Senate Business, Professions and Economic Development Committee
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Senate Business, Professions and Economic Development Committee California State Senate
Follow its sittingsSpeaker 3
Okay, thank you. So hello everybody. I was wheeled into the Operating Room for thyroid surgery that was scheduled to take three hours. Nine and a half hours later, I was wheeled out to discover that my life would be forever changed. I was diagnosed with a rare and aggressive type of thyroid cancer known as anaplastic.
The typical survival time for this cancer is four to six months, and my daughter was expecting our first grandchild. I underwent seven weeks of simultaneous radiation and chemotherapy at Cedars Sinai in Los Angeles. When the cancer returned, my physicians supported my decision to seek care at MD Anderson Cancer Center in Houston. I received a newly discovered targeted therapy that has been successful for me. It's uncommon for a bill to undergo a test run-in public before enactment, but this is true for s b one zero zero two.
The pandemic led to federal and state executive orders allowing telehealth visits, which enabled doctors and patients to communicate about health issues across state lines. These executive orders have expired, leaving patients like me without lifesaving expertise from specialists practicing outside of California. There are times when I have been too ill or weak to travel, and because I'm immunosuppressed, I was at risk of exposure to other illnesses, and telehealth visits are truly a lifeline. Patients in my anaplastic thyroid cancer support groups are desperate to receive care from from specialists beyond California when needed. Some of us are in remission or with no evidence of disease.
This does not mean we are cured. We are still in jeopardy of recurrence and require careful continuity of care monitoring by our out of state specialist. I have survived over three years and now not only have a grandson, but have a granddaughter. So please allow Californians struggling with cancer and other life threatening diseases to receive the care that they need. Thank you.
Speaker 2
And Robin, if you would identify yourself? You didn't at the beginning, you didn't say who you were.
Speaker 4
You, Madam Chairman. Aaron Bone with the Medical Board of California. The Board has an opposed position on SB 1,002, as the Board believes that licensure is a vital form of consumer protection, and helps ensure that physicians practicing here have met the requirements relevant to treat patients in this state. Without a license, the board would be unable to discipline a physician who fails to treat California residents according to the standard of care. In addition, as the analysis points out, current law allows an out of state physician to consult on the diagnosis and treatment alongside a California licensed physician.
We do, however, recognize the concerns of the author and the sponsors, and we desire to collaborate with them to see if we can identify potential law changes that will support access to care while still preserving appropriate consumer protections. In the meantime, however, the Board is opposed to this version of SB ten oh two. Thank you.
Speaker 5
Good morning, Chair and members. George Sorries of the California Medical Association. We respectfully oppose unless amended to SB ten oh two by Senator Nilo. We understand this legislation is well intended, but it would dangerously expand existing law, which is intended for people with life threatening diseases who have not been accepted into a clinical trial in California. In general, granting licensure exemption risks, introducing physicians who may not be familiar with California laws, regulations, or standards of care, including critical mandates around informed consent, privacy, telehealth, and prescribing practices.
It would also make enforcement actions and disciplinary oversight much more difficult, removing the medical board's ability to protect patients from substandard care or misconduct. As noted, out of state physicians who seek to provide care to California residents can apply for temporary licensure with the medical board. This bill creates unnecessary loophole to that process. We understand the desire for some patients in remission to continue dialogue with their out of state physician. We believe that our proposed amendment would allow patients to consult with out of state physicians regarding medical opinions, such as receiving a second opinion, while protecting patients from a physician who would otherwise be eligible to practice under the California law.
We appreciate the author and the dialogue we've had with him so far. However, with this bill in its current form, we would respectfully ask that you vote no. Thank you, and I'm happy to answer questions.
Speaker 1
Thank you. If we can have Me Toos present themselves. Again, state your name, your organization, whether you support or oppose.
Speaker 6
Thank you, chair and members. Ryan Perini, on behalf of ATAction, the advocacy arm of the American Telemedicine Association, in proud support. Thank you.
Speaker 4
Bree Sempi with Pacific Legal Foundation, and we are in proud support of SB 1,002 as well. Thank you.
Speaker 1
Thank you. Seeing nobody else, any members on the committee would like to comment? Senator Caballero?
Speaker 7
Thank you very much, Madam Chair. I appreciate you bringing this forward. This is, in my mind, a really narrowly crafted bill, and I'm gonna be supporting your bill today. We've just I I respect the medical association's position in regards to licensing, but there's a point at which it's it's it's form over access. And in particular for rural communities, they're they're it's just getting a physician to physician appointment, an appointment with a physician is impossible.
So we're gonna have to figure out ways to be able to get access where that is equal or at least as close as we can get. And and I I think we really need to rethink our medical system. When I have a hard time accessing medical care and I don't have medical issues, I just wanna get in and get the yearly check up done, it's very simple, then there's no access. How you've defined life threatening disease and acts and care is is is pretty limited. And I think we can we can start expanding some of this.
At some point, it becomes protecting somebody protecting licensees in California as opposed to protecting patients and patient access to what can be very complicated medical procedures where there's not the expertise in the region. So I'm going to support your bill today.
Speaker 2
Senator Caballero made some very good points relative to my close. But I'd just point out a couple things with regard to the opposition. First of all, generally and overall, we've already passed the threshold of the concerns that they have with the Bauer Cahan bill, AB thirteen sixty nine, setting up this capability in the first place. And any qualified medical professional has to be an eligible out of state physician or surgeon in good standing with no history of prior discipline. So there are significant requirements for that as there is for the existing law.
And the medical association respect their concerns, but I challenge their use of the word dangerous with regard to this. If this is dangerous, then the a b the David Hall Act is dangerous, and we've already passed it. I happen to disagree that it's certainly not dangerous. It's prudent. And this legislature is in record with the same opinion.
And to have a patient that receives this care and advice while they are terminally ill to go into remission and say, You don't have that available to you anymore, that physician with whom you became comfortable, you can only get an opinion as opposed to the type of care that you received when, you were terminally ill. And as, my witness stated, just because you're in remission does not mean you're out of the woods. It's a common sense bill, and, I appreciate an aye vote.
Speaker 1
Thank you. Because we do not have quorum, we're still in a subcommittee mode. I will highlight that we will take motions at the appropriate time. I'm gonna move on to file item number four, SB thirteen eleven. Myself, I will be presenting this followed by s b fourteen sixteen, again, presented by myself.
If we can have the senate sergeants request that all members of this committee show up. Thank you.
Speaker 2
So the chair has put me in charge. You're all in trouble. First, we've got SB thirteen eleven. Madam Chair, you may proceed when ready.
Speaker 1
Thank you. SB thirteen eleven makes various statutory updates to the Dental Practice Act in order to ensure that unlicensed dental assistants are able to complete important infection control courses. I'd like to accept the amendments outlined in the analysis. The Dental Board of California does not license these individuals, so they are not subject to the same education and training requirements as registered dental assistants. Unlicensed dental assistants are also supervised by their dentist employer.
SB thirteen eleven allows an unlicensed dental assistant to either complete the dental assisting National Board's infection control examination or complete a course offered by various entities to be in compliance with the law. This bill is supported by the California Dental Association and California Association of Orthodontists. I understand that some dentists reached out late last week concerned about the fact that these individuals substitute coursework for passing a national exam. The Dental Assisting National Board's Infection Control Exam tests, whether a person knows how to prevent infections and how to make decisions. The exam covers hand hygiene techniques and protocols, how to select and use personal protective equipment, including the sequence for putting this on and taking this off, as well as cleaning and disinfecting treatment areas and OSHA and CDC requirements.
A course teaches and exam verifies. This standardized national exam serves as an important public protection tool for unlicensed people and allows them to get to work more quickly. My first witness, lead witness, is Lawrence Gayden with the California Dental Association, here to testify in support.
Speaker 8
Good morning. Lawrence Gayden here on behalf of the California Dental Association, representing over 27,000 dental professionals in the state, urging support for s b thirteen eleven, which would ensure unlicensed dental assistants can receive timely infection control course training via approved online courses. Just wanna take some time to thank the chair and staff on their commitment to this ongoing issue for our industry. Dental assistants really play a crucial role in the dental team and really strengthening this dental workforce will go a long way in improving patient care and patient access. We are really thankful for this commitment to this issue, as I mentioned, and we urge your eye vote.
Thank you.
Speaker 2
Do you have another primary No. Witness? So the opposition, I presume? No. Okay.
Support. You're in support. Okay. Well, let's hear at this point for anybody else in the room who is in support. One person can take up to two minutes.
The primary witness took up the first two minutes. And anybody else would just state your name and that you support.
Speaker 9
So I have two minutes? Yes. Hi, I'm Doctor. Guy Acheson. I'm representing the California Academy of General Dentistry.
We represent all the general dentists in the state of California. First, I want to say that I really appreciate how open you were to our position being support, if amended. And the analysis of the bill seems to be, and your speech indicated that you're accepting our slight change in wording to make it a more comprehensive definition of what infection control includes. We do have a new concern. We assume that an exam that has the title of the dental assistant's national board exam would have the same requirements for taking that exam as our national boards for dentistry or medicine, where we've completed a certain amount of coursework.
And for this dental assistants national board exam, there is no requirement for any coursework at all to qualify to take this exam. So there's no hands on training on how to do things like take gloves on and off properly, how to wear a mask, how to treat a respirator, how to clean a room. The hands on component is very important and it's missing with this exam. So that's my, that's our main concern. So we think that qualification as an alternative to a hands on course is not acceptable.
So our position will still be support if our amendment is accepted. Thank you.
Speaker 2
That being the case, I will label your testimony as primary opposition testimony, though qualified for an amendment. And I'll leave it to further discussion with the author on that. Do we have any other primary witness in favor of the bill? Do we have another primary witness in opposition to the bill? And so now go on to what we call me too testimony.
Anybody else in support of the bill, state your name and who you represent.
Speaker 10
Good morning. Michelle Rivas on behalf of the California Association of Oral and Maxillofacial Surgeons, in support.
Speaker 7
Morning. Jasmine Asher, representing the California Association of Orthodontists, in support.
Speaker 2
And are there any is there anybody in the room who is opposed to the bill that would state your name, organization, and position? Seeing none come forward, bring it back to the committee. Any questions or comments? Senator Caballero.
Speaker 7
Senator, could you address the issue that was raised? I'm confused as to exactly what's being asked and what you're taking. Yeah. I think this is a good bill. I was prepared to support it in its current form and do do with it what you will.
No.
Speaker 1
I appreciate that. Just to be clear, he was not a witness in lead support, and I want to be clear about that. The amendments that we are taking, the proposed amendments, make various technical changes to reflect updates from the recent sunset review bills for the Veterinary Medical Board and the Bureau of Security and Investigative Services. They also extend the time frame for applicants to the medical board's licensed physicians from Mexico program to apply. One of the things I do want to explain is that this national exam is very, very targeted and geared towards a specific infectious control.
And, you know, this is something that's already taught. The exam certifies that they understand this. And to our last bill that we also discussed is that we do need to understand that courses, education has changed. A lot of it is online. And this is one of them that falls under that.
And those are the proposed amendments that we are accepting.
Speaker 2
Are there other questions or comments? And just to support one thing that you said, senator Wahhab, the second primary witness was not in support. Yes. That was my error, but his testimony clearly illustrated he is opposed unless amended. We'll leave that to further discussions.
You may close.
Speaker 2
And again? We can get a quorum. Oh, we have a quorum now. Let's grab it while we can. Please call the roll.
Speaker 10
Archeleta here. Adegine? Caballero? Here. Caballero here.
Grayson? Here. Grayson here. Menjivar? Nilo?
Speaker 2
We have a quorum? We have a quorum. So do we have a motion for that bill? So moved by Senator Caballero. And please call the roll.
Speaker 10
Motion is due passed as amended to the Senate Appropriations Committee. Wahab? Aye. Wahab, aye. Choi Archeleta?
Speaker 10
Archeleta, aye. Adeguin Caballero? Aye. Caballero, aye. Grayson?
Aye. Grayson, aye. Mengevar? Nilo? Aye.
Nilo, aye. Smallwood Cuevas? Smallwood Quavis I. Strickland Umberg?
Speaker 2
Six-zero. We'll leave that on call. And now we will move to SB fourteen sixteen. Also, Senator Wahhab, proceed when ready.
Speaker 1
Thank you. SB fourteen sixteen is a simple bill. It simply speeds up the time frame for a consumer to receive a refund from their physician or dentist in the event of duplicate payments. The bill reduces the refund window from thirty days to twenty one days to allow patients to regain access to their own funds sooner, which can especially meaningful for families managing tight household budgets or ongoing medical expenses. This is a small but meaningful affordability assistance measure, ensuring that money that belongs to the patient returns to them more quickly.
A twenty one day refund window reflects the realities of modern billing systems and is a reasonable update to a statute written in the 1990s in a much less digitized health care environment. I have no witnesses with me, and I respectfully ask for an I vote.
Speaker 2
Are there is there anybody in the room who is otherwise in support of this legislation?
Speaker 10
Hello. Michelle Rivas, on behalf the California Association of Oral Maxillofacial Surgeons, we think this is a reasonable bill. We understand that people have financial constraints right now, so we respectfully support the bill. Thank you.
Speaker 2
Any other in support? Is there anyone in the room who is in opposition to the bill? Seeing no one coming forward, bring it back to the committee. Any questions or comments? Senator Archuleta moves the bill.
Seeing no other comments, you may close.
Speaker 2
That's a great close. One of the best I've heard for a long time. Please call the roll.
Speaker 10
Motion is due passed to Senate Appropriations Committee. Wahhab? Aye. Wahhab, aye. Choi?
Archuleta?
Speaker 10
Archuleta, aye. Adeguin? Caballero? Aye. Caballero, aye.
Grayson? Aye. Grayson, aye. Menjivar? Nilo?
Speaker 2
That is, 60, and we will hold that on call also. Now turning it back over to our chair.
Speaker 1
Thank you. Can I get a motion on the consent items? Just to repeat for those that weren't here, file item number one, s b twelve sixty three, file item number three, s b eleven forty eight, file item number five, s b thirteen seventy six, and file item number six, b thirteen ninety one.
Speaker 10
Archuleta, aye. Adegine? Caballero? Aye. Caballero, aye.
Grayson? Aye. Grayson, aye, Menjivar? Nilo? Aye.
Nilo, aye. Smallwood Cuevas? Aye. Smallwood Cuevas, aye. Strickland, Hamburg.
Speaker 1
Alright. Consent will be held on file until all our other members are able to vote on it. Can I get a motion on file item number two, s b ten zero two?
Speaker 10
Motion is due passed. The senate appropriations committee. Wahab? Aye. Wahab, aye.
Choi? Archuleta? Aye. Archuleta, aye. Adeguin?
Caballero?
Speaker 1
file item is on call. We are going wait for other members. Alright. So everything is on call. I appreciate everybody's support on this.
If we can have our other members show up. All right. We're gonna go into recess for about ten minutes until the other members come. Thank you. And economic development committee will begin again and return from recess within thirty seconds.
Alright. We had a motion on consent, so can we just get a roll call again for the absent members on consent?
Speaker 1
And 90, consent is out. File item number 2SB1002 by Nilo. Pretty much everyone has voted aye. Motion is to pass the
Speaker 10
Aye. Choi, aye. Arguin, Mnjivar, Strickland Aye. Strickland, aye. Aye.
Aye. Aye.
Speaker 1
Alright. That bill is out as well. Final item number four, s b thirteen eleven. Motion is due
Speaker 10
passed as amended senate appropriations committee. Current vote six to zero. Choi?
Speaker 1
90. That bill is also out. We're moving on to file item number seven, s b fourteen sixteen.
Speaker 10
Motion is due to pass the Senate Appropriations Committee. Current vote six to zero. Choi?
Speaker 1
Alright. That bill is also out. Meeting is adjourned. Thank you all for your time.
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