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SB-1981 Medical boards: sunset review.(1997-1998)

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Senate Bill No. 1981
CHAPTER 736

An act to amend Sections 651, 2001, 2020, 2066, 2102, 2135, 2151, 2185, 2225.5, 2428, 2460, 2462, 2472, 2475, 2496, 2569, 3501, 3504, 3505, and 3540 of, to amend and repeal Sections 3514 and 3515 of, to amend, repeal, and add Sections 2475 and 3535 of, to add Sections 473.17, 3503.5, and 3514.1 to, to repeal Sections 2101, 2148, 2473, and 2497.1 of, to repeal Article 23 (commencing with Section 2500) of Chapter 5 of Division 2 of, and to repeal and add Section 3513 of, the Business and Professions Code, relating to healing arts.

[ Filed with Secretary of State  September 22, 1998. Approved by Governor  September 21, 1998. ]

LEGISLATIVE COUNSEL'S DIGEST


SB 1981, Greene. Medical boards: sunset review.
(1)  Existing law regulating the practice of the healing arts establishes the Medical Board of California, the California Board of Podiatric Medicine, and the Physician Assistant Examining Committee. The existence of these boards and committee will be terminated July 1, 1999.
This bill would extend the existence of the boards and the committee until July 1, 2003, and make conforming changes.
(2)  The Medical Practice Act contains various requirements governing foreign medical graduates participating in clinical service programs or seeking licensure in this state as a physician and surgeon. The act also contains various requirements governing the issuance of a license as a physician and surgeon to a diplomate of the National Board of Medical Examiners.
This bill would modify these and other related requirements.
(3)  Existing law requires physicians and surgeons, podiatrists, and health care facilities to comply with a request for the medical records of a patient that is accompanied by the patient’s written authorization, as specified. Existing law imposes various civil penalties for failure to comply.
This bill would make failure to comply with a court order, issued in the enforcement of a subpoena, mandating the release of records to the Medical Board of California, a misdemeanor, thereby imposing a state-mandated local program by creating a new crime. It would enact related provisions.
(4)  The Medical Practice Act provides for creation of the California Board of Podiatric Medicine within the Medical Board of California, with various powers and duties relating to the regulation of podiatric medicine.
This bill would modify the membership of the board, repeal provisions granting a limited license to certain practitioners and requiring a special certificate for a podiatrist to perform surgical treatment of the ankle, authorize a podiatrist certified by the board on and after January 1, 1984, to perform surgical treatment of the ankle, and revise requirements for continuing education and examination. The bill would also permit a licensed podiatrist to include a statement in advertising that he or she is certified or eligible or qualified for certification by a private or public board or association, under certain conditions, and would require the Joint Legislative Sunset Review Committee to review the expenditure of funds for the support of educational and related programs in the field of podiatry. The bill would also repeal a requirement that the board establish and administer a diversion program for podiatrists impaired due to abuse of drugs and alcohol, among other things.
(5)  The Medical Practice Act provides for the Medical Board of California to renew existing licenses of persons holding a drugless practitioner’s certificate, which authorizes the holder to treat diseases, injuries, and other conditions without the use of drugs, as regulated by the board. Existing law provides that the classification of drugless practitioner is otherwise abolished.
This bill would repeal the provisions regulating drugless practitioners.
(6)  The Physician Assistant Practice Act provides for creation of the Physician Assistant Examining Committee, which has various powers and duties relative to making recommendations to the Medical Board of California concerning the regulation of physician assistants.
This bill would rename the committee as the Physician Assistant Committee and would modify its membership. The bill would also delete provisions requiring the board to approve applications of physicians who supervise physician assistants effective July 1, 2000, provide that a licensed physician assistant shall not be liable for civil damages for rendering emergency care in certain cases, and provide for the committee to recognize training programs for physician assistants approved by a national accrediting organization rather than approving those programs itself. The bill would also authorize physicians and surgeons licensed by the Osteopathic Medical Board of California to use or employ physician assistants under certain conditions, and would make violations of these provisions a misdemeanor, thereby imposing a state-mandated local program by creating a new crime.
(7)  The bill would enact other related provisions. (8)  The California Constitution requires the state to reimburse local agencies and school districts for certain costs mandated by the state. Statutory provisions establish procedures for making that reimbursement.
This bill would provide that no reimbursement is required by this act for a specified reason.

The people of the State of California do enact as follows:


SECTION 1.

 Section 473.17 is added to the Business and Professions Code, to read:

473.17.
 The Joint Legislative Sunset Review Committee shall review, in conjunction with the Legislative Analyst’s Office, and in consultation with the Board of Podiatric Medicine, the department, the University of California, and the California College of Podiatric Medicine, the expenditure of funds for the support of educational and related programs in the field of podiatry. The committee shall report its findings to the Legislature by April 1, 1999.

SEC. 2.

 Section 651 of the Business and Professions Code is amended to read:

651.
 (a)  It is unlawful for any person licensed under this division or under any initiative act referred to in this division to disseminate or cause to be disseminated, any form of public communication containing a false, fraudulent, misleading, or deceptive statement or claim, for the purpose of or likely to induce, directly or indirectly, the rendering of professional services or furnishing of products in connection with the professional practice or business for which he or she is licensed. A “public communication” as used in this section includes, but is not limited to, communication by means of television, radio, motion picture, newspaper, book, or list or directory of healing arts practitioners.
(b)  A false, fraudulent, misleading, or deceptive statement or claim includes a statement or claim which does any of the following:
(1)  Contains a misrepresentation of fact.
(2)  Is likely to mislead or deceive because of a failure to disclose material facts.
(3)  Is intended or is likely to create false or unjustified expectations of favorable results.
(4)  Relates to fees, other than a standard consultation fee or a range of fees for specific types of services, without fully and specifically disclosing all variables and other material factors.
(5)  Contains other representations or implications that in reasonable probability will cause an ordinarily prudent person to misunderstand or be deceived.
(c)  Any price advertisement shall be exact, without the use of phrases, including, but not limited to, “as low as,” “and up,” “lowest prices” or words or phrases of similar import. Any advertisement that refers to services, or costs for services, and that uses words of comparison shall be based on verifiable data substantiating the comparison. Any person so advertising shall be prepared to provide information sufficient to establish the accuracy of that comparison. Price advertising shall not be fraudulent, deceitful, or misleading, including statements or advertisements of bait, discount, premiums, gifts, or any statements of a similar nature. In connection with price advertising, the price for each product or service shall be clearly identifiable. The price advertised for products shall include charges for any related professional services, including dispensing and fitting services, unless the advertisement specifically and clearly indicates otherwise.
(d)  Any person so licensed shall not compensate or give anything of value to a representative of the press, radio, television, or other communication medium in anticipation of, or in return for, professional publicity unless the fact of compensation is made known in that publicity.
(e)  Any person so licensed may not use any professional card, professional announcement card, office sign, letterhead, telephone directory listing, medical list, medical directory listing, or a similar professional notice or device if it includes a statement or claim that is false, fraudulent, misleading, or deceptive within the meaning of subdivision (b).
(f)  Any person so licensed who violates this section is guilty of a misdemeanor. A bona fide mistake of fact shall be a defense to this subdivision but only to this subdivision.
(g)  Any violation of this section by a person so licensed shall constitute good cause for revocation or suspension of his or her license or other disciplinary action.
(h)  Advertising by any person so licensed may include the following:
(1)  A statement of the name of the practitioner.
(2)  A statement of addresses and telephone numbers of the offices maintained by the practitioner.
(3)  A statement of office hours regularly maintained by the practitioner.
(4)  A statement of languages, other than English, fluently spoken by the practitioner or a person in the practitioner’s office.
(5)  (A)  A statement that the practitioner is certified by a private or public board or agency or a statement that the practitioner limits his or her practice to specific fields. For the purposes of this section, the statement of a practitioner licensed under Chapter 4 (commencing with Section 1600) who limits his or her practice to a specific field or fields, shall only include a statement that he or she is certified or is eligible for certification by a private or public board or parent association recognized by that practitioner’s licensing board. A statement of certification by a practitioner licensed under Chapter 7 (commencing with Section 3000) shall only include a statement that he or she is certified or eligible for certification by a private or public board or parent association recognized by that practitioner’s licensing board.
(B)  A physician and surgeon licensed under Chapter 5 (commencing with Section 2000) by the Medical Board of California may include a statement that he or she limits his or her practice to specific fields, but may only include a statement that he or she is certified or eligible for certification by a private or public board or parent association, including, but not limited to, a multidisciplinary board or association, if that board or association is (i) an American Board of Medical Specialties member board, (ii) a board or association with equivalent requirements approved by that physician and surgeon’s licensing board, or (iii) a board or association with an Accreditation Council for Graduate Medical Education approved postgraduate training program that provides complete training in that specialty or subspecialty. A physician and surgeon licensed under Chapter 5 (commencing with Section 2000) by the Medical Board of California who is certified by an organization other than a board or association referred to in clause (i), (ii), or (iii) shall not use the term “board certified” in reference to that certification.
For purposes of this subparagraph, a “multidisciplinary board or association” means an educational certifying body that has a psychometrically valid testing process, as determined by the Medical Board of California, for certifying medical doctors and other health care professionals that is based on the applicants’ education, training, and experience.
For purposes of the term “board certified,” as used in this subparagraph, the terms “board” and “association” means an organization that is an American Board of Medical Specialties member board, an organization with equivalent requirements approved by a physician and surgeon’s licensing board, or an organization with an Accreditation Council for Graduate Medical Education approved postgraduate training program that provides complete training in a specialty or subspecialty.
The Medical Board of California shall adopt regulations to establish and collect a reasonable fee from each board or association applying for recognition pursuant to this subparagraph. The fee shall not exceed the cost of administering this subparagraph. Notwithstanding Section 2 of Chapter 1660 of the Statutes of 1990, this subparagraph shall become operative July 1, 1993. However, an administrative agency or accrediting organization may take any action contemplated by this subparagraph relating to the establishment or approval of specialist requirements on and after January 1, 1991.
(C)  A doctor of podiatric medicine licensed under Chapter 5 (commencing with Section 2000) by the Medical Board of California may include a statement that he or she is certified or eligible or qualified for certification by a private or public board or parent association, including, but not limited to, a multidisciplinary board or association, if that board or association meets one of the following requirements: (i) is approved by the Council on Podiatric Medical Education, (ii) is a board or association with equivalent requirements approved by the California Board of Podiatric Medicine, or (iii) is a board or association with the Council on Podiatric Medical Education approved postgraduate training programs that provide training in podiatric medicine and podiatric surgery. A doctor of podiatric medicine licensed under Chapter 5 (commencing with Section 2000) by the Medical Board of California who is certified by an organization other than a board or association referred to in clause (i), (ii), or (iii) shall not use the term “board certified” in reference to that certification.
For purposes of this subparagraph, a “multidisciplinary board or association” means an educational certifying body that has a psychometrically valid testing process, as determined by the California Board of Podiatric Medicine, for certifying doctors of podiatric medicine that is based on the applicant’s education, training, and experience. For purposes of the term “board certified,” as used in this subparagraph, the terms “board” and “association” mean an organization that is a Council on Podiatric Medical Education approved board, an organization with equivalent requirements approved by the California Board of Podiatric Medicine, or an organization with a Council on Podiatric Medical Education approved postgraduate training program that provides training in podiatric medicine and podiatric surgery.
The California Board of Podiatric Medicine shall adopt regulations to establish and collect a reasonable fee from each board or association applying for recognition pursuant to this subparagraph, to be deposited in the State Treasury in the Podiatry Fund, pursuant to Section 2499. The fee shall not exceed the cost of administering this subparagraph.
(6)  A statement that the practitioner provides services under a specified private or public insurance plan or health care plan.
(7)  A statement of names of schools and postgraduate clinical training programs from which the practitioner has graduated, together with the degrees received.
(8)  A statement of publications authored by the practitioner.
(9)  A statement of teaching positions currently or formerly held by the practitioner, together with pertinent dates.
(10)  A statement of his or her affiliations with hospitals or clinics.
(11)  A statement of the charges or fees for services or commodities offered by the practitioner.
(12)  A statement that the practitioner regularly accepts installment payments of fees.
(13)  Otherwise lawful images of a practitioner, his or her physical facilities, or of a commodity to be advertised.
(14)  A statement of the manufacturer, designer, style, make, trade name, brand name, color, size, or type of commodities advertised.
(15)  An advertisement of a registered dispensing optician may include statements in addition to those specified in paragraphs (1) to (14), inclusive, provided that any statement shall not violate subdivision (a), (b), (c), or (e) of this section or any other section of this code.
(16)  A statement, or statements, providing public health information encouraging preventative or corrective care.
(17)  Any other item of factual information that is not false, fraudulent, misleading, or likely to deceive.
(i)  Each of the healing arts boards and examining committees within Division 2 shall adopt appropriate regulations to enforce this section in accordance with Chapter 3.5 (commencing with Section 11340) of Part 1 of Division 3 of Title 2 of the Government Code.
Each of the healing arts boards and committees and examining committees within Division 2 shall, by regulation, define those efficacious services to be advertised by business or professions under their jurisdiction for the purpose of determining whether advertisements are false or misleading. Until a definition for that service has been issued, no advertisement for that service shall be disseminated. However, if a definition of a service has not been issued by a board or committee within 120 days of receipt of a request from a licensee, all those holding the license may advertise the service. Those boards and committees shall adopt or modify regulations defining what services may be advertised, the manner in which defined services may be advertised, and restricting advertising that would promote the inappropriate or excessive use of health services or commodities. A board or committee shall not, by regulation, unreasonably prevent truthful, nondeceptive price or otherwise lawful forms of advertising of services or commodities, by either outright prohibition or imposition of onerous disclosure requirements. However, any member of a board or committee acting in good faith in the adoption or enforcement of any regulation shall be deemed to be acting as an agent of the state.
(j)  The Attorney General shall commence legal proceedings in the appropriate forum to enjoin advertisements disseminated or about to be disseminated in violation of this section and seek other appropriate relief to enforce this section. Notwithstanding any other provision of law, the costs of enforcing this section to the respective licensing boards or committees may be awarded against any licensee found to be in violation of any provision of this section. This shall not diminish the power of district attorneys, county counsels, or city attorneys pursuant to existing law to seek appropriate relief.

SEC. 3.

 Section 2001 of the Business and Professions Code is amended to read:

2001.
 There is in the Department of Consumer Affairs a Medical Board of California which consists of 19 members, seven of whom shall be public members.
The Governor shall appoint 17 members to the board, subject to confirmation by the Senate, five of whom shall be public members. The Senate Rules Committee and the Speaker of the Assembly shall each appoint a public member, and their initial appointment shall be made to fill, respectively, the first and second public member vacancies which occur on or after January 1, 1983. This section shall become inoperative on July 1, 2003, and, as of January 1, 2004, is repealed, unless a later enacted statute, which becomes effective on or before January 1, 2004, deletes or extends the dates on which it becomes inoperative and is repealed. The repeal of this section renders the board subject to the review required by Division 1.2 (commencing with Section 473).

SEC. 4.

 Section 2020 of the Business and Professions Code is amended to read:

2020.
 The board may employ an executive director exempt from the provisions of the Civil Service Act and may also employ investigators, legal counsel, medical consultants, and other assistance as it may deem necessary to carry into effect this chapter. The board may fix the compensation to be paid for services subject to the provisions of applicable state laws and regulations and may incur other expenses as it may deem necessary. Investigators employed by the board shall be provided special training in investigating medical practice activities.
The Attorney General shall act as legal counsel for the board for any judicial and administrative proceedings and his or her services shall be a charge against it. This section shall become inoperative on July 1, 2003, and, as of January 1, 2004, is repealed, unless a later enacted statute, which becomes effective on or before January 1, 2004, deletes or extends the dates on which it becomes inoperative and is repealed.

SEC. 5.

 Section 2066 of the Business and Professions Code is amended to read:

2066.
 (a)  Nothing in this chapter shall be construed to prohibit a foreign medical graduate from engaging in the practice of medicine whenever and wherever required as a part of a clinical service program under the following conditions:
(1)  The clinical service is in a postgraduate training program approved by the Division of Licensing.
(2)  The graduate is registered with the division for the clinical service.
(b)  A graduate may engage in the practice of medicine under this section until the receipt of his or her physician and surgeon’s certificate. If the graduate fails to pass the examination and receive a certificate by the completion of the graduate’s second year of postgraduate training, all privileges and exemptions under this section shall automatically cease.
(c)  Nothing in this section shall preclude a foreign medical graduate from engaging in the practice of medicine under any other exemption contained in this chapter.

SEC. 6.

 Section 2101 of the Business and Professions Code is repealed.

SEC. 7.

 Section 2102 of the Business and Professions Code is amended to read:

2102.
 Any applicant who either (1) is a United States citizen, or (2) has filed a declaration of intention to become a United States citizen, a petition for naturalization, or a comparable document, or (3) was admitted or licensed to practice medicine and surgery in a country or other state of the United States wherein licensure requirements are satisfactory to the Division of Licensing, whose professional instruction was acquired in a country other than the United States or Canada shall provide evidence satisfactory to the division of compliance with the following requirements to be issued a physician and surgeon’s certificate:
(a)  Completion in a medical school or schools of a resident course of professional instruction equivalent to that required by Section 2089 and issuance to the applicant of a document acceptable to the division which shows final and successful completion of the course. However, nothing in this section shall be construed to require the division to evaluate for equivalency any coursework obtained at a medical school disapproved by the division pursuant to this section.
(b)  Certification by the Educational Commission for Foreign Medical Graduates, or its equivalent, as determined by the division. This subdivision shall apply to all applicants who are subject to this section and who have not taken and passed the written examination specified in subdivision (d) prior to June 1, 1986.
(c)  Satisfactory completion of the postgraduate training required under Section 2096. An applicant shall be required to have substantially completed the professional instruction required in subdivision (a) and shall be required to make application to the division and have passed steps 1 and 2 of the written examination relating to biomedical and clinical sciences prior to commencing any postgraduate training in this state. In its discretion, the division may authorize an applicant who is deficient in any education or clinical instruction required by Sections 2089 and 2089.5 to make up any deficiencies as a part of his or her postgraduate training program, but that remedial training shall be in addition to the postgraduate training required for licensure.
(d)  Pass the written examination as provided under Article 9 (commencing with Section 2170). If an applicant has not satisfactorily completed at least two years of approved postgraduate training, the applicant shall also pass the clinical competency written examination. An applicant shall be required to meet the requirements specified in subdivision (b) prior to being admitted to the written examination required by this subdivision.
Nothing in this section prohibits the division from disapproving any foreign medical school or from denying an application if, in the opinion of the division, the professional instruction provided by the medical school or the instruction received by the applicant is not equivalent to that required in Article 4 (commencing with Section 2080).

SEC. 8.

 Section 2135 of the Business and Professions Code is amended to read:

2135.
 The Division of Licensing shall issue a physician and surgeon’s certificate to an applicant who meets all of the following requirements:
(a)  The applicant holds an unlimited license as a physician and surgeon in another state or states, or in a Canadian province or Canadian provinces, which was issued upon:
(1)  Successful completion of a resident course of professional instruction equivalent to that specified in Section 2089. However, nothing in this section shall be construed to require the division to evaluate for equivalency any coursework obtained at a medical school disapproved by the division pursuant to Article 4 (commencing with Section 2080).
(2)  Taking and passing a written examination that is recognized by the division to be equivalent in content to that administered in California.
(b)  The applicant has held an unrestricted license to practice medicine, in a state or states, in a Canadian province or Canadian provinces, or as a member of the active military, United States Public Health Services, or other federal program, for a period of at least four years. Any time spent by the applicant in an approved postgraduate training program or clinical fellowship acceptable to the division shall not be included in the calculation of this four-year period.
(c)  The division determines that no disciplinary action has been taken against the applicant by any medical licensing authority and that the applicant has not been the subject of adverse judgments or settlements resulting from the practice of medicine that the division determines constitutes evidence of a pattern of negligence or incompetence.
(d)  The applicant (1) is certified by a specialty board approved by the American Board of Medical Specialties or approved by the division pursuant to subdivision (h) of Section 651; (2) has satisfactorily completed at least two years of approved postgraduate training; or (3) takes and passes the clinical competency written examination.
(e)  The applicant has not committed any acts or crimes constituting grounds for denial of a certificate under Division 1.5 (commencing with Section 475) or Article 12 (commencing with Section 2220).
(f)  Any application received from an applicant who has held an unrestricted license to practice medicine, in a state or states, or Canadian province or Canadian provinces, or as a member of the active military, United States Public Health Services, or other federal program for four or more years shall be reviewed and processed pursuant to this section. Any time spent by the applicant in an approved postgraduate training program or clinical fellowship acceptable to the division shall not be included in the calculation of this four-year period. This subdivision does not apply to applications that may be reviewed and processed pursuant to Section 2151.

SEC. 9.

 Section 2148 of the Business and Professions Code is repealed.

SEC. 10.

 Section 2151 of the Business and Professions Code is amended to read:

2151.
 Notwithstanding any other provision of law, the Division of Licensing may issue a physician and surgeon’s certificate to a diplomate of the National Board of Medical Examiners provided the following requirements are met:
(a)  The standard of the National Board of Medical Examiners on the date the diplomate certificate was issued was in no degree or particular less than that which was required for a physician and surgeon’s certificate under this chapter on the same date.
(b)  The applicant shall file an application with the division as provided in Article 4 (commencing with Section 2080). The applicant shall not, however, be required to comply with any provision of that article which is inconsistent with or in conflict with the provisions of this section.
(c)  The application shall be accompanied by the fee required in Section 2435.
(d)  The applicant shall satisfy the division that the diplomate certificate was procured without fraud or misrepresentation.
(e)  The applicant shall not have committed any acts or crimes constituting grounds for denial of a certificate under Section 480 or Article 12 (commencing with Section 2220).

SEC. 11.

 Section 2185 of the Business and Professions Code is amended to read:

2185.
 Notwithstanding Section 135, an applicant for examination who fails to pass any part or parts of the written examination after two attempts shall not be eligible to be reexamined in that part or parts of the written examination until the applicant presents evidence satisfactory to the division that he or she has completed additional appropriate medical instruction satisfactory to the division in a program conducted under the auspices of a medical school or an approved postgraduate training program. A failure of any part of the written examination administered in another state shall be considered a failure of that part for purposes of this section, if the division finds that the written examination administered in the other state is the same examination as that administered by the division under this chapter.

SEC. 12.

 Section 2225.5 of the Business and Professions Code is amended to read:

2225.5.
 (a)  (1)  A licensee who fails or refuses to comply with a request for the medical records of a patient, that is accompanied by that patient’s written authorization for release of records to the board, within 15 days of receiving the request and authorization, shall pay to the board a civil penalty of one thousand dollars ($1,000) per day for each day that the documents have not been produced after the 15th day, unless the licensee is unable to provide the documents within this time period for good cause.
(2)  A health care facility shall comply with a request for the medical records of a patient that is accompanied by that patient’s written authorization for release of records to the board together with a notice citing this section and describing the penalties for failure to comply with this section. Failure to provide the authorizing patient’s medical records to the board within 30 days of receiving the request, authorization, and notice shall subject the health care facility to a civil penalty, payable to the board, of up to one thousand dollars ($1,000) per day for each day that the documents have not been produced after the 30th day, up to ten thousand dollars ($10,000), unless the health care facility is unable to provide the documents within this time period for good cause. This paragraph shall not require health care facilities to assist the board in obtaining the patient’s authorization. The board shall pay the reasonable costs of copying the medical records.
(b)  (1)  A licensee who fails or refuses to comply with a court order, issued in the enforcement of a subpoena, mandating the release of records to the board shall pay to the board a civil penalty of one thousand dollars ($1,000) per day for each day that the documents have not been produced after the date by which the court order requires the documents to be produced, unless it is determined that the order is unlawful or invalid. Any statute of limitations applicable to the filing of an accusation by the board shall be tolled during the period the licensee is out of compliance with the court order and during any related appeals.
(2)  Any licensee who fails or refuses to comply with a court order, issued in the enforcement of a subpoena, mandating the release of records to the board is guilty of a misdemeanor punishable by a fine payable to the board not to exceed five thousand dollars ($5,000). The fine shall be added to the licensee’s renewal fee if it is not paid by the next succeeding renewal date. Any statute of limitations applicable to the filing of an accusation by the board shall be tolled during the period the licensee is out of compliance with the court order and during any related appeals.
(3)  A health care facility that fails or refuses to comply with a court order, issued in the enforcement of a subpoena, mandating the release of patient records to the board, that is accompanied by a notice citing this section and describing the penalties for failure to comply with this section, shall pay to the board a civil penalty of up to one thousand dollars ($1,000) per day for each day that the documents have not been produced, up to ten thousand dollars ($10,000), after the date by which the court order requires the documents to be produced, unless it is determined that the order is unlawful or invalid. Any statute of limitations applicable to the filing of an accusation by the board against a licensee shall be tolled during the period the health care facility is out of compliance with the court order and during any related appeals.
(4)  Any health care facility that fails or refuses to comply with a court order, issued in the enforcement of a subpoena, mandating the release of records to the board, is guilty of a misdemeanor punishable by a fine payable to the board not to exceed five thousand dollars ($5,000). Any statute of limitations applicable to the filing of an accusation by the board against a licensee shall be tolled during the period the health care facility is out of compliance with the court order and during any related appeals.
(c)  Multiple acts by a licensee in violation of subdivision (b) shall be punishable by a fine not to exceed five thousand dollars ($5,000), or by imprisonment in a county jail not exceeding six months, or by both that fine and imprisonment. Multiple acts by a health care facility in violation of subdivision (b) shall be punishable by a fine not to exceed five thousand dollars ($5,000) and reported to the State Department of Health Services and shall be considered as grounds for disciplinary action with respect to licensure, including suspension or revocation of the license or certificate.
(d)  A failure or refusal of a licensee to comply with a court order, issued in the enforcement of a subpoena, mandating the release of records to the board constitutes unprofessional conduct and is ground for suspension or revocation of his or her license.
(e)  Imposition of the civil penalties authorized by this section shall be in accordance with the Administrative Procedure Act (Chapter 5 (commencing with Section 11500) of Division 3 of Title 2 of the Government Code).
(f)  For purposes of this section, a “health care facility” means a clinic or health facility licensed or exempt from licensure pursuant to Division 2 (commencing with Section 1200) of the Health and Safety Code.

SEC. 14.

 Section 2428 of the Business and Professions Code is amended to read:

2428.
 (a)  A person who fails to renew his or her license within five years after its expiration may not renew it, and it may not be reissued, reinstated, or restored thereafter, but that person may apply for and obtain a new license if he or she:
(1)  Has not committed any acts or crimes constituting grounds for denial of licensure under Division 1.5 (commencing with Section 475).
(2)  Takes and passes the examination, if any, which would be required of him or her if application for licensure was being made for the first time, or otherwise establishes to the satisfaction of the licensing authority that passes on the qualifications of applicants for the license that, with due regard for the public interest, he or she is qualified to practice the profession or activity for which the applicant was originally licensed.
(3)  Pays all of the fees that would be required if application for licensure was being made for the first time.
The licensing authority may provide for the waiver or refund of all or any part of an examination fee in those cases in which a license is issued without an examination pursuant to this section.
Nothing in this section shall be construed to authorize the issuance of a license for a professional activity or system or mode of healing for which licenses are no longer required.
(b)  In addition to the requirements set forth in subdivision (a), an applicant shall establish that he or she meets one of the following requirements: (1) satisfactory completion of at least two years of approved postgraduate training; (2) certification by a specialty board approved by the American Board of Medical Specialties or approved by the Division of Licensing pursuant to subdivision (h) of Section 651; or (3) passing of the clinical competency written examination.
(c)  Subdivision (a) shall apply to persons who held licenses to practice podiatric medicine except that those persons who failed to renew their licenses within three years after its expiration may not renew it, and it may not be reissued, reinstated, or restored, except in accordance with subdivision (a).

SEC. 15.

 Section 2460 of the Business and Professions Code is amended to read:

2460.
 There is created within the jurisdiction of the Medical Board of California and its divisions the California Board of Podiatric Medicine.
This section shall become inoperative on July 1, 2003, and, as of January 1, 2004, is repealed, unless a later enacted statute, which becomes effective on or before January 1, 2004, deletes or extends the dates on which it becomes inoperative and is repealed. The repeal of this section renders the California Board of Podiatric Medicine subject to the review required by Division 1.2 (commencing with Section 473).

SEC. 16.

 Section 2462 of the Business and Professions Code is amended to read:

2462.
 The board shall consist of seven members, three of whom shall be public members. Not more than one member of the board shall be a full-time faculty member of a college or school of podiatric medicine. The Governor shall give consideration to recommendations of the board after the division has consulted with the board, except with regard to the public members.
The Governor shall appoint the four members qualified as provided in Section 2463 and one public member. The Senate Rules Committee and the Speaker of the Assembly shall each appoint a public member.

SEC. 17.

 Section 2472 of the Business and Professions Code is amended to read:

2472.
 (a)  The certificate to practice podiatric medicine authorizes the holder to practice podiatric medicine.
(b)  As used in this chapter, “podiatric medicine” means the diagnosis, medical, surgical, mechanical, manipulative, and electrical treatment of the human foot, including the ankle and tendons that insert into the foot and the nonsurgical treatment of the muscles and tendons of the leg governing the functions of the foot.
(c)  No podiatrist shall do any amputation or administer an anesthetic other than local. If an anesthetic other than local is required for any procedure, the anesthetic shall be administered by another health care practitioner licensed under this division, who is authorized to administer the required anesthetic within the scope of his or her practice.
(d)  Surgical treatment of the ankle and tendons at the level of the ankle may be performed by a doctor of podiatric medicine who was certified by the board on and after January 1, 1984.
(e)  Surgical treatment by a podiatrist of the ankle and tendons at the level of the ankle shall be performed only in the following locations:
(1)  A licensed general acute care hospital, as defined in Section 1250 of the Health and Safety Code.
(2)  A licensed surgical clinic, as defined in Section 1204 of the Health and Safety Code, if the podiatrist has surgical privileges, including the privilege to perform surgery on the ankle, in a general acute care hospital described in subparagraph (1) and meets all the protocols of the surgical clinic.
(3)  An ambulatory surgical center that is certified to participate in the Medicare program under Title XVIII (42 U.S.C. Sec. 1395 et seq.) of the federal Social Security Act, if the podiatrist has surgical privileges, including the privilege to perform surgery on the ankle, in a general acute care hospital described in subparagraph (1) and meets all the protocols of the surgical center.
(4)  A freestanding physical plant housing outpatient services of a licensed general acute care hospital, as defined in Section 1250 of the Health and Safety Code, if the podiatrist has surgical privileges, including the privilege to perform surgery on the ankle, in a general acute care hospital described in paragraph (1). For purposes of this section, a “freestanding physical plant” means any building that is not physically attached to a building where inpatient services are provided.
(f)  The amendment of this section made at the 1983–84 Regular Session of the Legislature is intended to codify existing practice.

SEC. 18.

 Section 2473 of the Business and Professions Code is repealed.

SEC. 19.

 Section 2475 of the Business and Professions Code is amended to read:

2475.
 (a)  Unless otherwise provided by law, no postgraduate trainee, intern, resident postdoctoral fellow, or instructor may engage in the practice of podiatric medicine, or receive compensation therefor, or offer to engage in the practice of podiatric medicine unless he or she holds a valid, unrevoked, and unsuspended certificate to practice podiatric medicine issued by the division. However, a graduate of an approved college or school of podiatric medicine upon whom the degree doctor of podiatric medicine, doctor of podiatry, or doctor of surgical chiropody has been conferred, who is issued a limited license, which may be renewed annually for up to four years, for this purpose by the division upon recommendation of the board, and who is enrolled in a postgraduate training program approved by the board, may engage in the practice of podiatric medicine whenever and wherever required as a part of that program under the following conditions:
(1)  A graduate with a limited license in an approved internship, residency, or fellowship program may participate in training rotations outside the scope of podiatric medicine, under the supervision of a physician and surgeon who holds a medical doctor or doctor of osteopathy degree wherever and whenever required as a part of the training program, and may receive compensation for that practice. If the graduate fails to receive a license to practice podiatric medicine under this chapter within two years from the commencement of the postgraduate training, all privileges and exemptions under this section shall automatically cease.
(2)  Podiatric hospitals functioning as a part of the teaching program of an approved college or school of podiatric medicine in this state may exchange instructors or resident or assistant resident podiatrists with another approved college or school of podiatric medicine not located in this state, or those hospitals may appoint a graduate of an approved school as such a resident for purposes of postgraduate training. Those instructors and residents may practice and be compensated as provided in paragraph (1), but that practice and compensation shall be for a period not to exceed one year.
(b)  This section shall become inoperative on July 1, 2000, and as of January 1, 2001, is repealed, unless a later enacted statute, which becomes effective on or before January 1, 2001, deletes or extends the dates on which it becomes inoperative and is repealed.

SEC. 20.

 Section 2475 is added to the Business and Professions Code, to read:

2475.
 (a)  Unless otherwise provided by law, no postgraduate trainee, intern, resident postdoctoral fellow, or instructor may engage in the practice of podiatric medicine, or receive compensation therefor, or offer to engage in the practice of podiatric medicine unless he or she holds a valid, unrevoked, and unsuspended certificate to practice podiatric medicine issued by the division. However, a graduate of an approved college or school of podiatric medicine upon whom the degree doctor of podiatric medicine, doctor of podiatry, or doctor of surgical chiropody has been conferred, who is enrolled in a postgraduate training program approved by the board, may engage in the practice of podiatric medicine whenever and wherever required as a part of that program under the following conditions:
(1)  A graduate in an approved internship, residency, or fellowship program may participate in training rotations outside the scope of podiatric medicine, under the supervision of a physician and surgeon who holds a medical doctor or doctor of osteopathy degree wherever and whenever required as a part of the training program, and may receive compensation for that practice. If the graduate fails to receive a license to practice podiatric medicine under this chapter within two years from the commencement of the postgraduate training, all privileges and exemptions under this section shall automatically cease.
(2)  Podiatric hospitals functioning as a part of the teaching program of an approved college or school of podiatric medicine in this state may exchange instructors or resident or assistant resident podiatrists with another approved college or school of podiatric medicine not located in this state, or those hospitals may appoint a graduate of an approved school as such a resident for purposes of postgraduate training. Those instructors and residents may practice and be compensated as provided in paragraph (1), but that practice and compensation shall be for a period not to exceed one year.
(b)  This section shall become operative on July 1, 2000.

SEC. 21.

 Section 2496 of the Business and Professions Code is amended to read:

2496.
 In order to insure the continuing competence of persons licensed to practice podiatric medicine, the board shall adopt and administer regulations in accordance with the Administrative Procedure Act (Chapter 3.5 (commencing with Section 11340) of Part 1 of Division 3 of Title 2 of the Government Code) requiring continuing education of those licensees. The board shall require those licensees to demonstrate satisfaction of the continuing education requirements and one of the following requirements at each license renewal:
(a)  Passage of an examination administered by the board within the past 10 years.
(b)  Passage of an examination administered by an approved specialty certifying board within the past 10 years.
(c)  Current diplomate, board-eligible, or board-qualified status granted by an approved specialty certifying board within the past 10 years.
(d)  Recertification of current status by an approved specialty certifying board within the past 10 years.
(e)  Successful completion of an approved residency or fellowship program within the past 10 years.
(f)  Granting or renewal of current staff privileges within the past five years by a health care facility that is licensed, certified, accredited, conducted, maintained, operated, or otherwise approved by an agency of the federal or state government or an organization approved by the Medical Board of California.
(g)  Successful completion of an approved course of study of at least four weeks’ duration at an approved school within the past five years.

SEC. 22.

 Section 2497.1 of the Business and Professions Code is repealed.

SEC. 23.

 Article 23 (commencing with Section 2500) of Chapter 5 of Division 2 of the Business and Professions Code is repealed.

SEC. 24.

 Section 2569 of the Business and Professions Code is amended to read:

2569.
 The powers and duties of the board, as set forth in this chapter, shall be subject to the review required by Division 1.2 (commencing with Section 473). The review shall be performed as if this chapter were scheduled to become inoperative on July 1, 2003, and would be repealed as of January 1, 2004, as described in Section 473.1.

SEC. 25.

 Section 3501 of the Business and Professions Code is amended to read:

3501.
 As used in this chapter:
(a)  “Board” means the Division of Licensing of the Medical Board of California.
(b)  “Approved program” means a program for the education of physician assistants which has been formally approved by the committee.
(c)  “Trainee” means a person who is currently enrolled in an approved program.
(d)  “Physician assistant” means a person who meets the requirements of this chapter and is licensed by the committee.
(e)  “Supervising physician” means a physician and surgeon licensed by the board or by the Osteopathic Medical Board of California who supervises one or more physician assistants, who possesses a current valid license to practice medicine, and who is not currently on disciplinary probation for improper use of a physician assistant.
(f)  “Supervision” means that a licensed physician and surgeon oversees the activities of, and accepts responsibility for, the medical services rendered by a physician assistant.
(g)  “Committee” or “examining committee” means the Physician Assistant Committee.
(h)  “Regulations” means the rules and regulations as contained in Chapter 13.8 (commencing with Section 1399.500) of Title 16 of the California Code of Regulations.
(i)  “Routine visual screening” means uninvasive nonpharmacological simple testing for visual acuity, visual field defects, color blindness, and depth perception.

SEC. 26.

 Section 3503.5 is added to the Business and Professions Code, to read:

3503.5.
 (a)  A person licensed under this chapter who in good faith renders emergency care at the scene of an emergency that occurs outside both the place and course of that person’s employment shall not be liable for any civil damage as a result of any acts or omissions by that person in rendering the emergency care.
(b)  This section shall not be construed to grant immunity from civil damages to any person whose conduct in rendering emergency care is grossly negligent.
(c)  In addition to the immunity specified in subdivision (a), the provisions of Article 17 (commencing with Section 2395) of Chapter 5 shall apply to a person licensed under this chapter when acting pursuant to delegated authority from an approved supervising physician.

SEC. 27.

 Section 3504 of the Business and Professions Code is amended to read:

3504.
 There is established a Physician Assistant Committee of the Medical Board of California. The committee consists of nine members.
This section shall become inoperative on July 1, 2003, and, as of January 1, 2004, is repealed, unless a later enacted statute, which becomes effective on or before January 1, 2004, deletes or extends the dates on which it becomes inoperative and is repealed. The repeal of this section renders the committee subject to the review required by Division 1.2 (commencing with Section 473).

SEC. 28.

 Section 3505 of the Business and Professions Code is amended to read:

3505.
 The members of the committee shall include one member of the Medical Board of California, a physician representative of a California medical school, an educator participating in an approved program for the training of physician assistants, a physician who is an approved supervising physician of a physician assistant and who is not a member of any division of the Medical Board of California, three physician assistants, and two public members. Upon the first expiration of the term of the member who is a member of the Medical Board of California, that position shall be filled by a member of the Medical Board of California who is a physician member. Upon the first expiration of the term of the member who is a physician representative of a California medical school, that position shall be filled by a public member. Upon the first expiration of the term of the member who is an educator participating in an approved program for the training of physician assistants, that position shall be filled by a physician assistant. Upon the first expiration of the term of the member who is an approved supervising physician of a physician assistant and not a member of any division of the Medical Board of California, that position shall be filled by a public member. Following the expiration of the terms of the members described above, the committee shall include four physician assistants, one physician who is also a member of the Medical Board of California, and four public members.
Each member of the committee shall hold office for a term of four years expiring on January 1st, and shall serve until the appointment and qualification of a successor or until one year shall have elapsed since the expiration of the term for which the member was appointed, whichever first occurs. No member shall serve for more than two consecutive terms. Vacancies shall be filled by appointment for the unexpired terms.
The Governor shall appoint the licensed members qualified as provided in this section and two public members. The Senate Rules Committee and the Speaker of the Assembly shall each appoint a public member.

SEC. 29.

 Section 3513 of the Business and Professions Code is repealed.

SEC. 30.

 Section 3513 is added to the Business and Professions Code, to read:

3513.
 The committee shall recognize the approval of training programs for physician assistants approved by a national accrediting organization. Physician assistant training programs accredited by a national accrediting agency approved by the committee shall be deemed approved by the committee under this section. If no national accrediting organization is approved by the committee, the committee may examine and pass upon the qualification of, and may issue certificates of approval for, programs for the education and training of physician assistants that meet committee standards.

SEC. 31.

 Section 3514 of the Business and Professions Code is amended to read:

3514.
 (a)  The board shall formulate by regulation guidelines for the approval of licensed physicians to supervise a physician’s assistant. Each physician desiring to supervise a physician’s assistant shall file a separate application, except as provided in Section 3516.5.
(b)  The committee shall formulate by regulation guidelines for the consideration of applications for licensure as a physician’s assistant.
(c)  The committee shall formulate by regulation guidelines for the approval of physician’s assistant training programs.
(d)  This section shall become inoperative on July 1, 2001, and, as of January 1, 2002, is repealed, unless a later enacted statute, which becomes effective on or before January 1, 2002, deletes or extends the dates on which it becomes inoperative and is repealed.

SEC. 32.

 Section 3514.1 is added to the Business and Professions Code, to read:

3514.1.
 (a)  The committee shall formulate by regulation guidelines for the consideration of applications for licensure as a physician’s assistant.
(b)  The committee shall formulate by regulation guidelines for the approval of physician’s assistant training programs.
(c)  This section shall become operative on July 1, 2001.

SEC. 33.

 Section 3515 of the Business and Professions Code is amended to read:

3515.
 (a)  The board shall approve an application by a licensed physician to supervise a physician’s assistant, where the applicant has met all of the requirements of this chapter and the board’s regulations.
(b)  This section shall become inoperative on July 1, 2001, and, as of January 1, 2002, is repealed, unless a later enacted statute, which becomes effective on or before January 1, 2002, deletes or extends the dates on which it becomes inoperative and is repealed.

SEC. 34.

 Section 3535 of the Business and Professions Code is amended to read:

3535.
 Notwithstanding any other provision of law, physicians and surgeons licensed by the Osteopathic Medical Board of California may employ physician’s assistants provided:
(a)  Each physician’s assistant so employed is a graduate of an approved program and is licensed by the committee.
(b)  The scope of practice of the physician’s assistant shall be the same as that which is approved by the Division of Licensing of the Medical Board of California for physicians and surgeons supervising physician’s assistants in the same or a similar specialty.
(c)  The supervising physician and surgeon is approved by the Osteopathic Medical Board of California. The Osteopathic Medical Board of California may deny an application, or suspend or revoke or impose probationary conditions upon any osteopathic physician and surgeon approved to supervise any physician’s assistant in any decision made after a hearing as provided in Section 3528.
(d)  Any physician’s assistant licensed by the committee shall be eligible for employment by any physician and surgeon approved by the Osteopathic Medical Board of California; except that no physician and surgeon shall supervise more than two physician’s assistants. The Osteopathic Medical Board of California may restrict physicians and surgeons to supervising specific types of physician’s assistants including, but not limited to, restricting physicians and surgeons from supervising physician’s assistants outside of the physician’s and surgeon’s field of specialty.
(e)  Each physician and surgeon desiring to supervise a physician’s assistant under this section shall file a separate application. The fees to be paid to the Osteopathic Medical Board of California for approval to supervise a physician’s assistant are to be set as follows: An application fee not to exceed fifty dollars ($50) shall be charged to each physician and surgeon applicant. An approval fee not to exceed one hundred dollars ($100) shall be charged to each physician and surgeon upon approval of an application to supervise a physician’s assistant. If the approval will expire less than one year after its issuance, the fee shall be 50 percent of the initial approval fee currently in effect. The Osteopathic Medical Board of California shall renew approval to supervise physician’s assistants upon application for that renewal. A biennial renewal fee not to exceed one hundred fifty dollars ($150) shall be paid for the renewal of that approval. The delinquency fee is twenty-five dollars ($25). The duplicate license fee is ten dollars ($10). The fees collected by the Osteopathic Medical Board of California pursuant to this subdivision shall be deposited in the Osteopathic Medical Board of California Contingent Fund.
(f)  Any person who violates subdivision (a), (b), (c), or (d) of this section shall be guilty of a misdemeanor punishable by imprisonment in the county jail not exceeding six months, or by a fine not exceeding one thousand dollars ($1,000) or by both that imprisonment and fine.
(g)  This section shall become inoperative on July 1, 2001, and, as of January 1, 2002, is repealed, unless a later enacted statute, which becomes effective on or before January 1, 2002, deletes or extends the dates on which it becomes inoperative and is repealed.

SEC. 35.

 Section 3535 is added to the Business and Professions Code, to read:

3535.
 (a)  Notwithstanding any other provision of law, physicians and surgeons licensed by the Osteopathic Medical Board of California may use or employ physician assistants provided (1) each physician assistant so used or employed is a graduate of an approved program and is licensed by the committee, and (2) the scope of practice of the physician assistant is the same as that which is approved by the Division of Licensing of the Medical Board of California for physicians and surgeons supervising physician assistants in the same or similar specialty.
(b)  Any person who violates subdivision (a) shall be guilty of a misdemeanor punishable by imprisonment in a county jail not exceeding six months, or by a fine not exceeding one thousand dollars ($1,000), or by both that imprisonment and fine.
(c)  This section shall become operative on July 1, 2001.

SEC. 36.

 Section 3540 of the Business and Professions Code is amended to read:

3540.
 A physician assistants corporation is a corporation which is authorized to render professional services, as defined in Section 13401 of the Corporations Code, so long as that corporation and its shareholders, officers, directors, and employees rendering professional services who are certified physician assistants are in compliance with the Moscone-Knox Professional Corporation Act, the provisions of this article, and all other statutes and regulations now or hereafter enacted or adopted pertaining to the corporation and the conduct of its affairs.
With respect to a physician assistants corporation, the governmental agency referred to in the Moscone-Knox Professional Corporation Act (commencing with Section 13400) of Division 3 of Title 1 of the Corporations Code) is the committee.

SEC. 37.

 No reimbursement is required by this act pursuant to Section 6 of Article XIII  B of the California Constitution because the only costs that may be incurred by a local agency or school district will be incurred because this act creates a new crime or infraction, eliminates a crime or infraction, or changes the penalty for a crime or infraction, within the meaning of Section 17556 of the Government Code, or changes the definition of a crime within the meaning of Section 6 of Article XIII  B of the California Constitution.
Notwithstanding Section 17580 of the Government Code, unless otherwise specified, the provisions of this act shall become operative on the same date that the act takes effect pursuant to the California Constitution.