensure absolute confidentiality
and the communication to the board it would not be allowed to provide information to any
other entity although this board bill requires the program to report to the board participants
who fail to meet the requirements it does not specifically require reporting to the
board of those whose treatment does not substantially alleviate the impairment those who withdraw
or terminate prior to completion or those those who after an assessment are unable to
practice medicine safely it appears as lack of reporting one and oversight and how the
bill was drafted but this is a possible amendment lastly this bill would increase the biennial
license renewal fields to all physicians and surgeons to 39.55 3950 to find the cost of
the PHP in the committee this would be effective January 1st 2013 board staff does have a concern
with implementing the phia crease on January 1st the board sends renewal notices to physicians
90 days in advance of the expiration date for licensees with the ruminal expiration
date of January 1st of renewal letters go on October 1st with the transition to a new
computer system set for October 15th the board’s current computer system is frozen and no new
changes can currently be made the new system will not be able to accept provisions until
mid to late November and then the programming time to accomplish this update to revise the
room debris noodle forums the website cache area etc will take approximately 3 to 4 months
board staff would not have time to update the computer system revise the renewal forms
get out the renewal letters by october 1st 2012 12 or staff instead but you don’t have
to delay the renewal of those applicants or have to send an additional letter requesting
the 3950 and renewal fees the additional workload result in the fiscal impact to the board of
20,000 at the board if it stays as it is with the implementation date of January 1st the
board would like to would be able to implement this bill in a more efficient manner if the
increased fee has a delayed implementation date of July 1st 2013 this would give the
board until April 1st 2013 to update the computer system and revise the forms and allow the
board the necessary time to do this within its normal workload as I’m miss Yaroslavsky
said this bill was discussed at the executive staff committee meeting on Wednesday some
important things to point out before we start discussion on this bill is this bill it’s
not the same as the boards diversion program it it does not divert people from enforcement
so it’s it’s a program created and and it’s intended to be basically like a referral system
to refer physicians to monitoring programs physicians would pay the cost of the monitoring
programs this program doesn’t actually provide monitoring services but it also does not divert
people from enforcement and so that’s just an important difference to point out between
the two programs if the board were to find out this you know the position was participating
the program and the board was to find out that something happened regarding patient
care we would do the name normal complaint process that we would always do so this would
not exempt these physicians from enforcement or divert from enforcement so I just wanted
to point that out before discussions ensued so I can defer to the chair on what happened
in executive committee okay thank you miss suppose for that explanation the executive
committee voted to recommend to the board a neutral if amended position with these amendments
one is to clarify applicants must report on medical board applications the change effective
date to renewals from I do July 1st and after and clarified that reports must come to the
board in a section eight thirty point one zero friends e4n one so that is the motion
I’d like to make and I’d like to second to that motion clear thank you for the second
so now we’re going to have discussion for the members of the board and then we will
take public comments so let’s start if this in dr. carrion you have any questions microphone
please microphone 125,000 licensees and so if it’s thirty nine fifty per cycle I’m doing
20 per year looks like 2.5 million dollars a year in the program you probably have to
defer the sponsors but I think that’s the in the right ballpark but the participant
would be paying for the actual treatment so it’s unclear to me like how many employees
I mean what are we getting for that 2.5 million per year it’s not that somehow turned onto
math all of a sudden they’re probably the sponsors are probably have to speak to that
okay Oh welcome to dr. LOH do you have some questions it’s not just the word that’s gonna
have to pay it’s it’s all the different boards right now this is only Medical Board address
the Medical Board because this is only impacting physicians only physicians this is not for
the entire Health Professions boards the purist program was everyone that might be what you’re
thinking about the cares program does your phone but this this is only impacting physicians
and surgeons dr. Giselle no comment okay dr. Diego no comment ships game doctor the beam
miss Chang fine that’s fine dr. Ghana dead I’m late I have comments but I do want to
listen to games dr. Bishop seems like there’s a lot of money I’d like to hear where the
money’s going I’d like to have some accountability for it okay and on that just really quickly
and it is important to note this um this money the funds are subject to appropriation by
the legislature so that doesn’t mean that there’s a budget process in place that the
you know it may not happen at pub but once you know they have to get appropriated to
this fund and appropriate to the program so there is an accountability system at least
in the legislature where they have to prove to the budget committees in order to get that
money appropriated but I just wanted to let you know about that I’m sure but um because
the budget situation kid may not in fact decided to appropriate some of this money into the
general huh looks a little bit too far to to appropriation so so they guess the and
they do it by shit okay okay a procedural question why this was brought up an executive
committee so that we could have a full discussion of an issue that is bigger than the time we
had allotted for this meeting it took probably a good hour of discussion and to be honest
with you that’s why we put it there Executive Committee is open to any member that would
like to be there so no I understand that but this is not a usual issue but the Executive
Committee had members of the public there as well who addresses I’m fully aware that
but again that you know on the regular agenda you know usually under legislation that’s
where it is and where people know to expect the conversation to go on okay thank you okay
so now we’re gonna have members of the public I’m gonna ask Randall Hagar Hagar and I apologize
again for this pronunciation of your name because I don’t was yes on Wednesday Hagar
no there was a woman Hannah thank you madam chair I am Randall Hagar I represent the California
Psychiatric Association I’m the government affairs director and the CPA is one of the
four carbon co-sponsors of this legislation we’ve been working on this with other partners
for four years you know I’ll just say real briefly that I think what we have tried to
do and I think we have by most measures achieved in our bill is to present a new model that
is a public-private partnership it’s based on public health principles and as you read
through the bill I think you’ll see something very different particularly in the outreach
and educational functions of the the spelled out in the legislation so you know without
belaboring it because you did get a very good analysis from your staff I’ll just say that
I’m very happy to be here today I’m being allowed to testify I can answer questions
and we are here to ask for your support thank you Yvonne Chow good morning Yvonne Chen with
the California Medical Association we too are a sponsor of this bill and we are going
to ask for your support as well we did want to answer some of the questions that were
raised regarding the question that and two the number is roughly about 2.2 million I
mean renewals and you know what that you know how we start how that number was sort of arrived
at to give you some context the average annual cost of the previous diversion program was
about 1.2 million dollars a year it’s generally acknowledged that was pretty underfunded based
on the ratio of monitor ease to case managers it was it was it was understaffed looking
at you know other we look at other states how much they spend the lawyers Assistance
Program which is sort of highly regarded as well in the state they actually spent about
2.7 million dollars it’s our annual budget in terms of the types of activities and we
met we envisioned it as being a very similar kind of model in that they to do not provide
direct treatment and monitoring services they provide more of a case management function
so it would depend on you know you ask how many staff at this point it’s you know it’ll
depend on what DCA ends up contracting out for and they’ll get bids back in terms of
the exact number of staff but it’s envisioned that there would be some case managers that
would oversee you know the entire continuum of care for a participant from treatment and
monitoring and biological fluid testing or any other ancillary treat any ancillary services
that they may be participating in and so overseeing that and making sure that the providers are
doing what they say they’re going to be doing I’m happy to answer any other questions that
the board may have on this issue microphone okay I just want to clarify this point about
what the new organization my understand at the executive meeting I’m here today it sounds
like the Medical Board is going to be just a bank we collect money and we turned it over
to this new organization or Newcomb it’s correct that’s absolutely the new committee does not
do any testing they just monitor they’re going to hire someone and I monitors the future
program so it’s it’s different then we we were doing it actually seems to be a very
simplified process than the previous process so if some previous process only cost even
it’s under phone for 1.2 million dollars why are we meeting down much money at this point
on the look in terms of the structure it actually is either there was there the over the purpose
of the Oversight Committee will be to act as the sort of estate agent that will be responsible
for overseeing evaluation of the program making sure that the vendor is doing what they are
supposed to be doing that the composition if you’ll see in the legislation the Oversight
Committee is clinical experts so their job is to you know oversee it make sure that they’ll
be the ones that will be getting information from the vendor about the participants and
making determinations as to you know you know whether or not they’re put there progressing
appropriately within the program they will also do the ones that will be making reports
to the Medical Board as well pursuant to the statute in terms of participants who have
not completed the terms of their contract with the vendor you know are withdrawing from
the program otherwise excuse me otherwise not completing the program so they will act
as the source of communication with the board and they won’t respond so for designing the
program and you know specifying and what the program ought to look like today will be done
by a vendor this is only an oversight board that’s being created a 14-member board but
it’s being created to establish a program that the participant will pay for fully and
will pay every expense and cost fully that this I just want to correct what you said
a little bit before that in the past when we had a diversion program the issue I thought
that helped to give impetus and rise to this new idea was the expectation that with the
numbers that we had in diversion were much less than what was represented in reality
and society’s true as well so what I just wanted to clarify because earlier you I thought
weren’t exactly clear on that so that the issue here is that they’re going to be using
some of these funds to do tremendous outreach so but it is just a pass-through of money
of two point whatever million dollars to this new funded board if the department Consumer
Affairs the legislature and the governor’s decides that this is going to be an appropriate
use of dollars and the reason I’m really appreciating your staying here that sir asked question
answer questions is because you guys were the impetus and Ken has written okay so we
want you know we’re not attempting to be confusing about this we want to I would I’d like to
ask is would you be willing to accept the three amendments that we’ve recommended we
would have to go back to our coalition that I know that we are actively pursuing other
amendments as well with the author’s office so that’s how I better for the honors office
any questions my parents are way too put into the lobbying the funds raised would could
not be subject to borrowing for ways to fill in gaps to perhaps say oh we have this source
now now we will borrow and then yeah and then the fact remains is then you have committee
that isn’t properly funded because on to up to of these recent comments there is a provision
in the bill that says that these monies may not be used for any other purposes so we have
that nerve right we have we’ve addressed that maybe not better than you have putting in
language that one yeah that’s efficient it’s not for you other purposes borrowing is not
considered to be using for other purposes because the intent is they will put it back
so you know I think that that might be a sure way of getting the bell count well no but
I think that’s you know I think there may be that may be a little bit why there’s some
support for this I said it looks like it’s another little pot you have any other questions
for mr. Chandler or mr. Hager thank you I’ve got public speakers comment please thank you
very much for your time in candying we here today Julia D’Angelo Falmouth would you come
forward – good afternoon as I said you a Julie DeAngelo Falmouth from the center for public
interest law as I said to you in May this bill is not yet cooked it’s now July and the
bill is still not yet cooked there are still a lot of things wrong with this bill some
of which are pointed out in your staffs analysis it creates a new state regulatory board at
a time when the governor and his administration are trying to constrict government it allows
private trade associations to dictate the same trade associations which are the sponsors
of this bill to dictate the membership and control of the new state regulatory it requires
you to fund the new board and it’s a vendor with position licensing fees that’s tying
you in the eyes of consumers and the media to this new program over which you will have
no control and that was a huge problem for this board when it voted to oppose a b 214
a very similar bill in 2008 it will cause doctors over twice what they paid to fund
the old failed diversion program yet we have not seen any fiscal analysis supporting the
new surcharge on physician licensing fees we don’t know how the money will display between
the committee and its undefined unspecified staff and this vendor it is still incomplete
there are holes in the bill and it doesn’t even do what it purports to do it purports
to set up a certification program for private companies that monitor substance abusing doctors
but there’s no mechanism and no standards for the certification of these programs but
the most astonishing thing that this bill does is not mentioned in your staffs analysis
and it requires you to recall some history about your failed diversion program that program
was created as part of this board in 1981 and shortly after it was created this board
established at the behest of the California Medical Association a liaison committee to
the diversion program the liaison committee existed for 24 years and it was controlled
by representatives of three of the four sponsors of this bill California Medical Association
California Society of addiction medicine California Psychiatric Association because of the existence
of the liaison committee this board did not exercise meaningful oversight over the diversion
program it left that to the folks on the liaison committee as most of you know the diversion
program failed five performance audits during its 27 year history and as a result of the
fifth failed audit in 2007 this board voted unanimously to end the program the liaison
committee was in place during four of the five failed audits and it failed to even address
much less resolve any of the deficiencies identified by any of those four sets of auditors
this bill hands control of this new program back to the same organizations that failed
to properly the diversion program along with a significant amount of public money and what
is even worse this bill requires the new State Board to hire and oversee a vendor that will
carry out much of the on-the-ground work a very recent analysis by the assembly business
and professions committee of this bill the analysis was dated June 26 reveals that CMA
in 2010 and the other sponsors created a California Public Protection and physician health ink
or cpp pH a nonprofit organization and they created this because they were unhappy with
this Board’s decision to end the diversion program that assembly analysis describes the
37 page business plan of the CPP BH which includes the passage of this bill and the
eventual conversion of the program that it creates back into a true diversion program
the very thing that this board voted to to abolish just five years ago and the CPP DHS
website reveals that yet the many of the individuals who control it are the exact same individuals
who sat on the liaison committee which failed to properly oversee your diversion program
for 24 years true you’re going to need to wrap it up I thank you so the bill not only
has control of the new State Board to the trade associations but sponsoring the bill
it hands control of the vendor potentially to the same folks who failed to properly oversee
your program this is appalling we have asked senator Steinberg to make significant amendments
to this bill including a vision saying that anybody associated with the old diversion
program or the liaison committee should not ever have a management or supervisory role
in this either the program or the vendor we ask you to take that same position if you
want to adopt your staffs recommendation of neutral if amended we hope that one of your
amendments will be just that precluding anybody who was connected to the diversion program
or the liaison committee to be in a management or supervision role in this program thank
you very much for your intention I’m sure the question it really has the senator responded
at all to you know the criticisms and or the proposed amendments II it’s my understanding
that the senator is working on this but this is July and you’re not gonna have another
meeting before the end of the legislative session you can’t take a position on a bill
you’ve never seen so you need to take a position on the bill as it exists today the reason
we’re taking the recommendation is a neutral unless amended position is so that we may
remain at the table as far as being participatory in the discussion process so I just wanna
make sure our board understands that we’re not giving up that responsibility yet so dr.
Simon financing you look question you went through those titles pretty quickly did I
understand that the group that will be selecting the vendor is comprised of some of the same
entities there’s a bunch of different levels here it’s very complicated the this this new
committee will exist within the Department of Consumer Affairs and the Department will
have some sort of oversight responsibility over the committee the committee is responsible
for overseeing a vendor which will do this on the ground work the department is responsible
for doing an RFP request for proposals from prospective vendors and selecting initially
selecting the vendor but the committee will oversee the vendor the obvious intent of the
new nonprofit created by CMA and the other sponsors is that this new vendor which is
a tentacle of CMA and the other sponsors will apply excuse me that the new nonprofit will
apply to be the vendor so not only will the committee be controlled by representatives
of the sponsors trade associations the vendor will also be a tentacle of the sponsors trade
association and they’re the same exact people who sat for 24 years failing to properly oversee
your diversion program we think they’ve had their chance they’ve proven that they don’t
know how to run one of these programs that will successfully protect patients from substance
abusing doctors I’m going to cut off that discussion and do you have any question just
a point of information Julie you said a significant transfer of public funds my understanding
is this is funded by the fee on licenses physician licensing fees paid to the Medical Board of
California is public money there will be the cost of setting up the board and maintaining
a board or Bureau doesn’t repair licensee fees it does but those are P that’s where
your father data Cal that’s your public part that’s public money so once they are paid
they become public funds yes that the state would have otherwise I mean no no other public
cap general there’s no times general fund a contribution this is the addition paid for
solely by a physician licensing fees paid to the Medical Board Medical Board is solely
a pass-through rightfully we’ve got okay so now we have one more speaker slipping tips
from that Tina mana to the money I see a patient now the kid victim and survivor of a doctor
in your default diversion program I’m not representing consumer Union regarding my opinions
here some of you know my starting some of you don’t I was a victim of a doctor who was
part of the defunct diversion program he not only enrolled in diversion once but twice
at that time the board allowed him to enter into the version twice with this bill how
many chances does a doctor get and how will you know that according to this bill it says
you only know they’re in this program if they’re a graduate or if they’re a student I think
you know who everyone is in this program first of all I encourage you to oppose it I don’t
support it and I encourage you to not support this bill what happened to me and countless
other victims it was very very sad but I’m here to tell you that by creating another
diversion program even though they don’t call that that it looks like it it smells like
it I think it’s another diversion program and I encourage you not to support it the
Medical Board California should know about everything and anything in terms of doctors
your Paramount priority is to protect the patients of California and consumers of California
no programs should be allowed to be run by other entities without you knowing about especially
this program that these doctors are trying to create in my opinion this is the fox guarding
the hen house it’s a same old program again except like Julie said it’s run by the same
exact people and you were charged by our legislature to protect the patients of California not
monitor these doctor however you should know about every participant that’s in the program
when keep doing the same things over and over and over expecting a different result it’s
called insanity and that’s part of psychology and treatment you can’t allow this doctors
to go into this program without you being aware of I don’t think a dot the only time
that you should be aware is when the doctor is being disciplined you should be aware about
everything that happens with a doctor when what I was injured by this doctor he lied
to you several times over and over and over because he was an addicted doctor number two
he tried to dilute his urine number three he was able to hire his office manager someone
he can hire and fire he paid a salary to you allowed him to hire his office manager to
monitor him during diversion in this program there the CMA and their friends are trying
to create the monitoring mechanism who is it do you even have to wrap it up who is it
I believe it’s the same people they’re all somehow related like Julie said so I encourage
you and I want to remind you that you’re paramount priority is Patient Protection and oppose
this bill okay thank you so now do I have any additional comments from members of the
board before we take a vote on this mr. nice thank you doctor gotta do madam chair thank
you if this was similar to all diversion program I absolutely have no interest in supporting
it but I’m not looking at this one as you know a program similar to all diversion program
my concern is the public members who spoke about public protection that is my number
one priority here as a medical board member what we are doing is in my mind without any
kind of program to support except for a few for-profit programs we’re just keeping our
head in the sand and saying that well you know if they complain to us we’ll take care
of it if we don’t know we don’t know so there are I deal with medical staffs there are a
lot of medical staff members want somebody referred somewhere their office staff wants
to refer somebody somewhere there we don’t have a mechanism so this is and these people
actually are harming public I agree with you these people are harming public they need
to be they cannot escape the Medical Board punishment but also these people need some
help not some of them so that’s what that’s all I’m looking for so I’m actually okay with
neutrally fermenting did you have any other comments from any of it yes well I think I
do remember the previous audit at least one of them and one of the pathways to diversion
program was the voluntary participation and that’s what we’d want participation before
adverse outcome and yet that was the smallest number of participants and I am not seeing
how this program is going to have this nebulous outreach I’m not seeing how this program will
get the preventive component that we’re hoping together thank you do I have any additional
oh I know I think Judy’s come in about the same people may be going to be able thing
and then eventually convert this program into a diversion yeah now since you’re looking
at this I’m just asking to see what’s the possibility of this happening we wouldn’t
be able to divert it to change it to a diversion program until they change log and so at that
point if that could be their business plan but this bill does not do that so if they
wanted to do that in the future they would have to change law to allow for diversion
from enforcement everything that we do in enforcement would remain the same new physicians
now can go to substance abuse you know treatment monitoring programs and we don’t we don’t
know about it it’s something that’s allowed for them to do preventative measures but if
they do something that affects patient care then that’s when the board would become involved
and the other thing to remember is DCA does have to do the contract for this and so it
has to go through the state’s contracting process so although there may there may be
a program that the sponsors are hoping gets picked it still has to go through the regular
contracting process it you know the state uses so there’s no comfort interest or that
possibility to happened this chain would you do you have an amendment that you’d like to
add to the amendments we have listed to be involved in the community with the board when
the boy or boy doing it or the company was doing it okay so the amendment your suggestion
is to prevent a conflict of interest by involving anyone or any entity as a member of new they’re
newly configured board or okay and we’re receiving contracts from I was on the board it was such
a painful decision to remove program we I really do not want to see it happen so that
I I will accept as the maker motion I will accept your additional amendment who is the
second of the you second will you accept so those now we have to have public comment on
that on the amendment yeah so do have any public comment on the amendment that’s been
added to the three resisting amendments in order for this board to vote whether or not
to adopt yes we don’t have a we don’t have anything in writing we don’t have anything
tangible to look at because there’s not been a bill that has been there in the process
of creating the bill so that what we’re doing is by having the discussion and having the
amendments that we will allow this board and got to vote to support this on a go-forward
basis to be at the table to have the discussions we haven’t seen it we can still we can still
when push comes to shove we’ll see the bill and we can still we can’t I just wanted to
speak maybe have her speak to like what we can actually include cuz it has to go through
the contracting process and I don’t know what the sooner we’re saying the only can take
and who you can’t so I just want to make sure it’s feasible for us to thank thank you mister
knows um my understanding of what what we’re talking about is what do these comments in
mind is that not actually who’s appointed to the committee but essentially how the RFP
how the contract is solicited that’s my understanding of where we have the board has the most concern
over the conflict of interest I understood for mr. Chang that she had concerns on both
sides the participatory [Music] past I don’t know how to I think you’re looking for transparency
total transparency and total absence of conflict of interest is what I heard you say no I’m
kind of listening to you for a few years I kind of get what you say so dr. Khanna did
that’s the situation right now there is no there is no bill we don’t know where the there’s
no high purchasers ago so my understanding is miss chunks amendment is that the people
who are on some previous committee they cannot be on the new committee that’s totally different
from institutions who are sponsoring the bill which you can’t you can’t eliminate the institution
California psychiatry Association of California Medical Association that doesn’t even make
sense but if it is the people I’m okay with it just the members who were on the previous
committee cannot be on and this newly created come to one of the amendments I don’t so do
I have any other public comments on the amendment that’s been added to the three previous amendments
that was recommended by the executive committee to this board to vote on I see some yeah okay
so we’re gonna give you a second bite at the Apple and it’ll be just a second randall hagar
again we will look at those amendments we have actually already heard concerns of that
sort and there is a discussion in process thank you good thank you thank you just to
briefly clarify what I was asking you pour I would hope that one of your amendments would
prohibit any one connected with the former diversion program or the liaison committee
to be in a management or supervisory position either on the new committee at the vendor
Miss Jane is that what you’re trying to Express that’s right back so the language we’ve got
you’ve got you’ve got the language okay so I’m going to ask for a now for vote all those
in favor of a support if amended if amended CI any opposed any abstentions okay so would
you like to continue with the legislation please okay all right it is brief I only have
four bills to go over okay so first I wanted to report on legislative outreach pursuant
to strategic plan go for objective 4.1 I can’t talk today later district and Capitol offices
to let them know about our quarterly board meeting and to extend an invitation and provide
information on our board meeting I’ve also contacted Capitol offices including this in
an office of research and the Senate and Assembly business and professions committees and one
of those staff is here today I continue to be with Capitol legislative and committee
offices on a daily basis on our sponsor bills bills we have positions on and on bills or
issues at surface that might impact the board the legislature is currently on summer break
until August 6 now if you would please reverse your legislative pockets and the first page
is the tracker list and everyone should have got an updated and enough dated tracker list
I would like to note that the status of four bills are changed and they’ve become chapter
which means they’ve been signed into law by the governor and the first one is a B 1533
Mitchell which is actually the board sponsor bill so this is good news and this is the
bill that would authorize a pilot for the University of California at Los Angeles this
bill passed through the legislature with no nuovo it’s a no opposition and was signed
into law by the governor on July 13th I’d like to thank Assemblymember Mitchell for
authoring this bill and the UC for their support as co-sponsors and the next bill is a B 1548
Carter this is a bill that prohibits outpatient cosmetic surgery centers from violating the
prohibition of the corporate practice of medicine and elevates the penalties of violating the
corporate practice of medicine provision the board took a support position on this bill
because it will help to prevent further apin offenses and help commits consumers with business
models in violation of this law to reconsider and revise their business practices this bill
is also signed into law by the governor AV 1621 Halderman is the bill that exempts physicians
on working on trauma cases from current law the requires physicians to provide specified
information on prostate diagnostic procedures the Board took a support position on this
bill and it was also signed into law the last bill that was recently chaptered is av 1896
Chesbro this is a bill that aligned state law with the federal Patient Protection Affordable
Care Act and exams all healthcare practitioners including physicians that are employed by
a tribal health program from attaining California licensure if there are licensed in another
state the board did not take a position on this bill on your chakra list the sponsor
bills are in pink and we already reviewed one of them or even review the other one the
bills in blue will also be discussed and the board needs to take positions the bills in
green are bills that we’ve already discussed and have taken positions on so we won’t be
discussing these unless a member would like to if are there any questions on bills in
green no okay if not let’s move on to SB 1575 under your omnibus tab this doesn’t bill as
a vehicle by which Omnibus legislation has been carried by the Senate business of professions
and Economic Development Committee the omnibus language would allow the board to send renewal
notices via email would clarify that the board has enforcement jurisdiction over all licensees
and would establish a retired license status for licensed midwives this bill is currently
in the assembly Appropriations Committee the board is supportive of the provisions that
impact the Medical Board now let’s move to 2011-12 legislation these are the bills in
blue and now we only have four four bills to cover SB 122 price this will actually be
discussed as part of the licensing committee update which is the next agenda item so we’ll
move on to SB 616 jisang yay this is a bill that was discussed by matarile briefly this
bill would establish the The Cure’s Fund which would consist of contributions collected from
organizations for purposes of funding the cure program should be administered by the
Department of Justice as Miss Harold said there’s ongoing meetings and the bill doesn’t
really specify what funding source will be used to find cures only that cures needs to
be funded so we we as the board generally support and funding cures the Board believes
cures is a very important enforcement tool in an effective aid for physicians to use
the board does currently help to fund cures and at a cost of $150,000 this year but these
funds can’t be used for staffing DOJ House is having some significant issues with not
enough funding for the cures program so the board is actively participating in the meetings
with DOJ the legislature and other stakeholders and so we would like to suggest that the board
actually support this bill do you need a motion I need a motion so I have a motion to support
so moved a second comment I do a public comment on this bill can I ask it the drug companies
have been approached to abundant actually the drug companies are in the meetings and
they’ve been asked they kind of set up maybe like a five dollar or licensing fee on all
the boards that use cures and then along I thought what I was talking about so then a
lump sum from like the drug drug manufacturers the wholesalers there’s a list of people and
I think right now I’ve loved something I asked you to 700,000 to start up a modernized cure
system go okay all those in favor of the motion please say aye any opposed thank you and I’d
like to say Kaiser was the only one that came to the table and said they’d be willing to
publicly and said they’d be willing to help fun cares it’s amazing when you have funny
what you can do okay moving on the next bill SB 2012 36 price and this was briefly reported
on by dr. lo and Miss Portman this is a sunrise bill for the physician assistant committee
this bill renamed the committee to the efficient assistant board and extend the sunset date
date till January 1st 2017 this bill would also create a retired license status for piays
along with other provisions and this bill would also revise the makeup of the members
of the physician assistant board upon expiration of the current medical board member this bill
would require a member but the board members to be appointed to the PAB that’s also member
the board but the member shall serve as ex officio and that would be a non-voting member
whose functions will include reporting to the board on the actions or discussion of
the physician assistant board board staff is suggesting the board take a support position
before we continue to perform investigative services for the physician assistant board
and the board and PSE currently have a cooperative working relationship and this bill would still
maintain close ties with the board and the physician assistant board they have a motion
for support second any public discussion on the motion any questions or concerns many
of the board members all those in favor please say aye any opposed thank you okay lastly
SB 1237 price and includes language to extend the sunset date of the vertical enforcement
program to the same dates as aboard sunset from one one thirteen to one one fourteen
this change will allow for the full evaluation of vertical enforcement as part of the board’s
2013 sunset review process where staff is just making the board aware of this bill no
position is needed at this time so I’ll take one okay that concludes my presentation on
2012 legislation are there any question doesn’t seem to be thank you very much next there
is the regulatory status of regulatory action agenda item 13b and these are in your board
packets the chart includes the status of all regulatory proposals that are in process and
are there any questions on the information included on this chart any questions no thank
you that concludes my presentation thank you very much and to conclude my presentation
on the executive committee the executive committee not only met about the legislation SB 1483
but also on the recommendation on the executive directors review annual review and I am pleased
to make sure that the audience is aware as they are executive director is aware that
she came through with flying colors and will be with us for another year and thank you
and congratulations like I hope it’s congratulations doing a good job good job well you know he
didn’t talk to me first of those we could have changed our discussion so I’m going to
move on the agenda to number 15 physician responsibility 14 sorry licensing update I
apologize miss ships key did you have a question a five-minute break okay so we’ll have 15
minutes it’s now 12 35 I’m going to suggest that we’re back in our seats ready to continue
at 10 to 1 that’s 15 minutes by my watch exactly lunch restroom whatever you need to do check
out go check out the weather the sun is shining life goes on I think this standard labor laws
in a half hour that’s hour after you had to 10-minute but I don’t know that they’ll be
true if we were full-time in place going to back to number 14 with the licensing committee
update impossible Constitution recommendations dr. Simonson I’ve also asked staff to try
and well I’m going to give kind of an abbreviated report and say that staff and I won’t mention
but they’re all excellent but various staff members updated us on the staffing issues
the business process reengineering recommendations an update on the implementation of SB 100
the outpatient surgery center requirement and the fact that this information is now
available on the website and we had a demonstration of that so I’d invite everybody to in the
future go to the website and check out that process and give us some feedback on how that’s
doing that it looked really like it’s up and running we also had a presentation on the
allied healthcare professions that are under the domain of the board and also a presentation
on continuing medical education and the fact that some physicians have failed their audit
and with automation we may have even more consistent information on that we had an update
on the implementation of the polysomnographic program and the various levels
of providers we get also find out about the licensing application and there were no changes
to the application at this time then to a really robust discussion it was really begun
with an excellent overview of the recognition process of international medical schools and
this was provided by dr. Silva who had been a Dean at UC Davis and has extensive experience
in the wreck mission process of the International Medical School’s I thought I think a highlight
of his talk was that the USMLE the test in as a standalone it’s not a sufficient evaluation
for the adequacy of medical training though an important factor and that’s why the recognition
process of the International Medical Schools is still important then mr. Wardin and mr.
heckler brought forward a legislative proposal and this is really to consider providing an
alternative pathway to eligibility for licensure for applicants who have had some or all of
their medical school training at an unrecognised which may mean not previously evaluated or
disapproved medical school and we recognize that this is a balancing act between allowing
physicians who have in other ways perhaps proven themselves to get a license but obviously
our primary goal is protecting the public so we have concerns about about this possibility
and I’d like to hear from mr. Warren and mr. heckler to state what the actual legislation
could provide and get the board’s input so I’m going to remind you that we have public
speakers as well and whatever it takes it takes centers I just want you know that we’ve
listened very well I appreciate it okay and so basically there was language previously
in Senate bill 122 that would allow the board to or and or require the board to license
individuals who obtain some of their medical education or all their medical education from
an unrecognized and or disapproved school and the language that was in there had some
specific things that were even actually less than what is required of some of our current
licensing requirements so the in your licensing packet on page 150 was the whole analysis
of that and the specifics of the overview of that was on page 150 point 1 of what was
actually in the in the language and and basically it was to take him pass a written exam recognized
by the board hold an unrestricted license in another state country the military for
five years had no disciplinary action completed one year of medical postgraduate training
and had a BMS certification and was board I know grounds for denial which is not equivalent
to what a normal international graduate would require for licensure at this time normal
well I think normal I mean an applicant for intern at home as we currently have a tool
usual you know I’m not normal so let’s go on from there we didn’t have any public discussion
there’s a possibility of 16 combinations of medical schools education combinations that
we came up with that is available out there and that’s on page one fifty point two which
was sort of important for you to sort of understand to understand how many types of schooling
processes that would be there and and how it could affect the board as the way that
the bill was repeatedly written it would increase that boards workload probably quite a bit
and we declare all of them to go through the AR see I asked a mate based on how it was
previously written we would get at least 200 applications a year and the amount of workload
that was determined that would be you’re looking at that was on that was on page one fifty
point four where I did the analysis of that it would require basically twenty five hours
per quarter for a RC reviews alone that that’s a significant increase and I would need additional
staff to do the preps for all that an average prep for an a RC memo is twenty hours not
including the initial review of that hour the manager and the chief staff came up with
after meeting with the sponsor of the field staff a possible alternative to the language
that would maybe be provide more consumer protection and still meet some of the requirements
that the sponsor the bill was looking for and that is a in your attachment number two
which is on page one fifty point ten the original language was in attachment 1 with was an age
fifty point eight and there was one amendment that was recommended for our proposed language
and that was to include the board’s authority to adopt regulations to further define it
I know they mr. heifer go from now Thank You mr. Wardin madam president members I think
the easiest way to think about this bill as I said yesterday when licensing licensing
committee sort of had a robust and animated discussion on this issue was that attending
a disapproved or a attending a disapproved or an unrecognized school does not does not
act as an automatic bar to licensure and it’s important to remember two things what we’re
talking about here is not the automatic granting of licensure it’s a consideration that these
these applicants will be eligible for licensure and they when a person is found not eligible
it’s not the same thing as denial so what we’re talking about is the mr. Wardin team
talked about is what came out of SB 22 and what this board is contemplating putting in
SB – 122 and I’ll just go through kind of nuts-and-bolts of it for what if the applicant
had attended a disapproved school well we we talked about much like we have another
quarter sections we require essentially 20 years of licensure an application of active
practice and licensure another state if you’re from an unrecognized school which means perhaps
we haven’t gotten there it’s 10 years also you have to be board certified you have to
pass the USMLE you can’t be the subject of disciplinary action and you must also have
completed three years of postgraduate training traditional or regular you’re not subject
to denial for the usual causes under 480 which is criminal conviction act that sort of thing
and you have not had a healing arts license disciplined by another state so if you help
some of the license what’s important to note as their tour the things that are important
to say this would not apply to you talked about it special faculty permits and its are
some members are familiar with the 21 11 2113 specialized on exemptions for licensure essentially
associated with the UC this section would not apply to them nor would it allow know
where an impact postgraduate cleaning all the whys known as the P tile process meaning
that in order to get a P towel which is required for International Medical School grad you
must also you must have graduated from an approved school so what this is to some it’s
sort of an alternative pathway the board has kind of an alternative pathway in the twenty
one thirty five twenty one thirty five point five series which grants the board the authority
to issue licensing issue licenses and non-traditional yes depends on what they it’s a different
way to get other doctors who one of those pathways is the way that we use for students
who have gone to a school that we have recognized that they may have gone through the school
a little before the recognition so that’s that come those particularly applicants qualify
under twenty one thirty five point five but they’re reviewed by the application review
committee prior to them being so I guess the fundamental thing to remember here is we in
this proposal we do differentiate between an unrecognized school and disapprove school
and the disapproved school has the 20 the 20 year rule the under pro school has the
ten year rule but the board may aggregate is permanent for the board to aggregate in
that variation but even if it advocates meaning combines there must be one continuous five
year this state licenses so you can’t be licensed in 20 states for one year in order to aggragate
to the 20 so with that I’ll be quiet I’d be more than happy as mr. warden will to answer
any questions you may have I believe the board the Licensing’s committees was for the board
to consider it so am I looking for a motion yes so I’m looking for motion to adopt what
we just heard well then you have public comments from the board we’ll have public comments
from the public and then we’ll take a vote a second thank you you have comments or questions
from members dr. Conte there Michael my comments or questions are related to disapproved medical
schools so if you look at this approved medical school that term itself sounds pretty bad
so you you’re mentioning that if they weren’t only part time but graduated from an approved
medical school that’s what we’re recommending is that correct but not graduated from it
is approved medical school the way our language if you acquired any part of your professional
instruction from a medical school that was disapproved in the 20-year rule would apply
if you acquired any part of your unrecognized school the tenure rule would apply so yes
you could have graduated from a disapproved school the 20 year criteria three years board
certification not ours refer disciplined applies it allows them the ability to apply it does
not it just applies for the demotion eligible to be considered for license well eligible
to apply let’s be very clear on that well I think that’s why I do not understand about
your eligible I have to say I was the de veau who didn’t go along with the community recommendation
so I’m making it not clear at this point if you have all this and somebody comes in as
a bona fide records they went to disapprove the school for four years and they come in
and nothing sticks up he’s good searching good recommendations in everything can hear
disapprove him under this law can you disapprove him to apply for licensure doesn’t guarantee
life under this is nothing about the person that is going to be licensed this is about
the person applying for licensure so it’s only that very narrow focus okay applying
for licensure so if I am a grad student if I’m a surgeon I have to be that way for once
in my life not if I am sergeant I went to Caribbean four years of disapproved school
and I got my DNS boy certification I practiced oh dunk America oh yeah oh don’t America anywhere
USA missed me I’m not naming the stadium talking because I don’t know what the laws are in
other states so so I come almost 20 years I actually probably practiced trying to I’m
using this and I come in application you turn me down can I go to number one go to the Senate
and then the the community and then say Medical Board turn me down this is not fair number
two can I go to the state of California and then say hey I all the criteria so they have
where is a ground coming down to the board person who would apply for example if I would
apply in my current status I would be found not eligible for various amount of reasons
number one example the division of Licensing would find me ineligible for licensure my
remedy at that point is twofold I can request a hearing just like we would do for any person
the statement of issues or a disciplinary proceeding and I all all also may challenge
that board decision of finding a knowledgeably in eligibility in Superior Court those two
mechanisms are in place now and would be in place with the passage of this bill I’m trying
to use the ordinary example I’m not just a regular example some 100 this criteria and
the criteria and there’s nothing wrong with me when you think looking at to me is once
you set this rule up even ordinary people come in here you have to do him the less ordinary
good people come in here you have to give him that license you have a why don’t you
call it that we’re changing the rule and not saying we came from the opportunity to look
at the rule so let me clarify the process and the procedures just 10 seconds applying
for licensure does not guarantee you a license and we do turn down applicants for a variety
of reasons not these yet maybe or maybe these I know doesn’t matter we do turn down licensee
people that want to be licensed in the state of California that’s that we do do that but
what you’re asking about is what I think also is what happens if we now put you through
the 20 years the the board specialty the no discipline all of this stuff and now you are
licensed who does the public have to go back to and hold responsible if you went to a disapproved
school do you not ask me that question I’m trying to say yes once we pass this rule we
pass this rule we gave somebody who fit the qualification not just a chance and pretty
much if you fitted qualification he is getting the license so don’t don’t say you’re saying
it’s automatic yeah you still have to apply you still would have example for example in
the application things all the things that would normally denied applicant for would
still be in play here okay after David and dr. Simonton but currently if I apply from
a disapproved school I’m not eligible to apply correctly I guess what what Hetty is saying
now that would not be a reason to not if if I’m perfect on stellar nothing wrong with
me except that I’m from a disapproved school you’re not going to not give me my license
because why wouldn’t you there’s nothing wrong with me that’s what you’re saying again I
guess that’s why she’s painting all these does essentially is make people have to ride
out here and the previous thing I know what the current law that applicant would be essentially
somewhat automatically wouldn’t meet the criteria for eligibility what this does is essentially
remove that out of money bar and say okay now what lease is eligible to be considered
considered where previously it’s not there’s no automatic granting of licenses you just
fall into the eligibility pool I’m gonna move to dr. Simonson thing which is yes it creates
an alternative pathway and one might argue that it’s not necessarily an easier pathway
because to get a license coming directly from an approved school or recognised school you
only need two years of training in the US and by putting the bar at board certification
I don’t think any of us can think of anything that’s less than three years and in one program
sufficient that they actually passed their board certifying test which is I think why
I felt comfortable with it and combined with the fact of twenty years of practice I think
this won’t make medical schools not want to go through the recognition process because
I don’t think most students would say it doesn’t matter if I go to an unrecognized school I
can still practice in California Chris gonna have to practice 20 years elsewhere first
so I think that still validates the necessity of international schools to want to be recognized
to the world California is now 15 students accepting doctors who we disapprove the school
whole thing I understand your your logic the ABMS is is definitely required and with the
pool of the people who come into United States for licensure you know right now half of them
from the American speaking students and the half of them are coming from foreign real
foreign countries and when we’re talking about the ABMS qualification you know all the United
States graduating nowadays 90% of them has a BMS the portion who does not I actually
are the foreign graduates whether it is american-born or not so we are getting the top of that pot
you know for them to have the ibms qualification and I agree with you on that one my only concern
is for Health Medical Board of California to go out and say we’re now accepting someone
we had disappointing dr. Ghana didn’t in dr. Levine that I really need to hear from public
I just clarify for me this 10 20 rules is licensed in another state not in another country
is that correct okay so within the United States correct dr. Levine I just want to clarify
that ibms certified means at the time of application so someone who had allowed board certification
to lapse would not be eligible correct product correctly okay so now I’m going to have some
public comment and who called bill gage forward you’ve been here all day I guess you’d say
your turn now good afternoon my name is Bill gage I’m the chief consultant for the Senate
business and professions committee I’ve been with the committee for 20 years then with
the Senate for 25 I feel I’ve enjoyed working with the Medical Board over the past 20 years
I think we’ve done a lot of good work I’ve made a lot of good changes enjoyed working
with Linda I think we’re still friends after 20 years so but this is uh this is again one
of these issues that we’re trying to deal with came to the attention the senator several
months ago he was made aware of the fact that there are physicians from other states they
have a number of years of experience and he thought he thought at the time he asked me
he said well doesn’t the board have discretion currently to look at these physicians from
other states and make a determination based on based on the fact that they’ve been practicing
in this state for a number of years I said well if they’re from an unrecognized or disappear
of school then they’re automatically denied the opportunity to even apply for a license
but we did go back to our Legislative Counsel we asked them if we should have asked them
the question if if you have a physician from another state has protraction for number of
years if it was if it was possible for the board still to make a determination even though
they’re from an unrecognized or disapproved school council felt that looking at the language
and the codes that the board did have that discretion we went back to the board of course
we met a president aboard and staff and legal counsel met with the senator we discussed
you know well what we don’t have a process in place for this and since there could be
a dispute in terms of whether or not the board does have discretion under the situation that
we should clarify at least and in code exactly what it is and what the process would be and
at least set up said well we consider as a threshold for even applicants being considered
again we looked at it it wasn’t going to be a mandate we considered that it effectively
provides just discretion to the board in terms of looking at the SAP of him but at least
setting studied some sort of number of years that they actually been in practice before
they even to be considered just you know almost I think all of our health boards currently
have that discretion from day one so if they have somebody who comes in who’s had five
years two years three years of experience they basically can determine based on their
practice even though they’re from and in the instance of most of the health other other
health wards is from unaccredited schools obviously we don’t have a situation here currently
that we have an accrediting agency that looks at all the international schools international
medical schools to determine some sort of accreditation standards that at least the
Medical Board can rely upon so the medical boards put so to put in the situation like
all the other 50 states that you happen to make a determination as to whether you’re
gonna recognize the school and just approve the school I think what we’re trying to accomplish
at least with the language we started out I mean we actually had our Legislative Council
draft the language for us they came up with the five year requirement we did indicate
to the board that you know that isn’t something we were we were wedded to in terms of using
that five years as the threshold so with that we came back to the board and said well we’ll
take out the language out of the bill that we had currently and the only reason we had
to put it in initially because we had to let the assembly committee business operations
committee know that we’re gonna but we took the language out of the bill to work with
the board in terms of coming up with language that makes you know more sense in terms of
how we can accomplish this by looking at practitioners from other states you need to realize the
legislature has been really focused on this whole idea of cross border practice we’ve
looking of all the other professions in terms of providing and sort of taken away any arbitrary
barriers that we have to reciprocity in terms of those practitioners coming into California
so it’s a real emphasis not only on our committees part but the Health Committee is both in the
assembly and Senate and looking at ways to to allow a more cost Board of practice and
sort of you know at least eliminating any will we would consider any barriers to practitioners
coming into California I need you to wrap it up okay thank you very much for being here
thank you very much for listening to our concerns as well we appreciate that Stewart shave Barbie
dr. Fineman to come up you get the same three minutes together to collect a three-minute
– madam president and members of the board good afternoon my name is Mitchell Fineman
and I’m a triple board-certified rheumatologist and internist practicing medicine in South
Carolina I support the change of the law and policy of the Medical Board of California
to permit physicians who have overtime and with appropriate credentials practice medicine
in California after my graduation from the University of Southern California I attended
mundial University’s School of Medicine in Santo Domingo Dominican Republic on learning
that the school was not academically on par with USA regulators I proactively applied
to Ross University School of Medicine an approved California medical school after Ross vetted
my medical records my academic records I was admitted as a second-year medical student
I would like to stress that the Board disapproved mundial University after I left the school
and then transferred to Ross University from that point on my medical education and career
has been by all counts fulfilling rewarding and successful I did several of my clinical
rotations at Boston University School of Medicine I was accepted in post doctoral programs in
1987 at st. John Hospital Medical Center in Detroit I compete I completed my Rheumatology
fellowship in 1992 at Washington Hospital Center in Washington DC a Georgetown affiliated
hospital I took my boards in 1990 in 1992 I obtained licenses to practice medicine in
Florida the District of Columbia Maryland and Michigan in 1990 and South Carolina since
1996 I have maintained professional and academic affiliations and have practiced medicine in
the United States for over 20 years without any disciplinary actions against me in any
jurisdiction I practice medicine I think I have proven to the public at large and the
medical community that I am competent to practice medicine and protect consumers I have learned
that the current interpretation of the law by the Medical Board of California does not
even permit me to apply for licensure not because I am not qualified or did not graduate
from an approved foreign medical school but because a small fraction of my medical education
was at a disapproved school that interpretation is not the letter of the law I graduated from
an approved medical school which is the law I have met all the other requirements under
the law as such I support the recommended change in the law and policy to permit me
to practice medicine here in California thank you very much for your time thank you very
much start to join me Kirk I just have a real quick I think I also represent a three other
physicians who are graduates from foreign medical schools one teaches at Baylor as faculty
member of Baylor Medical School another one is licensed in New York and Connecticut they
all are board certified they’ve all been practicing over ten years I find it they were are very
supportive of this they can’t even apply the general – member Chang we were having this
conversation right now if you are thick if they apply it’s immediately it’s not his would
be done to me and goes on the National Data Bank if I’m correct and so he’s gotta know
if he was rejected the application okay Bonnie I’m matching the Habeas understand finding
the findings of ineligibility are not reportable yeah that’s so you can’t even get to that
level but they all support the change and the only thought the thing I would like to
mention was the fact that I don’t think twenty years is reasonable I think it’s way way way
too long but uh that’s for the board just to quit don’t know thank you thank you thank
you Christa Somers three minutes together yeah good afternoon I work with the office
of Albert Robles who represents doctors seeking licensure to California and in that regard
as to this bill now before the board we agree with dr. Simonson that the reciprocity pathway
and comparison to the regular pathway for licensure is not an easier pathway by far
and I’d like to address in the time that had just a few provisions in the proposed amendments
which we believe would undermine the board’s goal of having this in the first place which
is to promote access to quality care first the provisions relating to the minimum required
years of practice by everyone’s admission five years of Senator price the ten to twenty
years now before the board has been put in writing without careful consideration of data
that might correlate better what those years should be I believe longer than necessary
we can easily envision a circumstance of a young doctor having actively practiced for
five years having had numerous patient contacts each day and who in that five-year period
would have amassed a track record such that the board could readily see whether there’s
a pattern that would establish that the clear competency of that doctor and by the same
token someone practicing for ten years who doesn’t have an active practice who has much
less patient contacts you could not make that kind of a determination based on their track
record so that is something I would like the board to to consider more with reasoned and
validated data the other is one that dr. Fineman who spoke before us raised in his talk and
that is a bath amendment makes no link between the timing of the board’s disapproval or non
recognition of a medical school with the timing of the doctors have actually attended that
school so the result is for example that a doctor then likely a naive medical student
in his twenties attends and perhaps even graduates from an unrecognized school subsequent to
graduation the board evaluates that school finally get to that school and then disappear
in that example the dr. density reciprocity would be subject to that presently said 20-year
minimum years of experience for disapprove schools when it really wasn’t his fault that
the school became disapproved and had no choice at the time he was making it as to whether
or not the skin may or may not be disapproved and with that I’ll turn it over to dr. Garth
God thank you I have one minute okay thank you very much I’ll keep this very brief I
know most of the points I wanted to make her actually have already been made on a couple
of occasions but essentially for me the same story applies by the way I’m sorry my name
is Ravi Jarrett and then to the introduction but you know I I trained as a foreign medical
graduate all of my clinical training has been based in the u.s. from my third year of medical
school onwards and since then I’ve also I think in my career achieved a point where
I’m very content actually serving as a medical director for an inpatient program starting
a pediatric inpatient program and and being in charge of educating residents as well as
medical students where I currently work which is Las Vegas and just briefly you know we
actually live my family and I live in California and I for the past six years have been commuting
to Las Vegas to work simply to be able to provide my wife with her veterinary education
here in the state which is why we moved and the main thing that I was trying to get across
or wanted to get across was I think that as a general consensus we all feel that clinical
achievements and and the length of practice as far as clinical skills can be shown to
be adequate by the time and the amount of patient contact a physician has and of course
20 years 10 years is the discussion but I feel like if a physician in my position can
prove competency to the board in one way that may help believe some of the concerns and
one quick point I wanted to make was perhaps if a topic of discussion could be perhaps
using hospital credentialing for these physicians that are applying for example getting reports
that have been run from the individual hospitals where these clinicians have been credentialed
sometimes is a more stringent process and actually obtaining a license in a state they
keep track of your patient contacts and any actions that have been taken against the physician
that may prove to be useful to the board to sort of alleviate some of the concerns of
competency when it comes to that thank you good recommendations again just out of curiosity
where did you go to medical school I graduated from the University of st. Eustatius which
is a neither approved and nor disapprove schools the case thank you okay so we have a motion
on the table we’ve had public comment the issue is again let me just remind everyone
this is for the opportunity to apply for licensure this is not anything from what I understand
other than that now dr. Ghana did I know you have a comment so could you make it brief
clear so we can take about the the 20 years actually sounds really so long to me I mean
what I’m looking at the California kids who made a mistake and went to a school got everything
else afterwards and that putting that 20 year period and also if the school was not accredited
by other but it was not disapproved by us at that time I think that we have punishing
these people rather than anything else candy years and I’m fine with it if we’re trying
to disapprove braces are there two different we’re talking about it is approved schools
if they were not disapproved when they went to school I guess I would just like to say
that there are so many different permutations I think however many that Kurt told us so
I guess like about 16 or 18 so if anyone is interested in all the different combinations
yeah I guess my feeling you what I guess I was hoping from the board was are we receptive
to an alternative pathway and then the details of the length of time for the alternative
could be worked out but the we chose will be rien principle there should be an alternative
pathway let me just let me just point out Madam President numbers that right now it
is contemplated that there could be hybrids or what I call the aggregates that if you
were multiple licensed in multiple states you could get to the 20-year rule but there
would be one block a five year continuous license in one state so the medical board
or at least staff when it got that proposal had taken in to consent the hybrid or the
aggregate model okay thank you for that clarification I’m going to ask the members now for vote
and support you know come back as a regulation sure so the motion is on the table everything
we’ve gone through the process all those in favor the motion has this please say aye any
opposed any abstentions abstentions thank you what an obsession one obsession so now
we’re going to move on to item number and item number 32 and then I promise after two
o’clock I’ll take a deep breath and we’ll go this long thank you for accommodating my
name to go on my volunteer trip well it’s not a volunteer trip it’s a medical mission
so are you working but it’s by choice I’m going to be working yeah we got I just want
to clarify thank you thank you so do we’re going to entertain nominations for the officers
of the board it’s a time and dr. Sahlman I wouldn’t like you anxious I am that but I’m
anxious been more than one way because I would very much like to nominate dr. Sharon Levine
for the office of president Oh second now do have any other nominations for the office
of President any other nominations for president we don’t need any board discussion on this
one okay all those in favor we’re going to close the nominations no public discussion
no board discussion all those in favor of the motion please say aye any opposed any
abstentions very conflicting there’s always conflict in life it’s what like this thank
you so now congratulations dr. Levine but I think I’ll continue to run the meeting for
the rest the day okay okay okay so now do we have any nominations for Vice President
dr. justo to the second do I have any comments on any any other nominations and he it’s just
going off the smooth okay all those in favor shots are so doctors do so being nominated
vice president please say aye any opposed okay now we’re going to go on first nomination
for secretary of the board dr. Diego thank you do we have any other nominations nominations
are closed all those in favor dr. carrion secretary the board say I claim all those
opposed I’m not used to having such a smooth thank you so now we have our team for now
thank you thank you all and I wish the new board all the best and our congratulations
so now dr. Simonson safe journey safe travel so we’re going to move to item number 16 15
physician responsibility my apologies miss ships bi I really apologize please for the
report so just when the repeal of are calling for not paying attention for me not being
attention oh all right we had a the Committee on physician supervisory responsibilities
we met yesterday afternoon and the purpose of the meeting was to discuss the requirement
of SB 100 which was the price bill which requires the board to adopt regulations regarding the
appropriate level of physician availability needed within clinics or other settings using
laser oil told her input on four regulatory proposals drafted by staff the for proposals
consisted of the following the first that we would adopt a community standard proposal
which would require a physician to be available to the provider in accordance with the standards
for the community in which the procedure is being formed performed or number two and on
premises proposal which would require a physician to be physically present on the premises where
the procedure is being performed throughout the duration of the procedure or three a physically
present and immediately available proposal which would require a physician to be physically
present interruptible and able to furnish assistance and direction throughout the performance
of the procedure and for a not physically present but immediately available proposal
which require a physician to be immediately available and contactable by electronic or
telephonic means without delay interruptible and able to furnish assistance and direction
throughout the performance of the procedure the staff recommended that the committee focus
their discussion on either option 1 or option 4 however the committee discussed all four
options the the discussion did take place on all the options the discussion then focused
on option 4 it was the consensus that option 4 is probably the most practical and then
also we’d have a discussion about ensuring that any practitioner performing elective
cosmetic procedures using lasers and intense pulse light devices and physicians supervising
these practitioners have appropriate training to ensure community concern protection so
after much input from the committee members and members of the public the committee voted
to recommend to the full board that I go forward with a regulatory proposal for a vies option
number four and that revised option number four reads as follows so is this part of your
motion mischiefs key well I’m going to read it first and then we’ll entertain a motion
for it because it’s a two-part thing there’s two parts to it okay it was recommended that
the regulation should read as follows whenever an elective cosmetic procedure involving the
use of a laser or intense pulse light device is performed by a licensed healthcare provider
acting within the scope of his or her license a physician with relevant training and expertise
shall be immediately available to the provider for purpose of this section immediately available
means contactable by electronic or telephonic means without delaying interruptible and able
to furnish appropriate assistance and direction throughout the performance of the procedure
and inform the patient of provisions for post procedure care and such shall be contained
in standardized procedures or protocols it seemed also to be the consensus of the committee
that because the regulations that were being sought primarily focused on the supervision
of the provider who’s performing you know the laser what it failed to do was is take
into account that the bigger overriding issue is those that are performing and supervising
have to be specifically trained to be able to do so and so the committee also is for
it in a recommendation that this board approached the legislature going forward and indicate
to the legislature that we believe further legislation is necessary to enhance consumer
protection in this area by requiring specific training and/or certification so what I’d
like to do is call for a motion the proposed language that is a revision of option four
it does contain additional language requesting that the person have relevant training and
expertise and most importantly we thought was it added that the patient would be informed
of procedures for post procedure care and that this all be contained and standardized
procedures or protocols so that’s so much that is my motion thank you may have a second
sir okay now I have discussion on the motion dr. Levine just a clarification so if the
means of contact is electronic or telephonic correct what does that mean in terms of available
to intervene basically if necessary the the committee discussed extensively because obviously
we have the issue about telemedicine but we also have the issue that in many other types
of procedures that the physician have it can be available immediately available means by
telephone and we’re asking that that person provide appropriate assistance obviously if
that person is not on the premises or within a reachable transit time then as the community
standard would be they would call 9-1-1 if they needed appropriate backup the difficulty
we had and certainly mr. Hepler can comment on this is that the statutory outline which
this board had received to put together regulations is somewhat narrow and so what we were attempting
to do is to stretch that to make certain that we had some additional consumer protections
in there and then with the second part that we really there’s much more that’s needed
and we need to let the legislature know that you’re going to death actually I appreciate
what committee did did a great job my one question is what what prevents and what are
the safeguards where one position covers multiple laser clinics coral court of these people
practicing without medical license we didn’t have that discussion and the difficulty about
setting out particular in these regulations a ratio of one to so many it’s very problematic
because we don’t have that requirement in any other area except with the supervision
of either physician assistant or nurse practitioner many registered nurses are doing these procedures
under standardized protocols so that was discussed and and counsel can weigh in about why this
would be problematic to put a ratio in there Thank You mr. key dr. gonorrhea of the ratios
and mischiefs keys spoke of our essentially statutory ratios where the legislature has
spoken it was my considered opinion that going to a ratio in regulation would be on the very
cusp of what we could do by regulation and perhaps that there’s a statutory racial needs
to be said it could be addressed in that in the ongoing approach ongoing communication
with the legislature but I felt it was a little bit of a stretch to get to a ratio by regulation
my concern is is still the same that is that this entire line my opinion was to really
make sure that consumers are protected by appropriate supervision by the physicians
so if we don’t have any any any restriction or what they can do it could be one person
in San Bernardino California supervising can ten of these clinics doing things which which
could be danger to the community nevermind I asked your question is there not usually
a treatment plan that’s in place when a doctor or a practitioner has a treatment of some
kind that they’re performing where the patient is there’s some kind of discussion that we’re
this would probably come forward automatically so that it’s not like all of a sudden we decided
to supervise ten different clinics in different ten different parts of Southern California
by one doctor in fact the doctor that is performing or has we don’t have that that’s not part
of normal protocol with a patient than a treatment let me just say this let me take one step
backwards of course with this regulation the statute really speaks to was some some licensed
person other than a physician doing these procedures and so at least I can speak as
counsel formal counsel of the PA and I think the PAS were represented yesterday some of
the the supervision and treatment protocol would be addressed already from the delegation
of services agreement down from the supervising physician to the PA so I’m confident that
at least backup plans or whatever standardized procedures would be encompass that plan I
really can’t I can’t speak to advanced practice nurses because I really don’t know not that
much about them but as far as the the procedure itself certainly it’s the case I was a robust
discussion as mischiefs key pointed out more than a robust discussion perhaps even going
as far as animated yesterday and my hope doctor gana dev not to use hyperbole but if it’s
a 1 to 10 ratio that the the clause that says interruptible would be that hang on I can’t
take your call right now because I’m talking to my clinic in San Bernardino Riverside Orange
County Alturas and Blythe and so I would think that that would be essentially at least giving
guidance to the physician that you may be started he or she may be stretching them thin
because obviously I think a fact finder if we ever take this to accusation order would
be that you weren’t really available because you weren’t interrupted interruptible because
you are not giving advice or treatment or the appropriate assistance to another one
of whatever was going on there and if I can add there with the part of the discussion
that [Music] we’re gonna follow up on is that it was it’s felt that we can pursue some additional
perhaps restrictions by taking a look at the definition of Medi spas and how they obtain
fictitious name permits and then as we know there’s new legislation actually that is very
very directed at the corporate practice of medicine in the settings where in fact there
isn’t obviously a physician involvement in that you do have other people doing these
procedures so there’s a variety of tools that we are looking at again the the difficulty
dilemma we have is statutorily we’ve been told what specific regulations they’re looking
for so we we are trying to push the envelope to get that consumer protection knowing that
perhaps the statute itself is deficient and what we need to do is encourage that to be
changed as this is set for regulation you will have more public comments and more public
engagement and more professional engagement and I think this is exactly where you’re going
to get additional safeguards dr. Condon so do I have a motion if I could just clarify
the motion you hit on a miss madam president this emotional abuse and said the first part
emotional to be set this for regulatory hearing second okay now do I have more comment from
the board do I have any additional I don’t have any slips from the public but if there’s
some of that which to speak I’m fine so all those in favor the motion to set this for
regulatory hearing for October of 2012 please say I find opposed any abstentions thank you
so that’s done and on the second part meant of chair I’m what counsel can tell me I could
sees wasn’t agendized but it’s part and parcel of what we did the second recommendation needs
to go forward and that is that that excuse me I’m sorry the second recommendation also
needs to go forward from the committee that the board approached the legislature about
going forward on additional legislation that we felt would enhance consumer protection
by specifically requiring training and/or certification for the both the provider and/or
the person the physician supervising so we should put that on the calendar for a future
board agenda counsel can we take up this because it was the course the recommendation the community
that they essentially wrapped that they be wrapped together because I think there are
sort of part and parcel about what was going on one is we made the recommendation but as
sort of an adjunct there’s my understanding the committee said hey we recognize that there
may be more attention needed to be directed to the legislature and statutory revisions
to gain the appropriate level of consumer protection so what I’m hearing from two different
years two different statements that I’m trying to pay attention what you’re saying and I’m
apologize for having a split personality so what I’m hearing is that it could be set for
2013 session well up to I would hope and I felt there was a sense of the committee that
when we go forward in the regulation so that we simultaneously communicate to you the author
of the legislation then there are some deficiencies okay it really do need to be addressed so
staff should take note of that so can a directive can that be part of our motion or do we have
to make a separate one mr. Adler it was my understanding I’m sorry that was part and
parcel of the let’s have that together with the original motion would that be all right
how’s it all those in favor of the motion as now amended please say aye aye thank you
very much and so just as reported our upcoming meetings we will be reviewing the entire issue
of at med spas and how in fact they do get fictitious name promise because they are medical
practices thank you on them to see what we can do about that thank you very much we’re
going to move to the enforcement I need a doctor though so the enforcement committee
met yesterday and had a very ambitious agenda in hopes of shortening today’s agenda discussion
started with a presentation by senior assistant attorney general Carlos Ramirez and supervising
Deputy Attorney General Gloria Castro about the topic of amended accusations so the presentation
began with a brief overview of the Administrative Procedures Act from which the rules relating
to administrative law is derived we learned about the respondents bill of rights which
essentially calls for due process being afforded to licensees the crux of the presentation
had to do with an amended accusation what an amended accusation is and why an accusation
becomes amended legally speaking an accusation is a written statement of charges setting
forth the acts or commissions with which the respondent is charged to the end that the
respondent will able be able to prepare a defense the accusation also has to set forth
the statute and rules the respondent is alleged to have violated so an amended accusation
may be filed at any time before the submission of the matter or decision where an amended
accusation presents a new charge the respondent must be afforded a reasonable opportunity
to prepare a defense hearings may be postponed for a good cause amendments to accusations
are made and served at any time during the course of the case as soon as new investigations
are completed and accepted for prosecution once the prern conference is held which is
six weeks prior to the hearing administrative law judges control whether and when an accusation
may be amended filed and served by setting deadlines it’s rare that accusations are meted
as to new charges during a hearing when it does happen it used the the result of new
evidence that was not disclosed in a pre-hearing discovery due to any number of valid reasons
so as an example for the year 2010 through 1125 of 226 which is 11 percent of the accusations
were amended of those two required filing a second admitted accusation there were no
third amended accusations of the 25 amended accusations 11 were amended well in advance
of the hearing date due to new investigations to an existing accusation for example there
may be a case pending at the AG’s office and another complaint has received in the field
that requires investigation once the investigation is complete and the case is accepted for prosecution
the deputy will have to add the charges to include the information obtained in the new
investigation so the 25 cases amended above one was emitted to address an issue required
for the surrender of a license and one was omitted the first day after hearing to conform
to the pleadings to the testimony of board expert witness so due to process due process
allows continuances so that the respondent can adequately defend against new charges
in an amended accusation amended accusations prevent the filing of multiple accusations
and multiple hearings against the respondent allowing for more efficient resolution of
the matters and lastly amended accusations pair down or add charges where justice requires
it because that was a discussion on amended accusations I’m sure that mr. Ramirez oakley
glad to answer any additional questions okay the next agenda item had to do with the expert
reviewer training so miss Laura sweet gave an update on the expert reviewer training
that was held at UC Davis Medical Center on May 19 2012 so this was a program where we
wanted to [Music] give expert reviewers more consistent training of what was expected of
them and if we hope to carry this up and down the state and this is our first effort the
training was a huge success over 100 doctors attended and the critiques of the training
were overwhelmingly positive comments included sentiments such as this is the best forensic
conference I’ve ever attended this exceeded my expectations and reinforces my feeling
good about being an expert for the Medical Board the scenarios and discussions are great
great to have viewpoints of both sides great seminar amazing amount of work put together
and thank you so miss we’d said that there were a few modifications you’d like to make
in the training of it that will be held in our next sessions and these are targeted take
place in February 2013 in San Diego or perhaps UC or perhaps in Irvine a few experts express
justified concern that they received little or no feedback as to their work as an expert
and the staff realizes that this is a problem and we’re working to resolve this and they
have been working on it as well at one point chief Threadgill had allocated two of the
consumer protection initiative and analyst positions to that unit and they even had space
allocated for the analyst but those positions were lost due to the required 5% of personnel
reduction then the thought was to utilize retired annuitants for those positions but
recently the board had to eliminate the use of 19 annuitants and are constructively forbidden
to hire new ones as far as the training process goes miss we proposed the feedback can be
incorporated into training by paring down the course to six hours and then giving the
experts additional hours of credit for preparing expert opinions on a sample expert case then
a panel of supervising investigator medical consultant and supervising Deputy Attorney
General will provide individualized feedback as to the written opinion additionally the
enforcement program is looking for other ways to augment the one individual who is currently
handling the expert program in order to systematically provide feedback to our experts including
the status of cases that have resulted in accusations being filed but as for the expert
training itself it was incredibly successful and well appreciated so at this point I’d
like to call forward that there’s Laura sweet can you come up here or maybe you can come
over and see Barbara the the staff would like to present Laura sweet something here the
purpose to get this done I want to really thank you Laura to have the metal board want
to thank you for your [Applause] separated you they need to know why you put your hands
on your certificate when you receive some kind of accommodation so that in the future
they can never remove you from the picture it’s very true thank you doctor though I can
tell you that there’s a lot of sweet then miss Threadgill did in the phenomenal job
and I think this is going to definitely raise the bar and the quality that we get from our
experts and you can see that these are some of the pictures from that training session
I mean it was intense not anybody left I mean everybody was focused the entire day okay
so on to the next agenda item we then heard from Susan Katie who gave an overview of the
CCU process and goals this is the complaint unit so the kind of the complaint process
the review process is much more detailed than many people realize when a complaint is received
it is entered into the computer and by law and a knowledge meant is sent the complaint
is then referred to an analyst who reviews the case to make sure that the board has jurisdiction
if it’s a quality of care case the analyst requests a release from the patient obtains
medical records and a summary from the physician the case is then sent out to the reviewer
in the same specialty to determine if the treatment was within the standard of care
if there is insufficient information to establish that or if there may be a deviation from the
standard from the standard the cases then referred to the district office for investigation
for non quality of care cases which might include sexual misconduct or the unlicensed
practice of medicine or physician impairment these cases are sent directly to the district
office for investigation so miss Katie showed us a chart depicting the average time it takes
to process a complaint during the past five fiscal years the time has increased about
24 days miss Katie then showed us under ideal circumstances the I’m allotted for each component
of the analysts job for example 10 days is allowed from the receipt of a complaint for
the complaint to be received initiated and acknowledged this is set forth by law overall
processing time can take 8 to 122 days the most time-consuming steps are requesting release
from the complaint and which can take up to 25 days and then requesting the medical records
by law physicians are entitled to 15 days to produce records hospitals are entitled
30 days within 7 days of receiving the records the file is referred for medical specialty
assignment the analyst then has another 10 days to find a specialty reviewer this can
increase if there are too few available specialists another 38 days can elapse to receive the
review from the specialty reviewer so miss Katy identified areas where improvements can
be made for example reducing the time it takes to acknowledge and to enter a complaint from
10 days to 5 so I think we’re trying very hard to make this whole process much more
efficient miss Katy will be giving a presentation about that at the next board meeting with
specific recommendations to us okay the next agenda item mr. Bern Hinds from Department
of Consumer Affairs gave us a presentation on potential auditable risks identified in
the medical boards central complaint unit so the DCA Commission mr. Heinz to determine
if its programs are prior our prioritizing and processing plants in an efficient and
effective manner mr. Heinz was tasked with identifying where high risk enforcement programs
can improve their processes and procedures with existing resources to better protect
the public so mr. Heinz assess 3599 complaints that were closed in a six-month period from
January 1 to January 30th 2011 on average it took four point three months to close the
3599 complaints and it took 12 months to close a hundred and sixteen of those cases and so
this I think was for many of us surprisingly efficient so the central complaint unit plus
the field investigation average of four point three months compares favorably to the other
DCA boards and bureaus that he has reviewed but 12 percent of the cases took a year or
more to process part of the audit scope was to include steps and procedures to ascertain
the cause for the delay and provide recommendations to reduce delay so one of the delays identified
was the implementation of Senate bill 1950 in 2003 that required a specialty reviewer
a process that essentially calls for any quality of care case to be reviewed by medical expert
before it can be referred to the field in 2008 2009 only 348 of all quality cases were
referred for field investigation of those 14 percent took longer than six months for
the medical specialist review so we identified areas of risk or concern which incidentally
coincides with miss Katie’s observation cases may not be assigned in a timely fashion to
medical specialists medical specialists may have the cases too long and CCU tracking are
missing prioritizing information so we made several recommendations he said that the central
complaint unit may want to revise medical specialist contracts or follow up more frequently
to try to reduce the medical specialist delay they also thought that the CCU could print
an overdue report to monitor all cases that are awaiting medical specialist assignment
that the report lists all urgent non urgent cases in date order and that the report be
modified to show the urgency level of outstanding cases so that the non urgent cases aren’t
assigned ahead of the more urgent cases additionally this ec you may want to revise medical specialist
contract or follow more frequently to try to reduce the medical specialists delay so
the next item related to the administrative law judge training program that the Medical
Board assisted in putting on for the office administrative hearing and those judges that
here the Medical Board cases this also went extremely well and in the initial session
the topics included things like pain management appropriate medication standards chronic pain
issues and new developments in medicine and other subjects and it was held up and down
the state via teleconference we see a lot of additional opportunities and this was extremely
well received by the judges and I think that certainly Linda Whitney and her staff did
a terrific job in coordinating things especially miss Threadgill who worked closely with judge
Liu to set up the program on June 29 another agenda item I met with the Medical Board and
the health quality enforcement staff and we discussed the reconciliation of data and statistics
I think that was a productive meeting we’re still not completely agreed on all the details
but I think the spirit is that we understand the problem we’re going to try to fix it and
be much more efficient mr. Kirsch Meyer gave us some background on enforcement annual report
format and word has come from and where it is now and she explained that the enforcement
section of the annual report is mainly driven by the information required to be reported
pursuant to business and profession code 23:13 this year the board will make a change the
annual report in that it will add a column to the enforcement processing timeframes and
at a section where the days have been converted to years in order for the public to have another
way of examining the information miss Curtis Mayer told us that the enforcement program
report always begins with a narrative of what has happened in the last and outlines any
improvements or accomplishments that are noteworthy she then walked us through the entire report
and solicited edits and changes that we would like to see made in the next report next miss
Katie gave us an update on the implementation of Senate bill 100 patients surgery settings
miss Katie provided us with a flow chart which explained how the board will respond to the
complaints received regarding an outpatient surgery complaints from an outpatient surgery
setting the complaints will initially be reviewed by the licensing program to determine whether
the setting is accredited or not if it is accredited the complaint will be referred
to the accrediting agency for inspection once the inspection report is received and licensing
all the findings will be reviewed to determine if any deficiencies were identified in the
categories that relate to patient safety patient safety deficiencies will then be referred
to the complaint unit to be initiated and referred for formal investigation let’s say
we then heard from Renee Threadgill and Carlos Ramirez in the process overview of the vertical
enforcement program this was a very detailed report from both sides and there was a consider
amount of explanation about the entire process I think it’s clear from the discussion that
was that the vertical enforcement program which is began in 2006 is definitely improving
things not everything is ideal but we’re continuing to make progress and I think there’s no question
that it’s a worthwhile endeavor that includes that concludes my report dr. Lowe thank you
very much there are there any questions for any of the board members other than our total
appreciation for for some of you that were not on the board during our licensing fiasco
it was a very hard time it was really a very difficult time but we took the bull by the
horns and we made some major cultural difference differences in the way things were handled
process in the work product period dr. Lowe has spent inordinate amount of time and energy
with staff to start to do the same thing with our enforcement program and I can’t think
of enough the differences is that it’s very detailed it’s not like it’s something that
just because someone filed a complaint it’s gonna you know take one day or twenty days
or a hundred days we don’t know what’s going to happen and I dr. I want to personally thank
you publicly again for your engagement involvement in this life and you know I do very little
but I think that the people that we have working at the Medical Board do a phenomenal job and
I mean everything is very complex and if you look at the very big picture with you an amazingly
strong job protecting the public we do I think that the issues that we just don’t get the
good news out we always hear about sometimes some not so good news but the good news is
that we are doing a very good job and staff is to be commended for the dedication and
in time that they’re putting into doing all this extra coordination so thank you I do
have public comment on this Ann Robinson I’m and ask you to keep it brief and to remember
not to talk to us on something you’ve already talked to us about please thank you madam
president members of the board I’m Ann Robinson from Chico I filed a complaint in 2006 about
my mother’s death in hospital no one at the Medical Board of California ever really read
the letters submitted nor the medical reports of that I got from the hospital the doctor
cancelled – my mother’s medications cold turkey when she was admitted to the hospital because
he didn’t really know what he was prescribing for my mother after she passed away I sent
him a letter asking why he had cancelled her medicines so that I could understand and he
sent a letter back stating that I was mistaken about what medicines my mother was taking
now I had been taking care of my mother who was wheelchair-bound from a stroke for 18
years I knew what medicines she took when she took them how often and what strengths
that he couldn’t even be bothered to look in his own records he sent me a letter saying
that she was never on those medicines and yet I got a letter from the legal department
of the pharmacy stating yes she was on those medicines and because it was expensive the
insurance company required that the pharmacy to call the doctor’s office every single month
to renew the prescription so all he had to do and he did renew those prescriptions every
month for more than a year I called often to check on the if anybody had even looked
at those two letters the letter from the doctor and the letter from the legal department of
the pharmacy they would have seen there was something wrong with that picture I often
called to check on the status I finally got a letter which stated that my mother had died
of advanced Parkinson’s this is proof that the medical expert never even looked at my
mother’s medical records because my mother never had Parkinson’s was never diagnosed
with Parkinson’s and it is never mentioned anywhere in any of her medical records so
where he came up with Parkinson’s he couldn’t have looked at this other papers very carefully
[Music] in fact if he’d even looked at the death certificate which was right on the top
he would have seen she died of respiratory arrest from an overdose of morphine that part
wasn’t on the death certificate but she was given morphine every hour on the hour because
she was in pain because the doctor had taken away her regular medications is this the kind
of an investigation that the board is proud of I don’t think so when I tried to appeal
in 2010 I hand-delivered the complaint to the Medical Board of California complaint
unit Dan I followed up every two weeks but was just jerked around and was told to leave
a message several weeks went by and no one ever called me back so I called to speak with
a supervisor and had to leave a message I left the supervisor multiple voice messages
several weeks later when I finally got hold of a supervisor she told me that my complaint
was being looked at and she would get back to me several weeks passed again I was told
each and every time that my complaint was being looked at and I needed to call back
in a couple of weeks this went on for six months and then it was finally Tolbert his
supervisor the statute of limitations had run out and the file was closed although I
had I believe nearly two years left on the on the statute of limitations I was very angry
I was shocked that the agency responsible for keeping patients safe couldn’t be bothered
to even read the papers that had been submitted and they didn’t even have the decency to send
me a letter to tell me they couldn’t find any extreme departure in my mother’s case
and the file was closed something is wrong with the system and it needs to be corrected
thank you for your time and consideration I’m going to suggest that you make the time
to speak with our chief of enforcement hood sitting over here mr. ed Gill before you leave
today and maybe you guys can figure out how to work this out I’m very sorry thank you
is the one I was expecting hear from you move to item number 23 which is consideration of
a petition to amend section 137 9.50 of the board’s polysomnographic regulations mr. Hepler
mr. Salgado would you please give us a discussion this is going to be a petition to amend regulation
so I don’t want everyone to be listening with that that’s where we’re going with this Thank
You Vera positive members this board just a few items ago considered some Lea’s some
regulatory proposals in the set for hearing that was directed by statute sometimes the
board thinks of its own regulations but there’s a provision of the government code that allows
an interested party to petition for an amendment to the regulations and that’s what and that
is the case here the American Health and Safety Institute has petitioned for the board to
revise its regulations to allow us basic life certificate issued by them to satisfy the
requirements and regulations for our polysomnographic trainees technologists and technicians at
this point in time what this really means is we’re not going amend the regulations today
when we would essentially you do is commence the rulemaking process if the board so chose
to grant this petition what the rule would do would be to set this matter for regulatory
hearing and the crux of the change can be found on pages 211 and 212 of your packet
right now the basic life support certificate must be issued by the American Heart Association
and what they what the ASAE HSI would like to do is make sure that a BLS certificate
issued by them would satisfy our registration requirement mr. Salgado sitting next to me
has reviewed the sort of criteria in the BA the American Heart Association uses to issue
said certificate compare that to the age and size criteria and has found that there is
no appreciable difference if I’m correct and there would be no appreciable loss in consumer
protection so it we staffs recommendation to grant this petition which means that the
board would commence the rulemaking procedure and set this matter for regulatory hearing
at the October meeting so I need a motion to do that please dr. Goebel second dr. Levine
any public comment any comment from any of the members of the board all those in favor
please say aye any opposed okay so that motion carries thank you very much hmm next to this
lunch break so the levity was very appreciative about now thank you excellent thank you we’re
going to move on to the enforcement’s number 30 the enforcement Chiefs report please but
she probably wasn’t expecting to speak now so I’m going to ask I don’t see him in the
room either I see her but I don’t see him I see him in and I see her so I’m going to
ask that I will speak slowly and ask that mr. Edgar chief of enforcement and mr. Ramirez
from the attorney general’s office come forward please slowly walking can report to us on
item number 30 on our agenda which is on page 2.1 in our folder please thank you good afternoon
I first may I have a motion to approve eight orders restoring licenses to clear status
following completion of probation and three orders for license surrendered during probation
or administrative action to have a motion second issue any public comment any comment
from the board members all those in favor please say aye any opposed you have your motion
turning to the expert utilization report which can be found on page 321 of your packet or
its agenda item 30 B the district offices use 205 experts during the first six months
of calendar year 2012 to review 293 cases the total active list of experts as of July
2nd 2012 has dropped to 944 267 experts did not return their signed contract during the
process of converting to the new contract system additionally 20 experts withdrew from
the program because of the low reimbursement rate and retirements and other considerations
some just found that they were not suited to do this work they were no longer interested
in doing it although this appears to be a significant drop I do not believe that there
is cause for alarm we are we’re still able to do business and we will still continue
to recruit I am pleased to report that as a result of our appeal regarding the loss
of 28 vehicles we were successful in retaining 24 of our cars I am also very excited to report
that we have identified candidates to fill all of our current vacant investigator positions
therefore our vacancy rate less the individuals in background results in a 0% investigator
vacancy rate and I am aware that this situation is not likely to continue however I’m enjoying
this fleeting moment we still have four supervising investigator one vacancies however there are
two individuals in background for two of those positions the retired annuitants managed by
OST have been essential in order for us to accomplish 41 peace officer backgrounds during
the past 12 months as I previously reported these or can there were a number of candidates
that withdrew from the process after the backgrounds were finished and that caused us to have to
complete more backgrounds than we had positions but we’ve managed to do it a lot of hard work
by our staff but they got it done backgrounds are required by peace officer standards and
training which is known as post the Commission on peace officer standards and training provides
us with the areas that we must investigate in a potential hire and I’d like to share
with you what that process looks like just in very rapid fashion an applicant completes
a 27 page personal history statement and then is interviewed by the background investigator
their fingerprints and firearm eligibility checks DMV driving record check local law
enforcement agency checks and this can be quite a few because if the applicant has moved
around we’re checking with local law enforcement in the areas in which the candidate has lived
there’s credit checks we obtain official transcript with birth certificates citizenship documentation
military Selective Service marriage dissolution employer contacts reference checks neighborhood
checks neighborhood contacts and of course medical and psychological clearance and this
is all prepared in a narrative report which is submitted inside and off by the background
investigator and myself post audits our compliance with their requirements annually and fortunately
we’ve not been we’ve gotten good ratings on our ability to follow the rules and and prepare
background packages that meet their requirement we are extremely fortunate to have the retired
annuitants to perform this critical function because it is allowed existing investigative
staff to focus on reduction of case timelines okay turning to page 325 which is related
to our strategic plan objective five point two we are very close to reaching our goal
of 50% of complaints in the complaint unit being under fifty days but that’s only part
of it we do realize that there are as Susan described in her report yesterday there are
other efficiencies that we intend to seek in order to lower than the number of days
in that process but we still only have 80 percent eight percent to go in order to reach
that that the goal that was set in the strategic plan the number of complaints received by
CCU the central complaint unit continues to increase and as you can see on the chart on
page 325 we have 209 additional complaints this year as opposed to the number we had
last year with regard to reduction of the investigation timeline we have reduced the
case age average to 264 days and I believe that Tim I know she passed a chart out earlier
and I wanted to share that with you to point out that back in 2008 July of 2008 I appear
before the board and I had some goals that were said at that time and oh he’s fastened
them out let him catch up but those one of the goals was that we would reach the investigation
time line would reach 275 days I at that time estimated that because we had the change in
the complaint unit requiring specialty reviewer that we were going to go up a few days which
we are but we just didn’t go up to where where I thought we would which is a good thing so
that that goal was a little off but and we are well under that but the goal of 275 days
we’ve not only met it we’ve exceeded that and I am very very it’s it pleased I think
it’s phenomenal that we will were able to do this considering the challenges such as
vacancies and furloughs we do however face future challenges with the implementation
of peel our personal leave program 2012 this will result in the loss of 736 hours each
month or looking at in another way 8832 hours in a year that in the next 12 months from
productivity from sworn personnel so that no for the people that don’t do math in their
head so fast how many thousand hours are there in a month or does this translate to anything
what I could understand well if they’re 40 working hours in a week correct so if you
have four weeks in a month roughly your effort so so 8,000 hours that’s in a year that 12
it will be equal to the year divided by its I just want it’s a bigger number than we expected
it’s a medicine well we I look at this just a sworn personnel for the month you know it’s
a loss of 736 hours and I’m just that’s if all our positions are filled which you know
so tomorrow right now yeah okay but we’re it that will make it difficult to maintain
the progress we have made in the reduction of the timeframes but hope hopefully this
will be mitigated with the augmentation of staff we also had with the filling of all
these positions that have been vacant and we’re hopeful that we’ll be able to at least
stay abreast and not lose any ground page pages 326 through 329 in the packet you’ll
find the enforcement program statistics there is on there prevent presented in a variety
of formats and I would like to bring to your attention a again the document reflecting
the goals I just if as you can see we surpassed those goals and we’re going to be in the process
of setting new goals for hopefully that we will be able to surpass but I’d like to point
out that on page 327 this is a this is a chart that has added the years the percentage of
years along with the average days so when you look at the process together when you’re
looking at the median it looks like we are on line with what I hope to get where I hope
to get us in 2008 where I said we would go in fact the median for the total days with
the time at the AG and the time an investigation is 640 days only one point five years for
that for that process however the story really is in the outliers and I’ll tell you a little
bit about that later the total average time from complaint processing through the total
time at AG if the average is 741 days or 2.03 years compared to 908 the average days or
2.4 nine years in fiscal year oh oh so we’ve made we’ve completed a lot of work and this
is another example of the outstanding work produced by both medical board and hqe staff
this past fiscal year of course I need to talk about the outliers when you look at the
medium numbers they seem entirely reasonable it’s the outliers that make the average numbers
look less impressive in that vein the we we reviewed cases that were over 700 days old
and the vast majority of them have the same thing they involve allegations of over prescribing
and inappropriate prescribing they involve other law enforcement entities such as DEA
FBI IRS our local police departments and we are often asked to stand by and allow these
agencies to also complete their investigation and we had doneness however some of the federal
agencies are notoriously slow in moving an investigation forward about a year ago we
realized that these agencies were not mindful of our statute of limitations and we’re impeding
our ability to complete the invest geishas timely consequently we have taken a zero-tolerance
position in delaying the investigations at the result of their verbal request and if
they are willing to put something in writing nology that it is their request that is presented
preventing us from moving forward then we will consider that written request many of
the agencies don’t want to put that in writing so we’ve been moving forward on those cases
prescribing cases are also compounded by the need for multiple undercover operations and
the planning and staffing that each operation involves prescribing in cases typically involve
numerous patients which translates to having to put procure and review voluminous medical
records typically we tried to limit the cases to five patients but when there are numerous
patient deaths this may go higher and then we also need to obtain death certificates
in autopsy reports often we need to obtain authorizations from individual patients to
get their records or the investigator might have to write a subpoena or search warrant
for the medical records then the investigator must visit numerous pharmacies to obtain the
original prescriptions get the physician to attend an interview and send the case to two
experts as required by our pain management guidelines generally the patients are not
cooperative since they want these prescriptions other common themes and outlier cases involve
inability to obtain records inability to obtain timely interviews and inability to prevent
case aging when dealing with cunning defense attorneys our oldest case is an example of
these challenges within two weeks of assignment the investigator served a subpoena on a hospital
three and a half months later records are received pursuant to the subpoena and those
records are incomplete the subpoena enforcement action was undertaken the investigator also
served a subpoena to appear on medical staff individuals 20 days after assignment calling
for appearance of individuals 20 days later four days before the interview is supposed
to take place defense counsel calls and advises he was unable to make the interview and asked
to have the date changed investigator agrees to a date 17 days later defense counsel subsequently
writes a letter that says the subpoena is invalid and he will not be complying five
months elapsed with the office of the Attorney General attempting to negotiate an interview
with defense counsel who is not being cooperative almost six months after assignment the case
is formally transmitted for subpoena enforcement to the office of the Attorney General nine
months after assignment investigator serves a new physician with a subpoena and is able
to interview him eight months after Simon a petition to compel compliance with investigational
Surenos was filed by the office of the Attorney General for attendants of two witnesses about
one month later the Superior Court granted the petition to compel which the defense quickly
appealed 2 years 1 month after assignment oral arguments were heard in the Court of
Appeals three weeks later the Court of Appeals affirmed the Superior Court’s decision one
month later the defense filed a petition to reach for review in the Supreme Court two
years six months after assignment a remit er was filed by the Superior Court of San
Diego and the judgment was entered against the witnesses four days later the witnesses
are served with the letter commanded their appearance one month later the fifth count
so advises he’s on call for federal grand jury and not able to attend for an additional
week two years seven months after assignment the inner are finally completed business are
a story of just one of our outliers and it has many of the problems that we face all
in that one case unfortunately that outlier happens to be the oldest case in the state
additionally there we there are sections of law that were designed to help us set BMP
code section 22:34 H was one of these laws however it has done nothing to improve problems
associated with interviewed delays on the part of subject physicians in accordance with
our strategic plan 2.3 we we’ve identified this section of law as one that will require
substantial modification in order to be of value and eliminating our subject interviews
and we’re going to in compliance with that section of a strategic plan be going through
and making recommendations to the board regarding legislation and amendments to let possible
proposed amendments to legislation and laws that we currently have in order to become
more efficient in conclusion I wish to convey appreciation and and thanks to enforcement
staff for all of their hard work and dedication to our mission of public protection I think
I have several a couple of investigators could you stand up Oh could you continue standing
and also could I ask all of the enforcement staff to stand up that’s here you don’t you
don’t often see them in board meetings so I’d like to thank them as well for the fine
job they’ve done this year thank you that concludes my report to have any questions
from a circle dr. Gondo you said about the medical expert I’m quite concerned about the
number of people who haven’t signed up what are we doing to attract more medical experts
especially from variety of areas rather than just from the academic institutions rural
areas different specialties are we doing something right as I as I said I mean this is nothing
to be alarmed about when we switched we knew the contract format when we we had to change
over to the new system for contracting with experts we knew that we were going to lose
a few so this is not alarming at all 944 is a substantial number in fact we were down
you know 200 plus but one of the things we’re doing is we’re continuing to advertise I’ve
in the past I’ve asked California Society of addiction medicine to run an ad I will
continue to contact those specialty organizations especially in the areas where we are underserved
with experts we have need for more pain management experts and more psychiatrists that are good
and my concern is be also the type of practice and the location of practice to not just what
I see is when I read through my discipline reaction most of them are at a place like
minority UC Davis or some large place but I would like to see some way barstow or are
these some inner cities I mean these local standards are a little different so just curious
– well they shouldn’t be different and that’s why we’re here the standard of practice they
have less work to do oh well they still have to meet the minimum qualification trying to
be helpful I’m not I would suggest also that it’s part of this did you plan from the public
information officer to also get back to us and we’ve asked for direct input as to what
he is doing specifically to do outreach to do better about getting us some and we were
confused to if any Hospital that would I mean we would love to present at medical societies
there was a time that we had the luxury of doing that more we have certain restrictions
now on travel and so it’s made it a little bit more difficult but we continue to reach
out we have I would like to add to the expert reviewer program so that I can make nm was
responsible for contacting hospitals clinics soliciting individuals and various specialties
for participation in our program so maybe you can work with mr. wooden let us know it
next meeting of the Education Committee where it’s been requested what those outreach opportunities
are and then dr. Gondo you can come to the Education Committee and you’ll find out what’s
going on no committee work mr. wooded mr. Gill will present to us whoever I said you
got the point mr. Gill I want to thank you very much the work in the stress and the lack
of support a hundred percent support from a team it’s hard to get the job done and I
can very well appreciate that the issue that that I have is if the outliers are not the
usual so that those that that are taking years five years ten years whatever the number is
it’s very frustrating and it’s got to be very difficult but we do realize that that the
bulk of the work that’s being done by the Enforcement Team is really over and above
the call of expectations who want to thank you for bringing this to our attention even
though it’s getting toward the end of the day not that’s not your fault it’s that the
hours going forward whether you want or not which is good that’s what’s supposed to happen
the clock continues to move forward okay okay I would like to thank dr. Levine also for
her suggestion that we examine the outliers we will continue to do that there’s a wealth
of information that we’ve learned and opportunity to implement some of it some changes and efficiencies
as a result of looking at those great so now we’re going to continue we are continuing
to provide statistical reports to the Medical Board staff at this point we provide a total
of six reports three of those are monthly three others are quarterly and those are customized
for the specialists of America board and we plan to meet with the data section in our
office in the future to make sure that the reports that we are providing suit the needs
of the Medical Board staff with regards to the staffing we’ve had a vacancy in Los Angeles
we’ve moved that vacancy to Fresno to begin staff and staff in that office that’s an office
that has long been either service out of Sacramento or LA and obviously that has entailed seems
to come on a big amount travel but we are moving to have someone there permanently someone
a distant Fresno and can service that office the objective is to have a second position
assigned to that office in the future that’s your report yes thank you very much any questions
mr. Maris thank you very much thank you very very much we’re gonna move on the agenda to
item number 19 miss Chang would you give us an update on the Federation of state medical
boards please I just do want to well we don’t want to you know length apart we’re looking
for report okay just couple things the foundation has selected additional board members due
to the fact that it was the board policy of the Foundation Board that they do not want
more than one person from the same state to be serving on the board two of our board members
actually has shown interest that wouldn’t happen so what I’m hoping is in the future
that that this California Board person will be off that position currently treasure for
them in the future that will be empty I’m hoping the same people would would apply and
also at the same time the same token two years from now I be off the board and I will still
be from California but I’m hoping one of the board members here will be interested to run
for the board precision of the Federation you know I you know I know a lot of you are
very involved in it already but please keep an eye on the future assignment to the Federation
one of them will be in a position to run for a board position either a public member or
a physician member there are two types other than that some interesting development is
the National org and the American College of medical schools Federation and the EC fmg
the for organization is getting together to do a joint venture they call it a portfolio
which is a lying portfolio that started from medical school and with all the records and
all the 40 for a medical students all the way up to a physician and licensed physician
it will be a it’s a initial concept that is being billed on so it will be interesting
in the next year or so to see how they involved but this four organization already put money
in on top of that their numerous other organization are interested in involved it will be like
a empty cloud they call it empty cloud is the do you when you can go to the empty cloud
trigger something triggered a mechanism and then they will collect information from all
four different organization god every piece when it’s complete got every piece of the
information about that physician it’s it’s it’s very different thinking at this moment
and Federation still working around the the it’s the life yeah it’s a it’s their mo Elias
yeah they’re there all kinds of pilot program is being implemented that there’s a 11 ports
are implementing the pilot program and telemedicine and uniform application of license is line
subject and they it will happend next week at Salt Lake City they have a big conference
for that and other than that I will come back and make reports to you especially if you’re
doing it in Bay Area and I will take you guys out to dinner and we’ll see you again thank
you and thank you for your service on the Federation board I want to acknowledge also
dr. Simonson who’s left but spent two days in Carlsbad California and just recently for
sfn f sm be meeting on step two and step three of the USMLE and i want to thank her as well
so we’re gonna move on the agenda so let’s start with the board member communications
with interest partyís and I know dr. Don Canada has reminded me so many times I have
not forgotten I want to make sure that I do disclose that I as a mem as a member of AMA
that is the American Medical Association delegation I was in a June meeting in Chicago and met
with FSM bball the executive director and the chair of the board along with the leadership
of AMA and CMA I do meet these leaders quite often but we do not discuss anything about
the Medical Board issues I want to make sure that I’ll let people know that and last month
the AAPI that is the the American Association of physicians from Indian origin had a annual
meeting it’s a 60,000 member Association in in Long Beach and they gave me the most distinguished
physician award so so I was there thank you but the the disclosure here is that CMA leadership
came to the meeting and sat with me so I just want to make sure that people are aware of
I keep that separate my activity of the Medical Association’s versus what I do at medical
board now I hope you don’t expect to hear about every meeting that I happen to see a
public official at you’re sitting up very high bar there but as I’ve mentioned before
as far as my meetings go is that everybody I meet with this interesting so therefore
I’m having interested parties meetings but anyway I have met with I didn’t meet officially
with the Senate business professions leader Kern price along with their staff and along
with dr. Lowe I’ve met with various elected officials but I do that normally so I I apologize
but it’s a joke but it’s not it’s serious but I I have not had any interested parties
of meetings with anything that needs to be disclosed as it might present any kind of
a conflict seriously so do I have any other meeting statements that anyone else would
like to make good so move on that so as far as the I’m going to give you a brief education
update and just let you know that we did have an education meeting yesterday and mr. wood
is staffing ensuring as staffing that meeting and I want to thank him very much for his
input and engagement it is a work in progress to be honest with you and the work of the
two combined meetings one which has not met since 2010 the other since 2011 gave us pause
for opportunity to have a very robust discussion forget animated it was electronic basically
electronic meaning a lot of dancing around so that’s supposed to be funny miss psychologists
but it will be interesting we are going to try and put the committee’s on off session
off cycle so that we have the time and and opportunity for robots discussion with the
opportunity of doing better at what we’re doing within these subjects that do impact
the Medical Board so I know that I have a speaker slip on number 17 Tina did you want
to speak quickly on something Tina Minassian I’m here on behalf of the consumers union
safe patient project a nationwide campaign that’s organizing patient safety advocates
from across the state of California as the California State patient Network the medical
wards website offers confusing information and patients who are trying to understand
and comply with deadlines for Kabam for filing complaints this has resulted in the Medical
Board refusing to review complaints that patients believe are filed timely when we met with
Miss Whitney and Miss Kirk Myer in January we supply them with several examples of problematic
unclear and misleading communications on the medical boards website related to the medical
board statutes of limitations we did not take it upon ourselves to do an exhaustive search
of the medical boards website even so we identified a number of examples and requested that the
Medical Board correct this information we are pleased that the Medical Board recently
made changes to one document but how complaints are handled brochure however we believe the
medical board should develop a thorough plan and make addressing this important issue throughout
its website a communications priority we also request that when the Medical Board learns
of an alleged improper act or omission by a physician from a source other than the patient
such that the 3-year statute of limitations begins to run that the patient be notified
immediately in writing that there’s Sol has begun to run in addition we request that when
a patient makes a complaint to the medical board that the medical board explaining the
statute of limitations and informed a patient how much time they have before the statutes
of limitations will run out in their case further the Medical Board should advise patients
as their complaints is making its way through the process as to whether it is in danger
of going over this statute of limitations timeframe when the statute of limitations
in a case runs out it can have the impact of allowing violating physicians to continue
to practice without discipline we are aware that the Medical Board may find an extreme
departure and yet close the case because the statute of limitations has run we believe
the Medical Board should put in place processes to guard against this happening and to be
sure that consumers are well are as well-informed as possible we hope that the Medical Board
will direct its staff to respond to these matters and report back to the board thank
you for your time and consideration thank you very much I’m going to move to the executive
directors report item number 26 and ask that as part of
that we also discussed the dates for the due dates for the the board meetings let’s start
with that let’s start with 26 yep if you could all turn to your packet item 26 F and trying
to get the page number we have proposed dates for the board meetings in 2013 that’s on 299
those are dates as well as locations I’ve asked that you all bring your calendars to
let us know if those dates and locations two of the dates the spring as well as the fall
have two different Thursday Friday dates on them and so we need direction from you or
if the other two the winter and summer dates work we’ve also proposed the normal location
area sites but if you would like to be more specific to give us direction that would be
helpful – as part of this discussion I’m also going to recommend that the dates be held
open for 60 days so that you can go back to your offices you can go back to your staffs
and make sure that in the scheme of things these dates for real are going to work so
that’s the recommendation I know dr. Condon have you had your hand up first please madam
chair I would like this board to consider using Ontario area for a one board meeting
it’s like on the way it is New Year palm springs yes it’s on the way to Las Vegas – as I as
a as part of the Los Angeles area because it’s for San Diego – Simon sir yes doctor
you want San Diego okay just rather not be here for Halloween yeah I would agree that
that for families that and for the safety of public safety issues that would be important
for us to be in our communities so Levine dr. Levine Mike Mike Mike May 4th is a Saturday
I think the dates are actually the 2nd and 3rd of May you don’t want to be here on a
Saturday that’s fine with me no but I actually only have a calendar to be honest you’ve cut
that goes through December of 2012 so I’m I would go along with you so I’m just looking
to clarify doctor it’s just second in third of May’s and I would second so the doctor
Diego’s recommendation that we not do this over Halloween I agree October as far as so
the October one you talking about the 24th or 25th for the April do you have a spring
request for spring I don’t know I don’t know which ones Easter I don’t think any of them
are right so it doesn’t I have no idea I don’t have a calendar with holidays of any essence
okay so I’m going to ask that everyone take these back and then it gets back to our part
of me we have a calendar here but it doesn’t have any holidays marked and when is Passover
since we’re doing Easter so I’m going to tell you that it’s for my for dr. Levine let me
tell you seriously having one week in between the FSM be meaning and this board meeting
is very difficult on your time so it’s my recommendation that you look at the calendar
seriously and make an additional alternate recommendation to the staff or the sixth and
seventh I mean I’m just telling if the meeting here is so when is the FSM beep so it’s like
the 20th yeah so 18 through 20th of April so then it would make sense to do it through
the main so it makes more sense to do the main aim and it’s not Mother’s Day so we’re
okay we could make it Mother’s Day maybe it’s Mother’s just somewhere mother okay so that’s
that’s good I’m just telling you that I’m telling you that physically there is a drain
on your your energy it’s very intense that meaning and you need to be up for both meetings
okay so as of now we’ve got the 31st in the 1st of February in the San Francisco Bay Area
we’ve got May 3rd and 4th somewhere in the Los Angeles Ontario area second in their design
and the mid July meeting in Sacramento area and San Diego the 24th 25th or the following
week in November is there these dates also need to coincide with a hundred days for the
for the cases so understand that these dates are not just random situations but then there’s
also the alternative of an interim meeting by the panel’s so that is an option we have
airplanes to go to Ontario kind of like going to Los Angeles it feels like now and there
are a Southwest flight there ok so let’s have staff do that good to us ok not any different
than Sacramento coming to ok continue with your reports it’s starting from the bottom
and going up we’ll discuss the status of the sunset review I think that’s very important
for the board members to be informed about first of all a little historic reference for
you sunset review is an opportunity for the board the legislature the public and the administration
to re-examine the laws and mission of the board to determine what changes or enhancements
need to be made or to eliminate the board our last sunset review was in 2004 the process
is receipt of a questionnaire from the Senate and business and professions committee the
responses are due November 1st responses are reviewed by the legislative staff and may
we maybe ask additional questions or clarifying questions for issues that have come up and
in formal or informational hearing may be held prior to the legislature going into their
session and that might be in early 2003 but the formal legislative hearing is basically
through the policy committee and is done usually in spring so that would be spring 2013 the
bill then moves through the legislative process and hopefully by the fall of 2013 it would
be signed with the extension and enhancements for the board for operations for another four
to six years we have actually received our questionnaire we have begun the process of
responding and collecting data to respond to the questions latisha Robinson our research
program specialist is working on this with assistance from Janie Cordray our research
analyst previously who has now retired annuitant she has extensive knowledge as she worked
on the sunset reviews in the past and we hope her assistance will be available we have identified
her as mission critical in the development of this report because she is a retired annuitant
we are working with the Attorney General to gather data on vertical enforcement prosecution
as that has been promised to the legislature pursuant to our evaluation report that was
submitted in March we are now at a point where we will need a couple of subcommittees of
board members appointed to assist with the development of the review in various sections
of the final report so it can be presented to the board in final draft at our October
meeting I will be seeking your interest through the president the new president and she then
can appoint subcommittees of two members to help staff work on different sections of this
report we will be examining the outliers as you’ve heard from this Threadgill to determine
what laws may need to be added to the codes to expedite or that process or different pieces
of that process but we will look at it so we do not eliminate due process and that’s
my update on the sunset report moving on update on the audit report miss Kirk Meyer could
you please give us a quick update on that it’s all in your packet you’ll see that starting
on page 284 283 to 280 298 as stated at the last meeting the legislation which changed
the board’s reserve mandate from two to four two months to two to four months also included
a requirement from the Department of Finance office of state audits and evaluation that
they would perform a preliminary review of the board’s financial status including but
not limited to its projections related to expenses revenues and reserves and the impact
of the loan from the contingent fund to the Medical Board of California from the contingent
fund of the Medical Board of California to the general fund made pursuant to the budget
Act of 2008 this audit was completed and submitted to the board in its final form on May 31st
2012 I’m asthma’s Whitney said it’s contained in pages 283 to 298 please be aware that when
the final draft was received miss Whitney and I met with Miss Yaroslavsky to go over
the report we then drafted our response to the audit report which you will actually find
on page 295 the specific results of the audit if you want to look at those are on page 289
to 292 but basically the outcome of the audit was that although the loans to the general
fund have not impacted the board’s ability to operate at this time should the board have
the anticipated increase in expenditures and the loans not be repaid the Munson reserve
will then drop below the mandated level of the two to four months upon review we found
that the report accurately captured the information provided and met the Mandate of the legislature
are there any questions on the audit any questions thank you very much then we’re going to hold
over the budget report and the update on breeze for a future meeting you do have all of your
budget materials in your packet if you have any questions regarding any of those materials
the fund condition please don’t hesitate to contact miss Kirk Mayer or myself I’d like
to give a brief update on staffing and administration mr. Kirk Meyer also has a brief update on
some staffing first of all I would like to extend a very very heartfelt thanks to my
program Chiefs Miss Threadgill mr. warden and Miss Simoes plus the deputy miss Kirk
Meyer for the outstanding work they have done in putting these board meetings together and
developing their staff demonstrating excellent leadership skills without them this board
really would not function we often recognize individuals staff effort and I would like
to publicly recognize the Chiefs last month we were able to promote mr. Einar he will
continue as the administrative assistant to the board but take on additional duties related
to the executive office miss Kirk Meyer would you please continue with an update on some
of the staffing and issues that we are facing okay I’m going to go quickly through them
but I just want to give a little bit of a comparison between last meeting and this meeting
at the last meeting we actually reported that we had 42 vacancies and our vacancy rate was
15% we also reported that we were going to have 18.1 positions swept from the board to
the due to the budget letter from the Department of Finance since this is the beginning of
the fiscal year I’m going to just give a brief overview of what our staffing levels are right
now on June 30th we actually had two hundred and eighty three point two positions on July
1st due to the budget letter we lost the 18.1 taking us to 265 point one positions however
with the passing of the budget on July 1st we also gained six operation safe medicine
positions which brings us now to a total for fiscal year 1213 of 271 point 1 positions
of those positions we currently have 27 of them that are vacant which is a 10% vacancy
rate however we have 19 individuals either in background or waiting eligibility or a
start date that brings our vacancy rate to 3% this is the bet the best we’ve been probably
since I’ve been with the board maybe not since miss Whitney’s been with the board but for
a significant amount of time and the kudos really do go to the managers and to the personnel
staff that really have moved those those hirings forward 11 actually of the 15 there’s 15 actually
pending backgrounds and 11 of those are actually not pending with the department or with the
medical board but they’re actually pending with the State Personnel Board so those are
out of our hands so as soon as those go through then those 11 individuals will be available
to hire as well in June we were notified that due to bargaining unit agreements each employee
with them board will be given one personal leave day I’m is Threadgill alluded to that
earlier this is actually a leave day that they have to take without pay this decrease
for employees equates to a four point six to pay cut and this Agreement is going to
be effective from July third 1st through June 30th of 2014 it’s similar to the furlough
program that we had previously but the offices aren’t going to be closed if the employee
gets to choose which day of the month are going to take in addition there were also
side letter agreements with these states bargaining units that stated effective September 1st
all students and assistants and non-essential mission-critical retired annuitants will have
to be released from the board the board actually identified 19 retired annuitants that do not
fit the criteria of mission-critical and those employees are actually they no longer were
working after July 1st we wrote justifications for the rest of remaining retired annuitants
and we’re awaiting state and Consumer Services agency decision on those retired annuitants
it will be a huge impact if we lose the student assistants and also any other three any of
our retired annuitants I would just like to give you a brief cost comparison for student
assistants right now we have student assistants that help out in our licensing and information
systems branch unit in looking at a cost comparison of employing those individuals versus having
to hire full-time permanent staff the cost difference is about $90,000 per year in addition
those students actually only work about 20 to 25 hours per week and they’re very flexible
they assist with extra projects and fill in when individuals are on vacation or extended
sick leave there’s a possibility that we may be able to hire these students as permanent
intermittent employees but again that will be a cost increase and the last item I just
want to touch on is for retired annuitants at the board these are individuals who have
retired from state service and have a wealth of information in most circumstances when
these individuals are hired they do not need extensive training in most cases they don’t
need any training at all and again these are very flexible when they’re done with a project
you can actually tell those individuals we no longer have our for you but please kind
of you know if we need you we’ll call you back in the future so that’s another benefit
of having the retired annuitants just in looking at the cost comparison it varies depending
on classification but just for those working in our licensing unit in one year we would
actually save $30,000 as compared to having full-time permanent staff in those positions
so that’s we wanted to just kind of give you a little bit of an idea of if we do have these
individuals in student assistance particularly come back as permanent in minutes that would
be an increase in cost we’ll let you know about our retired annuitants as soon as we
hear the final decision from the secretary agency secretary so I would hate to at this
point have a disagreement with my assistant executive director but in the base of fairness
I think that we all need to understand that the issue of employment in the state is in
dire straits you have to be honest the governor is in a very tough position and it’s not this
is not a push for the governor’s positions but more for us to understand that there are
a lot of people out there that have no jobs and have no benefits and have no opportunity
for for the opportunity to work and the idea of bringing students in does help us financially
it does cost us a whole lot less money but it’s it’s not doing anything for unemployment
rate in the state of California our retired new ones are very experienced they know what
they’re doing they cost us a whole lot less money but they’re able to still collect benefits
so in all the fairness I just want there the public as well as this board to understand
that there are hard issues that we have to deal with and our budget given the ability
for the state to sweep our money it is a consideration I’m not suggesting that that it is and but
I just want but there’s two sides of this coin so that’s all I’m suggesting not a disagreement
or not i justá– just a point of personal privilege okay the ships key don’t agree with
me actually I was gonna say something similar but I’m surprised that the employee union
that represents those employees has an hasn’t filed on that because when you replace permanent
positions with students that creates a problem exactly why the governor’s would like to bargain
in agreement so what I’d like to explain is that these mean of the students nor the retired
annuitants take any of our positions those are what are in a blanket temporary help position
budget line item they’re not any of our permanent full-time positions if we did need to go forward
to get the the work we have to go through the budget change process and as most of you
will understand how hard it is to get through that process to hire those employees but these
individuals that are in student assistant positions and retired annuitants are not in
any of our permanent full-time positions and again I would just caution that taking the
side of the the employee Association is that in fact if this work constitutes something
that should be done by permanent employees that’s the same ground by which students cannot
replace workers so I hope that when that’s not what we’re doing okay thank you very much
for your part I’m going to take another point of personal privilege and given that the hour
is the hour and there’s nothing to do with the amount of time I’m willing to spend here
but to be honest with you the flights out of Sacramento are very challenging and if
the legislature could do something beside what it’s doing they would do us a big favor
by getting Southwest to figure out that they can fly more regularly in California instead
of to Kansas or wherever else they’re playing and that’s where they’re doing I mean they
are going to Kansas so anyway I’m going to tell you that as a result of that number 18
number 20 number 21 number 22 28 and 29 are on in a safe position we will take them up
at a future board meeting but we’re not going to take up those issues today so moving forward
from that we have an agenda in October in the San Diego area and I’d like to ask for
agenda items for that board meeting as well as the opportunity within the next 60 days
to let our staff know of issues that they would last like to be placed on the agenda
mischiefs key I mentioned before the safe medication disposal ordinance that the county
has just passed it could be a real model throughout the state take-back program yes the take-back
program and then the other thing that I’ve run across in teaching health care administration
is if we can get information they’re actually returned by access to care there actually
is a a program or a concept is being used is called Christian health care cost sharing
plans where instead of insurance church members get together and they actually contribute
and it pays for the medical care and would be interesting to see if that’s being used
to any extent in California it’s an affinity group kind of I know it’s a net and they’re
not registered as an insurance plan or they it is something that’s being used just that
step to the depths access up here any other items for the doctor gonna do madam chair
I would like to see if we could do any outreach program like on the licensing guide you know
like mr. Shanker does and the enforcement to the medical staffs and and medical staffs
mainly to really reach to the physicians prevention of the mistakes they make rather than just
pursue the proactive kind of okay so we’ll ask the staff to put that on okay and doctor
no do you have anything for your doctor Giselle and dr. Loe I’m going to point you to a panel
be gerrae I thought you knew about them I apologize I didn’t do that before so doctor
that will be I’ll be true so I I would just like to say that I’ve had a very interesting
careers and chairing this board I have learned a lot I’ve forgotten a lot and I’ll continue
hopefully to remember occasionally a lot but the work that this board does and the staff
the dedication the to dedication to the doing the right thing by our staff is way above
what I’ve seen in other similar kinds of boards the staffs and I want to thank the staff I
want to thank the members of this board for allowing me the opportunity to be at the microphone
for the last three years I want to look forward to maybe having a little bit of some time
I I don’t know what I’m going to do with another two hours but you know I’ll figure it out
doctors me and I want to wish you the best it’s a rewarding experience I think it’s an
important experience and I think that you will bring a breath ethic of personal experience
to this board that we definitely need to move it forward and I want to wish you all the
best as well as the rest of the people that will be on the board and I want to thank the
board I appreciate the opportunity to do this and I will certainly do my best to follow
in your footsteps dr. Gallo madam chair we do want to thank you actually for a new member
who just came on six months ago and I wanted to see how it functions so I wanted to meet
with you before I even I came to the orientation and you were gracious enough to meet with
me and spend couple hours down and explained to me so thank you it’s my pleasure you’ve
been a pleasure I want to thank you also for your incredible dedication and passion I mean
I don’t think many of us would be able to do what you’ve done for us over the past few
years and I know I speak for the entire board I just want to say Barbara and Madam President
you’ve really your heart and soul in this job and you’ve done an excellent job for for
all of us representing the thank you so much it’s been really my pleasure to I stayed here
for to keep your quorum so you have the meeting but the more I sit here the more I wanted
to stay anyway I knew Barbara probably eight years yeah you’re you’re here just as long
as I was and I truly enjoy your friendship and the hard work and this actually goes quite
a bit of all the people in this room Shelton Linda Kim Julie Kevin and a lot of you over
sitting over they occurred and all the staff over there and it is really goodbye and congratulations
to all the good work that you’re doing and you’re going to do so since we’re yes and
ships thank you yes your zosky my pleasure mission I want to thank you you know for your
dedication in your hard work and the passion that you’ve had to really make you know this
board an extremely responsive and responsible entity for the the work that’s you know given
to my sending its most appreciated particularly appreciative that we’re going to have a physician
as the new president who understands the importance of going to the bathroom frequently for bladder
control I thought we were just doing exercises here as new yeah Barbara yeah anyway but and
and I do again in all sincerity in a barber barber got reappointed by the speakers there
because someone just asked so we will be here for another four years and that’s great another
three years I think was it four years yeah whatever for your women unless they they were
late in making the appointment yeah we don’t want to thank you and also I think having
you know since I’ve been on the board heady has always reached out and you know and always
made people I think feel welcomed and and really has gone that extra step that pretty
good as a public member I think is extremely important because we are outnumbered here
by the physician group but in all seriousness that you know you’ve really you’ve really
been a good friend and and someone who is really you know taking care of those of us
who when we first got on the board and and we’re gonna miss you and congratulate you
and I want you to know it is okay to leave okay all the presents I’m dead your presence
has been a president penny so I would call for a motion entertain a motion for adjournment
a German then I have a motion in a second consider us in Jordan thank you

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