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NEWSLETTER 

Volume 1, Issue 29 - July 16, 2021


Politics
Governor Newsom Won't Have "Democrat" Next to His Name on Ballot

As reported by the Sacramento Bee, Governor Newsom won't have his party affiliation next to his name when voters receive their recall ballots in a few weeks, a Sacramento Superior Court judge has ruled. 

Superior Court Judge James P. Arguelles said in his ruling that the secretary of state’s office does not have a responsibility to repair a mistake made by Newsom’s attorneys. Arguelles further wrote that a 2019 state law regarding elections does not compel candidates to identify party affiliation....

The conflict stems from an error made in February 2020 by Newsom’s attorneys, who say they failed to mark the governor’s party affiliation in their response to the recall petition.

When Newsom approached Secretary of State Shirley N. Weber to correct the error last month, Weber’s office said the deadline had passed, and a change would require a court decision. In response, Newsom’s attorneys sued Weber, the Democrat whom the governor appointed to the position last year.

Arguelles heard arguments from the parties on Friday, which included attorneys for recall candidate Caitlyn Jenner and lead recall proponents Orrin Heatlie and Mike Netter, who filed to intervene in the case out of concern that Weber would not mount a “robust” defense against Newsom.

Weber, in court filings, said the omission of Newsom’s party affiliation was an “unfortunate” mistake that could deprive voters of information they need. The election will be held Sept. 14, but all registered voters will begin receiving ballots by mail in mid-August.

“The secretary of state agrees that it would be unfortunate if an error by the governor’s attorney had the effect of depriving voters of accurate information on the ballot regarding Gov. Newsom’s party preference,” Weber said in court documents. “If the governor’s choice had been submitted by the statutory deadline, the secretary of state would have had a ministerial duty to accept it, and the statute would require that his party preference appear on the ballot.”

Will it matter on September 14 when voters finally get to weigh in on the recall? Maybe not, but it certainly doesn't help.


State Budget and Trailer Bills to the Governor
State budgeting is finally over, at least for now. The mental health-related items that we've reported on over the past several weeks are all part of the package now in front of Governor Newsom. We expect the Governor to sign the dozen plus bills with no controversy but most likely some fanfare and a victory lap or two. For a full summary of the budget to date, see here.

Legislature on Summer Recess
As of today, the legislature is in recess for a full month, returning Monday, August 16. Wondering what will happen when they return? For starters, there will only be policy committee hearings in extraordinary situations. By and large, the policy committee process has concluded for 2021. August 27 is the last day for fiscal committees to meet and report bills; this will then conclude the fiscal committee process for 2021. From August 30 - September 10, there will only be floor sessions in both houses. Barring unforeseen circumstances, the legislative year will end on September 10. Then, the Governor will have several weeks to act on bills sent to him at the end of the legislative year.

GA Committee Meeting Rescheduled to July 22
The GA Committee still plans to review the following three bills. Please note the update on the first one. 


AB 1156 (Dr. Akilah Weber) - Would reduce the required months of board-approved postgraduate training required to be issued a physician’s and surgeon’s license to 12 months for graduates of medical schools in the United States and Canada or 24 months for graduates of foreign medical schools other than Canadian medical schools, and make conforming changes. Author's background sheet here. It is now unclear if this bill will move forward in 2021; however, in conversations with the California Medical Association we have learned that portions of it may appear in SB 806 (Roth). There are other, broader "contextual" developments to be aware of more generally, which we report on below.

SB 48 (Limon) - Would, subject to an appropriation by the Legislature for this purpose, expand the schedule of benefits to include an annual cognitive health assessment for Medi-Cal beneficiaries who are 65 years of age or older if they are otherwise ineligible for a similar assessment as part of an annual wellness visit under the Medicare Program. The bill would make a Medi-Cal provider eligible to receive the payment for this benefit only if they comply with certain requirements, including completing cognitive health assessment training. By January 1, 2024, and every 2 years thereafter, the bill would require the department to consolidate and analyze data related to the benefit, and to post information on the utilization and payment of the benefit on its internet website. The bill would authorize the department to implement these provisions by various means, including all-plan letters, without taking regulatory action, and would condition the implementation of these provisions to the extent federal approvals are obtained and federal financial participation is available. Author's background sheet here.


SB 682 (Rubio) - Would establish the End Racial Inequities in Children’s Health in California Initiative (EnRICH CA Initiative). The bill would require the California Health and Human Services Agency, in collaboration with other specified groups and entities, to convene an advisory workgroup, as specified, to develop and implement a plan, as specified, that establishes targets to reduce racial disparities in health outcomes by at least 50% by December 31, 2030, in chronic conditions affecting children, including, but not limited to, asthma, diabetes, dental caries, depression, and vaping-related diseases. The bill would require the agency to convene the advisory workgroup as soon as January 31, 2022, and would allow the workgroup to disband after the implementation of the plan. The bill would require the agency to submit the plan to the Legislature and post the plan on its internet website on or before January 1, 2023, and to commence implementation of the plan no later than June 30, 2023. The bill would make implementation of its provisions subject to an appropriation by the Legislature. Author's background sheet here.

Other Bills -
AB 852 (Wood) - This is the NPs follow up bill to their AB 890 (Wood) from last year. We reported last week that it is now a two-year bill and promised more intel. Here it is; the NPs are saying that, "...the author decided to make AB 852 a two-year bill to provide additional time for discussions around 890 implementation specifically discussions regarding AB 890 implementation occurring as part of the Joint Legislative Sunset Review of the Bureau of Registered Nursing, as well as at the BRN's Nurse Practitioner Advisory Committee. But wait, there's more. The CMA has removed its opposition to AB 852. SYASL has discussed with CMA their reasons for doing so and will be discussing same with the GA Committee on July 22.


SB 516 (Eggman) - Unfortunately, SB 516 is now a two-year bill. As a reminder, the bill would permit evidence considered in a certification review hearing under the Lanterman-Petris-Short Act to include information regarding a person’s medical condition, as defined, and how that condition bears on certifying the person as a danger to self or others, or as gravely disabled. Senator Eggman is committed to getting this bill to the Governor next year. CSAP advocates at SYASL met with the Senator's staff this week and pledged to help on this bill in any way possible to keep it moving this two-year legislative session. 
 


LA Times Takes on the State Medical Board
On July 6, the Times published an editorial, Put non-physicians in charge of the state medical board. We are including it here in its entirety. You will note the mention of SB 806.
 
"It’s become a common scene at the quarterly meetings of the California Medical Board, the 15-member state panel that oversees physicians and other healthcare professionals: Witnesses tell heartrending stories about loved ones maimed or killed by a routine medical procedure, then blast the board for imposing little or no penalty on the doctor responsible. Even the board admits that the public has lost a lot of faith in its ability to protect consumers from bad doctors.

That’s why the board has joined a number of experts and advocates in urging the state Legislature to adopt several meaningful reforms, including one that’s rich in symbolism: Giving control of the board to people who aren’t doctors. Meanwhile, the board has burned through its budget and is in serious need of a cash infusion to keep investigating complaints and licensing doctors. As it happens, the board’s statutory authority is up for its periodic renewal this year. So you might think that lawmakers would use the opportunity to make some badly needed changes in the board and try to restore the public’s confidence in its work.

But instead of taking a big swing at the problems, the state Senate bunted in late May, proposing no change in the board’s makeup, suggesting a small increase in funding and offering little in the way of concrete action to improve enforcement efforts. A Senate committee had proposed to go further, only to run into a buzzsaw of opposition from one of the state’s most influential lobbying forces, the California Medical Assn. Specifically, the committee’s version of the bill (Senate Bill 806) endorsed the idea of adding two members from the general public to the board, giving non-physicians a slim majority of 9 to 8, and raising the biennial license renewal fee to $1,150 — a 46% hike. But before the Senate voted, the bill’s author, Sen. Richard Roth (D-Riverside), dropped the proposed change in the board’s makeup and cut the fee to $863 — a 9% bump.

Granted, changing the board’s balance of power and boosting its budget won’t necessarily lead to more effective enforcement and fewer instances of bad doctors continuing to practice. They’re just two parts of a larger package of needed changes, many of which the board itself has identified and more of which need to be embraced by the Legislature. But they’re necessary parts. One benefit of having a majority of non-physicians on the board is that it could give the public more confidence that the board is focused on protecting healthcare consumers, not healthcare providers. That’s what the law requires, but the public has to take it on faith that the board is complying because it does so much of its enforcement work in secret. Complaints about doctors are confidential, and unless some formal disciplinary action is taken — which happens in only about 3% of the cases — there is no disclosure to the public. And even when doctors are put on probation, reprimanded or hit with some other sanction, they don’t have to reveal much to the people they treat; they only have to disclose to new patients if they are currently on probation, and only if that penalty was imposed after January 2019. Otherwise, it’s up to patients to check the state’s database or ask the board for information about a doctor’s record.

No matter who holds a majority on the board, it will still rely on medical experts to investigate complaints and on the state Attorney General’s Office to provide the legal guidance and muscle needed to impose sanctions. But it’s up to the board members to decide whether to accept the recommendations from their investigators and the AG. Astoundingly, the board doesn’t regularly track how often it accepts, modifies or rejects those recommendations, or how often the settlements reached with physicians adhere to its own guidelines. It did gather those data for fiscal year 2019-20, though, and found that the board approved 99% of the proposed settlements without changes, even though less than half of those settlements comported with all elements of the board’s guidelines.
The numbers buttress the argument by patient advocates that the board and its experts are too lenient on doctors who give substandard care. Public board member 
Eserick “T.J.” Watkins, a life and fitness coach and former member of the state’s Physical Therapy Board, told a Senate committee that by his own estimation, the board deviated from its guidelines 90% of the time. According to Watkins, the board goes out of its way to protect physicians, not the public.

Bridget Fogarty Gramme, director of the Center for Public Interest Law at the University of San Diego School of Law, offered another compelling reason to give public members a majority on the board: to avoid the risk of antitrust lawsuits. The Supreme Court held six years ago that licensing boards run by people who work in the industry they regulate can be sued for antitrust violations if they’re not subject to “active supervision” by state officials. That’s arguably the case here, where the doctors on the medical board decide who can and cannot practice in California.

The center also has called for the state to appoint a temporary enforcement monitor to audit the board’s enforcement process, as the state did almost two decades ago. SB 806 declares the Legislature’s intent to appoint a temporary monitor, but it wouldn’t actually make it happen, and that’s a problem. A monitor could explore whether too many complaints are being dismissed without investigation (as more than 80% have been in recent years), why so many settlements aren’t hewing to the board’s guidelines, how the process could be made more transparent, and whether the board was gathering and analyzing data effectively. One clear limit on the board’s ability to investigate complaints quickly and thoroughly is its shortage of funds. The board’s budget comes from licensing fees paid by doctors, which haven’t increased in 15 years; meanwhile, its costs have grown faster than its revenues, putting it on the path to insolvency. That’s why it sought a significant fee hike. The medical association argued against the increase, contending that the board’s financial problems were caused by its own methods and inefficiencies. A 2020 consultants report to the board found, however, that most of those costs are outside the board’s control and that a fee increase of almost 50% was needed to get the board back to the level of funding and reserves required by law.

It’s easy to understand why the association would resist the higher fees, given the many costs their members have to bear. But they have a vested interest in a medical board that weeds out bad practices and bad doctors who damage their profession’s reputation. Consumers, too, need to tell legislators that they want a medical board they can trust. The current version of SB 806 falls short of that goal."


Then, today, the Times published a follow up article that you can review hereCSAP is watching this situation very closely and will continue to provide you reports as events warrant.
 

Worth a Look

 

CSAP is a cooperative effort between the Northern California Psychiatric Society, the Orange County Psychiatric Society, and the San Diego Psychiatric Society, and is open to all American Psychiatric Association District Branches in California. If your District Branch is not participating, reach out to your leadership and encourage them to join!

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