By Emily Powers

On April 26, 2023, the Medical Board of California (MBC) published a response to legislative concerns from the Senate Committee on Business, Professions and Economic Development and the Assembly Committee of Business and Profession regarding its 2022 Sunset.  The Joint Committee brought up a total of 18 concerns, which the Board responded to individually in its response letter.

The first issue lawmakers posed to the Board was the benefit of including additional members of the public in the composition of the Board. The Board stated it “recognizes that some members of the public have a perception that a physician-majority Board favors licensees in Board policies and disciplinary decisions” (p. 2). MBC stated that creating a public member majority is intended to restore public trust and confidence in the Board’s operations.

Another notable issue posed by the legislature was a recommendation to establish a formal liaison or unit to assist patients and increase the efficacy of the complaint process. MBC responded that a new Complainant Liaison Unit is estimated to cost approximately $450,000, adding that unless the Board’s financial position improves, it would be impractical to add this new unit (p. 4). MBC requested that the legislature approve a substantial fee increase to improve the Board’s overall financial situation. MBC also asked lawmakers to add language to the Medical Practice Act if it wants this unit to be established within a certain timeframe.

In the response above, the Board cites financial struggles, which are a theme of this Sunset Review process for the MBC. Lawmakers asked the Board about increasing revenues and its continued financial insolvency and reliance on loans. MBC responded with agreement that this is a priority and that the Board will continue to seek viable solutions.

Lawmakers also addressed the burden of proof standard for MBC, which is “clear and convincing” instead of “preponderance of the evidence” (the standard in most states and jurisdictions). MBC responded, “It is not clear to the Board how to apply a variable standard of proof that depends on the severity of discipline to be imposed” (p. 9). MBC also stated that changing the standard of proof would not change its typical investigative and prosecutorial practices; however, it may be expected to act on cases with slightly less proof.

Other issues discussed include the implementation of the Mexico Pilot Program, postgraduate licensing, probation modifications, and mental health inquiries on licensing applications. All 18 issues can be read in the response letter here.

Governor Newsom signed SB 815 on September 20, 2023 (Chapter 294, Statutes of 2023). The bill renews the existence of MBC until January 1, 2028. In its final form, the bill established a Complainant Liaison Unit (pending funding through the Budget Act) and increased initial and renewal licensing fees. SB 815 did not create a public-membership majority or amend the “clear and convincing” burden of proof for disciplinary proceedings.